Maternal Mental Health

Nearly one fifth of pregnancies and births are associated with mental health disorders. Cristen and Caroline detail why antenatal and postpartum anxiety and depression happen, where the gaps are in treatment and how culture factors into healthcare.

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Episode Transcript

Speaker 1 (00:03):
Welcome to Stuff Mom Never Told You from how stupp
works dot com. Hello, and welcome to the podcast. I'm
Kristen and I'm Caroline, and today we are talking about
three and postpartum depression and pregnancy. And it's taken us

(00:24):
a long time on the podcast to get around to
this topic, even though it's certainly come up in other
conversations that we've had around women's mental health and motherhood. UM.
But I am glad that we're talking about it right
now when this podcast is coming out during the holidays, because,

(00:46):
as with any type of mental health challenge, the holidays
tend to compound feelings of isolation and loneliness. Well. Sure,
and I mean the holidays are a huge each time
when you're already facing social stigma or feel that you
might face social stigma if you're not reveling in the

(01:07):
joy and the lights and the presence and the time
with people. Um. And the same kind of goes for
the conversation around postpartum depression. Uh, that women feel a
lot of stigma if they do experience anything other than
sheer joy throughout their pregnancy and after, and it can

(01:28):
be very isolating. Yeah, I mean a lot of This
speaks to the constructive motherhood that we have established that
says women um are allowed to express really nothing other
than pure joy um. That it's unacceptable and uncomfortable for

(01:50):
a new mom to say that she is not instantly
in love with her baby and that she doesn't want
to spend every waking moment with it um. But that
is a reality for a lot of women UM. And
it's only been in the past twenty years that postpartum
depression has really started coming out of the shadows, and

(02:12):
they're being a growing movement to destigmatize it. But really
it's only been in the last couple of years that
we are starting to learn and talk more about issues
of prenatal depression and also things distinct from postpartum depression,
like postpartum anxiety. Right. Yeah, maternal mental health for some reason,

(02:36):
for well, for several reasons, is really not well understood,
and that's kind of shocking. But one aspect that goes
into that that contributes to our poor understanding of both
prenatal and postpartum depression and anxiety is the fact that
it is unethical to do any sort of testing or
experimentation on pregnant women and their fetus. Now, you can

(03:00):
have studies like voluntary voluntary studies where uh, pregnant women
maybe some of them are on antidepressants or have been,
and some who are not will will join a study
and describe their experiences. But you don't have a whole
lot of studies out there, um because of this whole
ethical issue. And so I think that not only the

(03:24):
question of ethical studies, but also what we were just
talking about about, this stigma against women admitting to feeling
less than stellar about their pregnancy or their baby really
contributes to sort of a lack of information. Yeah. I mean,
there there's no way that you could set up a controlled,
randomized study, which is more of the gold standard of research,

(03:44):
where you bring in say fifty pregnant women and you
give twenty five of them this antidepressant or s s
R I of some sort that might help, and then
give the rest of placebo and hope that both grew
and both groups babies. Fair Okay, I mean you just
quickly get into really dicey territory there. So this is

(04:07):
a challenge not only for us as a society and
how we look at women and how we um treat mothers,
and also what we how we allow mothers to feel
maybe more that more than one emotion, which is joy um.
And also on the flip side of that, there's this

(04:29):
medical community that's grappling with the realities of all of
these constraints but also these very real needs, because what
we've known for a long time is that, yes, giving
birth often affects our mental health, whether it is temporarily
or for a longer period of time. Yeah, and I

(04:51):
would like to offer a bit of a disclaimer right
up front, um that a lot of the postpartum depression
research that is out there is very well estern centric, Um,
and the way that we are going to be talking
about uh mental health is very Western centric, because you
have to keep in mind that things like depression, mental health, childbirth,

(05:11):
and issues of family support in general really aren't necessarily
treated or viewed the same in all cultures across the world.
So we can't always even ask the same study questions
the same way to women who are in diametrically opposite
or very very different cultures. And so for today's episode,

(05:34):
we will definitely be focusing more on that Western based research. Yeah,
with with the caveat in mind that cultures of Uh,
childbirth and motherhood um are very different depending on where
you are. Uh. But if we look more at just
the basic science of postpartum effective disorders, the three main

(05:57):
types that have been highlighted start with baby blues, which
talk about our real marginalizing term. That was even the
name of a comic strip that I used to read
in the Sunday Funnies. Oh, i could see baby Kristen
sitting there with the newspaper un lap with her glasses.
I've got my little half spectacles thinking that's an awfully

(06:18):
marginalizing term for a name for a comic. Well, baby blues,
I mean that that tends to be the thing that
new moms are warned about more often, Like you might
feel a little weird the first couple of days, which
shake it off, you'll feel fine. And I mean, for
the most part, the women who do experience the so

(06:38):
called baby blues, that is true. I mean it's it's
this feeling that usually begins in the first couple of
days after birth and can last up to two weeks.
And you might feel mood swings or crying spells and anxiety.
You might have difficulties sleeping, but it does tend to
go away with a good support system, reassurance, help from

(06:59):
a partner for the rest of your family. But about
twenty of women new moms who experience these so called
baby blues, which I'm like, seriously, do we not have
a different name for this, um will see it turn
into postpartum depression and remaining briefly on baby blues, all

(07:20):
of those symptoms that you just cited are so much
more also than feeling weird, because even if our brains
in the delivery room or wherever you delivered were the
back of a pickup truck, even if our brains were
in beyond tiptop shape. Allah Bradley Cooper in the film Limitless,

(07:43):
which if you haven't seen it, I don't recommend it.
Just save your save your time. He like takes a
pill and it makes them super smart. It's like at
all times a billion anyway. So even if we had
Bradley Cooper's brain hashtag jelly um. Even that aside, like
just having a new baby all of a sudden being

(08:03):
a mother, like whatever trauma your body has gone through,
toss on that mood swings, crying spells. