May 14, 2025 • 34 mins
In this episode of Real Talk, Quincy interviews Certified Nurse-Midwife and Frontier Nursing University faculty member, Angie Chisholm (DNP, CNM). Nurse-midwives are integral in the care of mothers and babies during the perinatal and postpartum periods. Their knowledge and model of care can be especially helpful to families who are experiencing perinatal mood disorders and mental health conditions. Angie covers everything you and your support team need to know to be prepared to handle the emotional toll that can occur during and after pregnancy.
Resources:
Kentucky Resources:
KY Moms Maternal Assistance Towards Recovery (MATR)
Online Resources:
Postpartum Support International (PSI)
MothertoBaby Fact Sheets - Pregnancy and Breastfeeding Exposures
Mental Health Provider Locator
Connect with Frontier Nursing University:
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_02 (00:00):
Welcome to our second episode.
I'm your host, Quincy Feeneywith Frontier Nursing
University.
This podcast is a communityhealth initiative brought to you
by Frontier Nursing Universityand the Woodford County Chamber
of Commerce to improve communityhealth and increase healthcare
(00:23):
awareness.
In today's episode, we are goingto talk about perinatal mental
health disorders.
According to the Maternal MentalHealth Leadership Alliance,
maternal mental healthconditions are the most common
complications of pregnancy andbirth, affecting over 800,000
families each year in the US.
Suicide and overdose are leadingcauses of death for women in the
(00:45):
first year following pregnancy.
And most women impacted remainuntreated, increasing the risk
of long-term impacts.
Maternal mental healthconditions, as we will learn
today, go way beyond postpartumdepression.
Maternal mental healthconditions can occur during
pregnancy and up to one yearfollowing pregnancy and include
(01:06):
depression, anxiety disorders,OCD, PTSD, bipolar illness,
psychosis, and substance usedisorders.
Joining me today is certifiednurse midwife and frontier
faculty member, Dr.
Angie Chisholm.
Angie has been a midwife since2009, originally from Kentucky.
Thank you so much for joining meand tell me a little bit about
(01:27):
your background and why youwanted to be a midwife.
SPEAKER_01 (01:30):
Well, thanks for asking and thanks for inviting
me here to be a part of thisimportant podcast episode.
Like I said, I am from Kentuckyand growing up, I...
I noticed some things thataffected families that were dear
to me, things like mooddisorders and child abuse and
(01:56):
other traumas that I wanted toimpact in my career.
And so when I first went toschool, I studied social work
and I was on the path tobecoming a family mental health
therapist.
But as I was doing that, Ilearned about pregnancy and
birth and found out aboutmidwifery.
(02:16):
And once you feel the call to bea midwife, you really can't deny
it.
But I noticed that pregnancyseemed to be a sensitive time,
that if you could impact thetrajectory of that family during
pregnancy, you could potentiallyhave a big impact on preventing
(02:37):
further traumas down the road.
And so that's what inspired meto become a midwife.
And I think that's why thistopic is so important to me,
because I do feel like itsometimes goes unnoticed,
undiagnosed, and people are notgetting the help that they need.
Well, that's a fascinating
SPEAKER_02 (02:55):
background.
And I feel like it makes youperfect for this topic.
So starting off, perinatalmental health disorders, what
are they and who is affected bythem?
SPEAKER_01 (03:07):
Well, a lot more people than you would imagine.
And there is quite a range ofsymptoms.
And so we'll just Right.
(03:44):
and grab one of her kittens likeshe is going to be like yeah you
know so that is the way thatwomen are wired when they have a
baby they will become more hypervigilant temporarily they will
feel more anxiety and more worryand that typically lasts like
(04:05):
the first two weeks after theyhave a baby and we generally see
that resolve around that timeand when you get into into that
few weeks after that and peopleare still feeling that anxious
and that worried, then therecould be something wrong.
So I will just say baby blues ispretty common.
A lot of women experience it.
(04:27):
It's normal.
And when we recognize it asnormal, we can maybe not take it
so personally.
I feel like sometimes, you know,like mother-in-laws or spouses
may feel like oh she's attackingme because I didn't fold the
blanket right or something likethat and they feel really hurt
(04:49):
by that overreaction that shemight have experienced but it it
truly is a normal behavior andsomething that we expect
SPEAKER_02 (04:59):
right and I think Keyword there, temporary for
baby blues, which I think issomething I feel like that's
something we all hear about isthe baby blues.
But what is that?
And like, what's normal,especially for new moms and the
partners?
Like, is this, you know, beyondtwo weeks, is this still baby
blues or is this something more?
So
SPEAKER_01 (05:18):
typically if it's not resolving after that two
week period, because thehormonal shifts involved in
being early postpartum are whatcontribute to baby blues.
Um, And if it's not resolvingaround that time, then there's
probably something more goingon.
And the other thing that I wantto just say, some of the
(05:40):
misunderstandings that we haveabout, we call it perinatal mood
disorders, because we oftenthink about these things as
happening postpartum.
(06:00):
as well and so it's notconcentrated simply in that
postpartum period
SPEAKER_02 (06:05):
right okay so then kind of speaking to that Do you
have to have a pre-existingmental health disorder to have a
perinatal mental healthdisorder?
SPEAKER_01 (06:17):
No,
SPEAKER_02 (06:17):
no,
SPEAKER_01 (06:18):
no.
And I think that is a bigmisunderstanding that sometimes
people feel like that they'venever had depression or anxiety
before.
And maybe they are very happyabout being pregnant.
And so then their mood changesand they're not sure, you know,
what's going on.
And I do feel like clinicallywhat I see is that a lot of
(06:41):
people who are experiencinganxiety or depression in
pregnancy especially don'trecognize it until they feel
better.
Once they start feeling better,then they're like, oh yeah, I
think I did go through adepression phase.
But there are a lot of thingsthat can contribute outside of
(07:03):
that past history.
So past medical history of amood disorder is a common thing
that can contribute todeveloping a mood disorder, but
other things like a history oftrauma, a recognition, sometimes
you don't notice it until youare pregnant, but a recognition
(07:24):
that you don't have the supportthat you need for a healthy
pregnancy or healthy earlyparenting.
And so sometimes having adifficult birth or traumatic
birth experience can contributeto a mood disorder.
So there's a lot of factors thatdon't have anything to do with
(07:46):
your past medical history ofthose disorders that contribute.
SPEAKER_02 (07:50):
Okay.
And okay, so we kind of talkedon the baby blues, but what
beyond that?
What
SPEAKER_01 (07:56):
are the other categories?
Yeah.
So the other two common thingsthat come up are depression and
anxiety.
And often people think moreabout depression, especially
during the postpartum period.
Mm-hmm.
(08:21):
Mm-hmm.
Mm-hmm.
But are anxiety relatedsometimes getting fixated on
(08:45):
specific things that may or maynot be accurate?
Mm hmm.
you know, I think sometimespeople will have like, OCD type
of symptoms.
And it may come from a goodplace, like you're wanting to
make sure your baby is in ahealthy home environment.
(09:05):
So you want everybody to washtheir hands and be cautious when
they're holding the baby andthings like that.
But it can go to an extreme.
And that's where you need to beable to recognize.
And I If you are a mom who'sbeen affected or are currently
(09:26):
being affected, being able torecognize what's going on is so
important.
And then if you are a loved one,your role is also important.
And I think if I could give youany advice, I would say don't
take things personally whensomebody is pregnant or
postpartum.
Like really be compassionate andask some questions.
(09:47):
Find out if there's more goingon and what their needs might
be.
So depression, anxiety,sometimes OCD as a part of the
anxiety.
And then another category thatwe see more rarely, but is the
thing that I think induces themost fear in people is something
(10:09):
called postpartum psychosis.
maybe goes to more of an extremewhere they're having some
paranoid delusions or they'rereally not able to connect or
(10:29):
bond to the baby they're maybedisassociated from what's going
on and again that is a more rarelike more like 1% of the people
who are affected by mooddisorders but it can happen and
sometimes when I've seen ithappen it's really hard for the
(10:50):
family members to understand andfigure out what's going on.
So if you're feeling like.
your partner is not reallyconnecting with reality the way
that you're seeing it, then itis more urgent to get help right
away.
And these are the cases wherepeople may need some temporary
hospitalization or specificmedications to help them recover
(11:15):
from that experience.
SPEAKER_02 (11:16):
Right.
SPEAKER_01 (11:17):
So you
SPEAKER_02 (11:18):
mentioned being hospitalized.
And I think that's somethingthat's super scary and a reason
why people...
don't get help, even if it'snot, that's rare.
But I think even going to theirdoctor or midwife to say, hey, I
think there's a problemhappening here.
The fear that you are going tobe hospitalized or your baby is
(11:40):
going to be taken away from youis a real thing out there.
SPEAKER_01 (11:44):
Yeah, I totally agree.
And I see that in practice,often, people are afraid of
being judged.
And I think one of the thingsthat motivates moms quite often,
is the feeling that they aregoing to be a good mom, right.
And so when they are dealingwith some things that they, they
(12:08):
can't really help, you know,that they're having this
response, but somehow in theirmind, they're feeling like this
means I'm not going to be a goodmom or I'm not capable of being
a good mom and we really have towork on and that's why I'm so
glad that we're here talkingabout this today but we need to
work on decreasing that stigmaand letting people know that
(12:30):
it's not uncommon you know tohave some mental health changes
related to pregnancy and whywouldn't it be I mean it's one
of the biggest transitions bothfor you know moms and dads
really it's a big transition togo from not having children to
having children.
You are grieving the time inyour life, the way it's always
(12:52):
been, when you could take a napwhenever you want and you can do
kind of what you want.
Now you're kind of relying onneeding to parent and the
child's needs is gonna comefirst.
So that's a big transition.
And then I think socially, weused to have a lot more support
for parents.
(13:13):
We used to have grandparentsparents and extended families I
know even in my generation I hadso many cousins and aunts and
uncles and I don't think my momever had to pay for child care
but it's a totally differentreality now for most people and
we have parents trying to do itall literally they're trying to
(13:34):
work full-time careers and begood parents and then take care
of a household prepare healthyfood and You know, there's so
many things that go into it.
And it's no wonder, you know,that people aren't, you know,
having a difficult time.
But we need to sort of normalizegetting help and recognizing
(14:01):
that the support systems are notideal in this country.
And give people resources wherewe can and I think the first
step really is just addressingthat stigma and letting people
know it's okay to ask for helpboth you know in your family and
(14:21):
in your friend groups but alsofrom your health care provider
and health care providers needto also be doing a better job at
screening people sometimes theymay just look at somebody and
they have you know maybe theyare in good money or they look
put together when they come tothe appointment and they may not
(14:44):
recognize that that person issuffering you know from mood
changes so we need to beconsistently screening everybody
for mood disorders so that wecan give them timely help yeah
and I think a
SPEAKER_02 (14:59):
key thing that you said is that there could be
something wrong but it doesn'tmean that they're a bad parent
because I think that is thebiggest fear is that you're a
bad mom you're a bad dad or awhatever and that's not
necessarily the case and sogetting the good help or getting
the help shows that you areYeah, because you're taking care
(15:20):
of yourself so you can
SPEAKER_01 (15:23):
take care of your child.
(15:48):
when we need help and get thathelp.
SPEAKER_02 (15:52):
Okay, so what does that screening and getting a
diagnosis, what does that looklike?
SPEAKER_01 (15:56):
Yeah, so most clinics, OBGYN or midwife
clinics do, and sometimes evenpediatric clinics now, are
screening people for mooddisorders postpartum.
I think we could do a better jobof screening people in
pregnancy.
And I have a background as wellin working with people with
(16:20):
substance use disorder.
And I think we also really needto be screening folks at the
very beginning who havesubstance use disorder, or
sometimes even people withpre-existing mental health
(16:42):
problems, if we're notaddressing that in early
pregnancy, it may impact theirengagement with prenatal care
and ultimately their outcomeswith the birth and potentially
even, you know, long-termparenting.
Right.
Okay.
SPEAKER_02 (16:59):
And I think one thing you had just said, so the
screening early on and like mypediatrician, they did screen me
But I remember we didn't reallydo much.
It was like, okay, good.
Thank you for filling this out.
And then that was it.
One thing that I think isbeautiful about seeing a midwife
is that you have a two-weekappointment.
(17:20):
And I think that is critical.
And that's not the caseeverywhere or with every office.
And I think that was huge for meis that I got to see someone at
two weeks and then again at sixweeks.
Yeah.
Do you want to talk on that?
SPEAKER_01 (17:34):
Yeah, I would love to.
So ideally, we would be seeingpeople much more frequently
postpartum.
Like I said, it's a bigtransition period.
And I do think Kentucky has madesome big efforts to improve
postpartum care.
We did pass an initiative to getpostpartum care covered for the
(17:57):
first year postpartum.
So if somebody is dealing withlike a substance use disorder or
a mental health disorder we canum as their like obstetric
provider midwife or um obphysician could continue seeing
them for follow-up again we'vealready established a
relationship with them and it'snot to say that they don't need
(18:21):
other care and in an ideal worldwithin these ob or midwife
clinics we would have access tosocial work and other resources
whether that's um Like forsubstance use in a clinic that I
worked at, we had a specializedprogram that had a social worker
and a provider that couldprescribe medication and also
(18:46):
peer support.
So we could create reallyinnovative models to keep people
healthy and to keep themparenting with their kids.
But it's not happening enough.
It's happening some.
And I think what you describedas, you know, being screened,
but not really the follow upthat you needed.
(19:08):
And that's kind of a risk andwhy some of the providers aren't
doing the screening is becausethey don't know what to do
afterwards.
If somebody does identify, youknow, that they have a problem,
we need to have streamlinedreferral routes available.
Yeah, yeah,
SPEAKER_02 (19:24):
that That's I think super important.
Cause I do, I think back tothat, my pediatrician
appointments and I was like,well, what are you going to do
with this?
Like you guys can't do anythingfor me.
But so I think, well, do youwant to talk about treatment
options?
Yeah.
Let's talk about treatmentoptions.
And then I think one of the mostimportant, this episode, I feel
like when you, you look at it onpaper, it's kind of, you think
(19:47):
it's for moms or moms to be ornew, whatever.
But really it's for the supportpeople like that.
I think is the biggest takeawayis that the support around the
moms and the families is what'sgoing to help the most.
Um, but let's talk about thetreatment options available to
moms.
SPEAKER_01 (20:05):
Yeah.
Um, there are really goodtreatments and I think there's
also a lot of myths andmisunderstandings around
treatments.
So what I can tell you, um, thatwhenever I'm identifying
somebody with a mood disorder,whether it's during pregnancy or
postpartum, the The first thingthat I like to do is to screen
(20:26):
them for other medicalconditions that could cause
mental health changes.
So two common ones that show upin pregnancy are thyroid
disorders and iron deficiency.
And if we are going to have asuccessful treatment plan, we
want to rule those two thingsout first.
(20:46):
And then from there, I usuallytalk with patients about what
what their feelings are aroundinterventions.
Would they prefer like exploringtherapy options and going the
route of like a therapist orwould they like medication or
(21:10):
would they like both?
What the research tells us isthat both is often the most
evidence-based and successful,you know, treatment that we have
available right now.
They're also are some innovativelike new treatments coming out
but I won't go into a lot ofdetail because I do think that's
(21:31):
something that you shouldexplore you know with your
provider but sometimes peoplehave strong feelings like I
don't want to go to a therapistor I've had you know my
insurance doesn't cover atherapist or it's too difficult
to find somebody that I matchwith there's all those things
and then also on the other endyou'll see people who don't feel
(21:56):
comfortable you know takingmedication while they're
pregnant or while they'rebreastfeeding and what I will
say about that and this is oneof the links that we'll give you
in the show notes is there is agreat resource called mother to
baby that specifically looks atmedications and how they
interact with breastfeeding orpregnancy and many medications
(22:17):
are safe to take and what we doknow is that untreated
depression or anxiety is notsafe right so we when you're
looking at the risk versus thebenefit that's what we need to
think about it's not like takingmedication or not taking
medication it's like treatingdepression or anxiety versus not
(22:40):
treating it right you have tothink that through a little bit
and it can be confusing and Ithink particularly with anxiety
because sometimes what I see isthat the anxiety presents, like
if you're talking aboutmedication, then they can get
really fixated on, you know, thepotential harm of the medication
(23:01):
and that might be part of theiranxiety, but they don't even
realize
SPEAKER_02 (23:05):
it.
Yeah.
Yeah.
And they're not seeing thebenefits that, you know,
outweigh everything else.
And I like that you talk aboutlooking at the whole picture
before just jumping into amedicine and slapping it over,
you know, a disorder, butlooking at everything that's
happening with the patient andthen deciding the treatment
(23:27):
plan.
And that's part of the midwiferymodel is shared decision-making
and the provider is telling youwhat the evidence is, and then
helping you make a decision.
SPEAKER_01 (23:37):
Yeah.
And I also think there is, youknow, room to really look at
your lifestyle.
Things like exercise andnutrition and certain targeted
supplements can also help withmood.
But it can be very overwhelming.
I mean, I think, especially withdepression, in this case, the
(23:58):
motivation to really make bigchanges or, you like reaching
out and finding resources, whenyou feel this overwhelming
depression, it can be verydifficult.
So I think really just havingthose conversations with a care
provider who can help understandwhat's what's important to you
(24:19):
and help you move from the placethat you're in now to a
healthier place.
Yeah.
SPEAKER_02 (24:24):
Okay, so finding support in your community and at
home.
Where let's start within thecommunity, where can you find it
first?
And how can community membersYeah,
SPEAKER_01 (24:36):
that's a great question.
Like I was saying earlier, youknow, our communities don't look
like they used to look.
So we sometimes have to findcommunities.
our own communities as newparents.
Sometimes there are likeFacebook groups and it
depending, like if you go tochurch, sometimes you can find
(24:57):
mentors or people to support youin your church community.
Um, sometimes if you have, um,work friends or other people,
um, who've had kids before thatyou can connect with.
Um, but definitely, um, thething that I see within family
(25:17):
dynamics sometimes is that whensomebody is struggling with
mood, um, it can be hard forlike, um, saying earlier for
families not to take itpersonally.
And we really just have to moveaway from that and look at like
when somebody is exhibiting someof these symptoms, how can we be
helpful?
And sometimes the things that wethink will be helpful won't be
(25:40):
helpful to that person.
You know, a really common thingis that um family friends or
in-laws may want to come overand take the baby for a few
hours but if somebody's having alot of anxiety about the baby
then taking the baby is notgoing to solve the problem and
maybe that is what they need butit's not going to work and so um
(26:04):
maybe what would be helpful isif you came over and did their
dishes or did their laundry orum brought them meals for the
week um So sometimes supportlooks different than the way you
think.
And so maybe asking what wouldbe helpful versus just assuming
that you know what's best andand people, you know, family and
(26:26):
support people, especiallypeople with more lived
experience, do have solutionsand know how to help.
But sometimes.
you can interfere with yourability to give the help if
you're just making thoseassumptions that you know
better.
SPEAKER_02 (26:41):
Right.
And not taking it personally andnot playing the victim, I think,
because then it makes the personwho is struggling not want to
ask for help whenever they'reeven ready to ask.
And I just jot down some notesbecause I had a baby, so he's 18
months old now.
And within my my community, Ifound this is kind of weird, but
(27:03):
like my lactation specialist, Imean, I was going to go to her
because she became part of like,that was kind of therapy for
that was therapeutic for me.
And that was really helpful.
Um, my physical therapist, likejust those different places that
I found community and help.
And, um, just kind of not whereyou would expect it, but that's
(27:23):
where I felt the mostcomfortable and the most, I
would say accepted.
But then I also found there areso many like free new mom
circles and new mom groups.
And so I think that's reallyhelpful, especially for having
infants.
I think once you kind of getpast that three month mark, it
(27:43):
kind of fizzles out because as asociety we don't, We kind of
view that's postpartum, butreally it's up to a year.
And so I think kind of lookingwhere you least expect it and
just kind of trying to findwhere you can find it.
And I think for those people,just where I found it, they led
(28:05):
with compassion and theylistened and didn't offer
unsolicited advice, but also...
knew when to say something andwhen to offer gentle help
SPEAKER_01 (28:17):
to me.
I'm glad you brought up theunsolicited advice thing because
I do think that that is a sourceof stress for new parents.
And it's a source of conflictsometimes.
What I usually advise people todo, unsolicited, is to really
(28:41):
listen with your heart aroundthe advice that you're getting.
And If there are things that youfeel because you get to
establish what your family isgoing to look like, and the kind
of family that you want to have,and it might look different than
the childhood that you hadgrowing up, or what other people
(29:01):
in your community feel like isnormal.
So I think if you get advice,you know, listen to what feels
good to you and feels right toyou.
And it's okay to pursue thosethings.
But if you're getting advicethat's causing you more anxiety
and more stress or doesn't feellike it resonates with you then
(29:22):
you don't have any obligation totake that vice or to try it or
anything but I do think mostpeople have good instincts and
they just need to be supportedin following those and we're all
different so we're all going todo it a little different so
there's not necessarily right orwrong you know paths but there's
(29:44):
going to be the path that'sright for your family and And it
gets a little confusing wheneverybody's telling you to do
something different.
Right, right.
Or Facebook's telling you to sayand then you have
SPEAKER_02 (29:54):
the internet and it's telling you a million
things too.
Yeah.
it's hard for them because theyfeed off of your energy and, and
they're going through a hugelife change as well.
So how can they be supportive?
Um, what can they look out for?
(30:16):
And yeah,
SPEAKER_01 (30:17):
Well, I do think that partners are really
instrumental in diagnosing, youknow, mood disorders.
And so I do think keeping an eyeout, like, is my partner losing
interest in things that theyused to really care about?
Are they feeling like down anddepressed a lot of the time?
(30:40):
Or, you know, on the anxietyspectrum?
Are they lashing out at me?
Are they seeming unreasonable?
Yeah.
Am I not wanting to come homefrom work because of this?
So they are really key athelping identify when there's a
problem.
And I also feel like partnersfeel a lot of pressure to fix
(31:02):
everything quite often andrecognizing that.
Right.
Right.
(31:37):
feeding and I was waking up tofeed the baby anyway but my baby
was pooping every time and justthat little gesture of him
picking up the baby taking thebaby and changing baby's diaper
and bringing baby back you knowthat was a very simple thing
that he did that made all thedifference for me yeah not
(31:58):
always possible you knowdepending on people's work
schedules and so forth but theremay be little things that you
could do to give your partnermore rest and also I think
knowing what your partnernormally does for self-care like
in pregnancy or before pregnancyand reminding them of that like
(32:19):
maybe it's they need a pedicureonce a month or maybe it's you
know that they need um some timealone like to go for a walk or
to take a long bath or somethinglike that but suggesting those
things that they usually do forself-care or maybe giving them
the space to make those thingshappen and the okay you know to
(32:43):
do that because a lot of timesour needs will go on the back
burner you know when we have anew baby and over time that
builds up you know and um that'sa key thing i think partners can
do yeah and and i think
SPEAKER_02 (32:58):
um to my husband um taking time for himself too yeah
the support person for them toalso but i think still
addressing what's at home.
And if, if, you know, call themom's friend to come over so you
can go and do whatever you needto do, um, to have that time
away too is super important.
(33:19):
And I know one thing that I wasreally lucky, um, to have that
isn't necessarily normal here inthe U S is my husband had four
weeks off with me and that wasincredible.
And I still remember the daythat he had to go back to the
office because I was like, Ohno.
Okay, anything else that youthink we, we missed?
(33:40):
I mean, there's so much
SPEAKER_01 (33:40):
that we could talk about.
(34:05):
Yeah, well, thank you so muchfor joining me
SPEAKER_02 (34:10):
and for your sharing your expertise.
Yeah, thank you for having me.
I know that this can be a heavytopic, but it's important we
talk about it to help ourfamilies.
We hope that this wasinformative for new moms and
moms to be as well for thepeople who support us.
So grandparents, spouses,supervisors, neighbors, friends,
and so on.
Prioritizing your health and thehealth of those around us
(34:33):
creates a happier and healthierover time.
We'll see you next time.
Welcome to our second episode.
I'm your host, Quincy Feeneywith Frontier Nursing
University.
This podcast is a communityhealth initiative brought to you
by Frontier Nursing Universityand the Woodford County Chamber
of Commerce to improve communityhealth and increase healthcare
(00:23):
awareness.
In today's episode, we are goingto talk about perinatal mental
health disorders.
According to the Maternal MentalHealth Leadership Alliance,
maternal mental healthconditions are the most common
complications of pregnancy andbirth, affecting over 800,000
families each year in the US.
Suicide and overdose are leadingcauses of death for women in the
(00:45):
first year following pregnancy.
And most women impacted remainuntreated, increasing the risk
of long-term impacts.
Maternal mental healthconditions, as we will learn
today, go way beyond postpartumdepression.
Maternal mental healthconditions can occur during
pregnancy and up to one yearfollowing pregnancy and include
(01:06):
depression, anxiety disorders,OCD, PTSD, bipolar illness,
psychosis, and substance usedisorders.
Joining me today is certifiednurse midwife and frontier
faculty member, Dr.
Angie Chisholm.
Angie has been a midwife since2009, originally from Kentucky.
Thank you so much for joining meand tell me a little bit about
(01:27):
your background and why youwanted to be a midwife.
SPEAKER_01 (01:30):
Well, thanks for asking and thanks for inviting
me here to be a part of thisimportant podcast episode.
Like I said, I am from Kentuckyand growing up, I...
I noticed some things thataffected families that were dear
to me, things like mooddisorders and child abuse and
(01:56):
other traumas that I wanted toimpact in my career.
And so when I first went toschool, I studied social work
and I was on the path tobecoming a family mental health
therapist.
But as I was doing that, Ilearned about pregnancy and
birth and found out aboutmidwifery.
(02:16):
And once you feel the call to bea midwife, you really can't deny
it.
But I noticed that pregnancyseemed to be a sensitive time,
that if you could impact thetrajectory of that family during
pregnancy, you could potentiallyhave a big impact on preventing
(02:37):
further traumas down the road.
And so that's what inspired meto become a midwife.
And I think that's why thistopic is so important to me,
because I do feel like itsometimes goes unnoticed,
undiagnosed, and people are notgetting the help that they need.
Well, that's a fascinating
SPEAKER_02 (02:55):
background.
And I feel like it makes youperfect for this topic.
So starting off, perinatalmental health disorders, what
are they and who is affected bythem?
SPEAKER_01 (03:07):
Well, a lot more people than you would imagine.
And there is quite a range ofsymptoms.
And so we'll just Right.
(03:44):
and grab one of her kittens likeshe is going to be like yeah you
know so that is the way thatwomen are wired when they have a
baby they will become more hypervigilant temporarily they will
feel more anxiety and more worryand that typically lasts like
(04:05):
the first two weeks after theyhave a baby and we generally see
that resolve around that timeand when you get into into that
few weeks after that and peopleare still feeling that anxious
and that worried, then therecould be something wrong.
So I will just say baby blues ispretty common.
A lot of women experience it.
(04:27):
It's normal.
And when we recognize it asnormal, we can maybe not take it
so personally.
I feel like sometimes, you know,like mother-in-laws or spouses
may feel like oh she's attackingme because I didn't fold the
blanket right or something likethat and they feel really hurt
(04:49):
by that overreaction that shemight have experienced but it it
truly is a normal behavior andsomething that we expect
SPEAKER_02 (04:59):
right and I think Keyword there, temporary for
baby blues, which I think issomething I feel like that's
something we all hear about isthe baby blues.
But what is that?
And like, what's normal,especially for new moms and the
partners?
Like, is this, you know, beyondtwo weeks, is this still baby
blues or is this something more?
So
SPEAKER_01 (05:18):
typically if it's not resolving after that two
week period, because thehormonal shifts involved in
being early postpartum are whatcontribute to baby blues.
Um, And if it's not resolvingaround that time, then there's
probably something more goingon.
And the other thing that I wantto just say, some of the
(05:40):
misunderstandings that we haveabout, we call it perinatal mood
disorders, because we oftenthink about these things as
happening postpartum.
(06:00):
as well and so it's notconcentrated simply in that
postpartum period
SPEAKER_02 (06:05):
right okay so then kind of speaking to that Do you
have to have a pre-existingmental health disorder to have a
perinatal mental healthdisorder?
SPEAKER_01 (06:17):
No,
SPEAKER_02 (06:17):
no,
SPEAKER_01 (06:18):
no.
And I think that is a bigmisunderstanding that sometimes
people feel like that they'venever had depression or anxiety
before.
And maybe they are very happyabout being pregnant.
And so then their mood changesand they're not sure, you know,
what's going on.
And I do feel like clinicallywhat I see is that a lot of
(06:41):
people who are experiencinganxiety or depression in
pregnancy especially don'trecognize it until they feel
better.
Once they start feeling better,then they're like, oh yeah, I
think I did go through adepression phase.
But there are a lot of thingsthat can contribute outside of
(07:03):
that past history.
So past medical history of amood disorder is a common thing
that can contribute todeveloping a mood disorder, but
other things like a history oftrauma, a recognition, sometimes
you don't notice it until youare pregnant, but a recognition
(07:24):
that you don't have the supportthat you need for a healthy
pregnancy or healthy earlyparenting.
And so sometimes having adifficult birth or traumatic
birth experience can contributeto a mood disorder.
So there's a lot of factors thatdon't have anything to do with
(07:46):
your past medical history ofthose disorders that contribute.
SPEAKER_02 (07:50):
Okay.
And okay, so we kind of talkedon the baby blues, but what
beyond that?
What
SPEAKER_01 (07:56):
are the other categories?
Yeah.
So the other two common thingsthat come up are depression and
anxiety.
And often people think moreabout depression, especially
during the postpartum period.
Mm-hmm.
(08:21):
Mm-hmm.
Mm-hmm.
But are anxiety relatedsometimes getting fixated on
(08:45):
specific things that may or maynot be accurate?
Mm hmm.
you know, I think sometimespeople will have like, OCD type
of symptoms.
And it may come from a goodplace, like you're wanting to
make sure your baby is in ahealthy home environment.
(09:05):
So you want everybody to washtheir hands and be cautious when
they're holding the baby andthings like that.
But it can go to an extreme.
And that's where you need to beable to recognize.
And I If you are a mom who'sbeen affected or are currently
(09:26):
being affected, being able torecognize what's going on is so
important.
And then if you are a loved one,your role is also important.
And I think if I could give youany advice, I would say don't
take things personally whensomebody is pregnant or
postpartum.
Like really be compassionate andask some questions.
(09:47):
Find out if there's more goingon and what their needs might
be.
So depression, anxiety,sometimes OCD as a part of the
anxiety.
And then another category thatwe see more rarely, but is the
thing that I think induces themost fear in people is something
(10:09):
called postpartum psychosis.
maybe goes to more of an extremewhere they're having some
paranoid delusions or they'rereally not able to connect or
(10:29):
bond to the baby they're maybedisassociated from what's going
on and again that is a more rarelike more like 1% of the people
who are affected by mooddisorders but it can happen and
sometimes when I've seen ithappen it's really hard for the
(10:50):
family members to understand andfigure out what's going on.
So if you're feeling like.
your partner is not reallyconnecting with reality the way
that you're seeing it, then itis more urgent to get help right
away.
And these are the cases wherepeople may need some temporary
hospitalization or specificmedications to help them recover
(11:15):
from that experience.
SPEAKER_02 (11:16):
Right.
SPEAKER_01 (11:17):
So you
SPEAKER_02 (11:18):
mentioned being hospitalized.
And I think that's somethingthat's super scary and a reason
why people...
don't get help, even if it'snot, that's rare.
But I think even going to theirdoctor or midwife to say, hey, I
think there's a problemhappening here.
The fear that you are going tobe hospitalized or your baby is
(11:40):
going to be taken away from youis a real thing out there.
SPEAKER_01 (11:44):
Yeah, I totally agree.
And I see that in practice,often, people are afraid of
being judged.
And I think one of the thingsthat motivates moms quite often,
is the feeling that they aregoing to be a good mom, right.
And so when they are dealingwith some things that they, they
(12:08):
can't really help, you know,that they're having this
response, but somehow in theirmind, they're feeling like this
means I'm not going to be a goodmom or I'm not capable of being
a good mom and we really have towork on and that's why I'm so
glad that we're here talkingabout this today but we need to
work on decreasing that stigmaand letting people know that
(12:30):
it's not uncommon you know tohave some mental health changes
related to pregnancy and whywouldn't it be I mean it's one
of the biggest transitions bothfor you know moms and dads
really it's a big transition togo from not having children to
having children.
You are grieving the time inyour life, the way it's always
(12:52):
been, when you could take a napwhenever you want and you can do
kind of what you want.
Now you're kind of relying onneeding to parent and the
child's needs is gonna comefirst.
So that's a big transition.
And then I think socially, weused to have a lot more support
for parents.
(13:13):
We used to have grandparentsparents and extended families I
know even in my generation I hadso many cousins and aunts and
uncles and I don't think my momever had to pay for child care
but it's a totally differentreality now for most people and
we have parents trying to do itall literally they're trying to
(13:34):
work full-time careers and begood parents and then take care
of a household prepare healthyfood and You know, there's so
many things that go into it.
And it's no wonder, you know,that people aren't, you know,
having a difficult time.
But we need to sort of normalizegetting help and recognizing
(14:01):
that the support systems are notideal in this country.
And give people resources wherewe can and I think the first
step really is just addressingthat stigma and letting people
know it's okay to ask for helpboth you know in your family and
(14:21):
in your friend groups but alsofrom your health care provider
and health care providers needto also be doing a better job at
screening people sometimes theymay just look at somebody and
they have you know maybe theyare in good money or they look
put together when they come tothe appointment and they may not
(14:44):
recognize that that person issuffering you know from mood
changes so we need to beconsistently screening everybody
for mood disorders so that wecan give them timely help yeah
and I think a
SPEAKER_02 (14:59):
key thing that you said is that there could be
something wrong but it doesn'tmean that they're a bad parent
because I think that is thebiggest fear is that you're a
bad mom you're a bad dad or awhatever and that's not
necessarily the case and sogetting the good help or getting
the help shows that you areYeah, because you're taking care
(15:20):
of yourself so you can
SPEAKER_01 (15:23):
take care of your child.
(15:48):
when we need help and get thathelp.
SPEAKER_02 (15:52):
Okay, so what does that screening and getting a
diagnosis, what does that looklike?
SPEAKER_01 (15:56):
Yeah, so most clinics, OBGYN or midwife
clinics do, and sometimes evenpediatric clinics now, are
screening people for mooddisorders postpartum.
I think we could do a better jobof screening people in
pregnancy.
And I have a background as wellin working with people with
(16:20):
substance use disorder.
And I think we also really needto be screening folks at the
very beginning who havesubstance use disorder, or
sometimes even people withpre-existing mental health
(16:42):
problems, if we're notaddressing that in early
pregnancy, it may impact theirengagement with prenatal care
and ultimately their outcomeswith the birth and potentially
even, you know, long-termparenting.
Right.
Okay.
SPEAKER_02 (16:59):
And I think one thing you had just said, so the
screening early on and like mypediatrician, they did screen me
But I remember we didn't reallydo much.
It was like, okay, good.
Thank you for filling this out.
And then that was it.
One thing that I think isbeautiful about seeing a midwife
is that you have a two-weekappointment.
(17:20):
And I think that is critical.
And that's not the caseeverywhere or with every office.
And I think that was huge for meis that I got to see someone at
two weeks and then again at sixweeks.
Yeah.
Do you want to talk on that?
SPEAKER_01 (17:34):
Yeah, I would love to.
So ideally, we would be seeingpeople much more frequently
postpartum.
Like I said, it's a bigtransition period.
And I do think Kentucky has madesome big efforts to improve
postpartum care.
We did pass an initiative to getpostpartum care covered for the
(17:57):
first year postpartum.
So if somebody is dealing withlike a substance use disorder or
a mental health disorder we canum as their like obstetric
provider midwife or um obphysician could continue seeing
them for follow-up again we'vealready established a
relationship with them and it'snot to say that they don't need
(18:21):
other care and in an ideal worldwithin these ob or midwife
clinics we would have access tosocial work and other resources
whether that's um Like forsubstance use in a clinic that I
worked at, we had a specializedprogram that had a social worker
and a provider that couldprescribe medication and also
(18:46):
peer support.
So we could create reallyinnovative models to keep people
healthy and to keep themparenting with their kids.
But it's not happening enough.
It's happening some.
And I think what you describedas, you know, being screened,
but not really the follow upthat you needed.
(19:08):
And that's kind of a risk andwhy some of the providers aren't
doing the screening is becausethey don't know what to do
afterwards.
If somebody does identify, youknow, that they have a problem,
we need to have streamlinedreferral routes available.
Yeah, yeah,
SPEAKER_02 (19:24):
that That's I think super important.
Cause I do, I think back tothat, my pediatrician
appointments and I was like,well, what are you going to do
with this?
Like you guys can't do anythingfor me.
But so I think, well, do youwant to talk about treatment
options?
Yeah.
Let's talk about treatmentoptions.
And then I think one of the mostimportant, this episode, I feel
like when you, you look at it onpaper, it's kind of, you think
(19:47):
it's for moms or moms to be ornew, whatever.
But really it's for the supportpeople like that.
I think is the biggest takeawayis that the support around the
moms and the families is what'sgoing to help the most.
Um, but let's talk about thetreatment options available to
moms.
SPEAKER_01 (20:05):
Yeah.
Um, there are really goodtreatments and I think there's
also a lot of myths andmisunderstandings around
treatments.
So what I can tell you, um, thatwhenever I'm identifying
somebody with a mood disorder,whether it's during pregnancy or
postpartum, the The first thingthat I like to do is to screen
(20:26):
them for other medicalconditions that could cause
mental health changes.
So two common ones that show upin pregnancy are thyroid
disorders and iron deficiency.
And if we are going to have asuccessful treatment plan, we
want to rule those two thingsout first.
(20:46):
And then from there, I usuallytalk with patients about what
what their feelings are aroundinterventions.
Would they prefer like exploringtherapy options and going the
route of like a therapist orwould they like medication or
(21:10):
would they like both?
What the research tells us isthat both is often the most
evidence-based and successful,you know, treatment that we have
available right now.
They're also are some innovativelike new treatments coming out
but I won't go into a lot ofdetail because I do think that's
(21:31):
something that you shouldexplore you know with your
provider but sometimes peoplehave strong feelings like I
don't want to go to a therapistor I've had you know my
insurance doesn't cover atherapist or it's too difficult
to find somebody that I matchwith there's all those things
and then also on the other endyou'll see people who don't feel
(21:56):
comfortable you know takingmedication while they're
pregnant or while they'rebreastfeeding and what I will
say about that and this is oneof the links that we'll give you
in the show notes is there is agreat resource called mother to
baby that specifically looks atmedications and how they
interact with breastfeeding orpregnancy and many medications
(22:17):
are safe to take and what we doknow is that untreated
depression or anxiety is notsafe right so we when you're
looking at the risk versus thebenefit that's what we need to
think about it's not like takingmedication or not taking
medication it's like treatingdepression or anxiety versus not
(22:40):
treating it right you have tothink that through a little bit
and it can be confusing and Ithink particularly with anxiety
because sometimes what I see isthat the anxiety presents, like
if you're talking aboutmedication, then they can get
really fixated on, you know, thepotential harm of the medication
(23:01):
and that might be part of theiranxiety, but they don't even
realize
SPEAKER_02 (23:05):
it.
Yeah.
Yeah.
And they're not seeing thebenefits that, you know,
outweigh everything else.
And I like that you talk aboutlooking at the whole picture
before just jumping into amedicine and slapping it over,
you know, a disorder, butlooking at everything that's
happening with the patient andthen deciding the treatment
(23:27):
plan.
And that's part of the midwiferymodel is shared decision-making
and the provider is telling youwhat the evidence is, and then
helping you make a decision.
SPEAKER_01 (23:37):
Yeah.
And I also think there is, youknow, room to really look at
your lifestyle.
Things like exercise andnutrition and certain targeted
supplements can also help withmood.
But it can be very overwhelming.
I mean, I think, especially withdepression, in this case, the
(23:58):
motivation to really make bigchanges or, you like reaching
out and finding resources, whenyou feel this overwhelming
depression, it can be verydifficult.
So I think really just havingthose conversations with a care
provider who can help understandwhat's what's important to you
(24:19):
and help you move from the placethat you're in now to a
healthier place.
Yeah.
SPEAKER_02 (24:24):
Okay, so finding support in your community and at
home.
Where let's start within thecommunity, where can you find it
first?
And how can community membersYeah,
SPEAKER_01 (24:36):
that's a great question.
Like I was saying earlier, youknow, our communities don't look
like they used to look.
So we sometimes have to findcommunities.
our own communities as newparents.
Sometimes there are likeFacebook groups and it
depending, like if you go tochurch, sometimes you can find
(24:57):
mentors or people to support youin your church community.
Um, sometimes if you have, um,work friends or other people,
um, who've had kids before thatyou can connect with.
Um, but definitely, um, thething that I see within family
(25:17):
dynamics sometimes is that whensomebody is struggling with
mood, um, it can be hard forlike, um, saying earlier for
families not to take itpersonally.
And we really just have to moveaway from that and look at like
when somebody is exhibiting someof these symptoms, how can we be
helpful?
And sometimes the things that wethink will be helpful won't be
(25:40):
helpful to that person.
You know, a really common thingis that um family friends or
in-laws may want to come overand take the baby for a few
hours but if somebody's having alot of anxiety about the baby
then taking the baby is notgoing to solve the problem and
maybe that is what they need butit's not going to work and so um
(26:04):
maybe what would be helpful isif you came over and did their
dishes or did their laundry orum brought them meals for the
week um So sometimes supportlooks different than the way you
think.
And so maybe asking what wouldbe helpful versus just assuming
that you know what's best andand people, you know, family and
(26:26):
support people, especiallypeople with more lived
experience, do have solutionsand know how to help.
But sometimes.
you can interfere with yourability to give the help if
you're just making thoseassumptions that you know
better.
SPEAKER_02 (26:41):
Right.
And not taking it personally andnot playing the victim, I think,
because then it makes the personwho is struggling not want to
ask for help whenever they'reeven ready to ask.
And I just jot down some notesbecause I had a baby, so he's 18
months old now.
And within my my community, Ifound this is kind of weird, but
(27:03):
like my lactation specialist, Imean, I was going to go to her
because she became part of like,that was kind of therapy for
that was therapeutic for me.
And that was really helpful.
Um, my physical therapist, likejust those different places that
I found community and help.
And, um, just kind of not whereyou would expect it, but that's
(27:23):
where I felt the mostcomfortable and the most, I
would say accepted.
But then I also found there areso many like free new mom
circles and new mom groups.
And so I think that's reallyhelpful, especially for having
infants.
I think once you kind of getpast that three month mark, it
(27:43):
kind of fizzles out because as asociety we don't, We kind of
view that's postpartum, butreally it's up to a year.
And so I think kind of lookingwhere you least expect it and
just kind of trying to findwhere you can find it.
And I think for those people,just where I found it, they led
(28:05):
with compassion and theylistened and didn't offer
unsolicited advice, but also...
knew when to say something andwhen to offer gentle help
SPEAKER_01 (28:17):
to me.
I'm glad you brought up theunsolicited advice thing because
I do think that that is a sourceof stress for new parents.
And it's a source of conflictsometimes.
What I usually advise people todo, unsolicited, is to really
(28:41):
listen with your heart aroundthe advice that you're getting.
And If there are things that youfeel because you get to
establish what your family isgoing to look like, and the kind
of family that you want to have,and it might look different than
the childhood that you hadgrowing up, or what other people
(29:01):
in your community feel like isnormal.
So I think if you get advice,you know, listen to what feels
good to you and feels right toyou.
And it's okay to pursue thosethings.
But if you're getting advicethat's causing you more anxiety
and more stress or doesn't feellike it resonates with you then
(29:22):
you don't have any obligation totake that vice or to try it or
anything but I do think mostpeople have good instincts and
they just need to be supportedin following those and we're all
different so we're all going todo it a little different so
there's not necessarily right orwrong you know paths but there's
(29:44):
going to be the path that'sright for your family and And it
gets a little confusing wheneverybody's telling you to do
something different.
Right, right.
Or Facebook's telling you to sayand then you have
SPEAKER_02 (29:54):
the internet and it's telling you a million
things too.
Yeah.
it's hard for them because theyfeed off of your energy and, and
they're going through a hugelife change as well.
So how can they be supportive?
Um, what can they look out for?
(30:16):
And yeah,
SPEAKER_01 (30:17):
Well, I do think that partners are really
instrumental in diagnosing, youknow, mood disorders.
And so I do think keeping an eyeout, like, is my partner losing
interest in things that theyused to really care about?
Are they feeling like down anddepressed a lot of the time?
(30:40):
Or, you know, on the anxietyspectrum?
Are they lashing out at me?
Are they seeming unreasonable?
Yeah.
Am I not wanting to come homefrom work because of this?
So they are really key athelping identify when there's a
problem.
And I also feel like partnersfeel a lot of pressure to fix
(31:02):
everything quite often andrecognizing that.
Right.
Right.
(31:37):
feeding and I was waking up tofeed the baby anyway but my baby
was pooping every time and justthat little gesture of him
picking up the baby taking thebaby and changing baby's diaper
and bringing baby back you knowthat was a very simple thing
that he did that made all thedifference for me yeah not
(31:58):
always possible you knowdepending on people's work
schedules and so forth but theremay be little things that you
could do to give your partnermore rest and also I think
knowing what your partnernormally does for self-care like
in pregnancy or before pregnancyand reminding them of that like
(32:19):
maybe it's they need a pedicureonce a month or maybe it's you
know that they need um some timealone like to go for a walk or
to take a long bath or somethinglike that but suggesting those
things that they usually do forself-care or maybe giving them
the space to make those thingshappen and the okay you know to
(32:43):
do that because a lot of timesour needs will go on the back
burner you know when we have anew baby and over time that
builds up you know and um that'sa key thing i think partners can
do yeah and and i think
SPEAKER_02 (32:58):
um to my husband um taking time for himself too yeah
the support person for them toalso but i think still
addressing what's at home.
And if, if, you know, call themom's friend to come over so you
can go and do whatever you needto do, um, to have that time
away too is super important.
(33:19):
And I know one thing that I wasreally lucky, um, to have that
isn't necessarily normal here inthe U S is my husband had four
weeks off with me and that wasincredible.
And I still remember the daythat he had to go back to the
office because I was like, Ohno.
Okay, anything else that youthink we, we missed?
(33:40):
I mean, there's so much
SPEAKER_01 (33:40):
that we could talk about.
(34:05):
Yeah, well, thank you so muchfor joining me
SPEAKER_02 (34:10):
and for your sharing your expertise.
Yeah, thank you for having me.
I know that this can be a heavytopic, but it's important we
talk about it to help ourfamilies.
We hope that this wasinformative for new moms and
moms to be as well for thepeople who support us.
So grandparents, spouses,supervisors, neighbors, friends,
and so on.
Prioritizing your health and thehealth of those around us
(34:33):
creates a happier and healthierover time.
We'll see you next time.
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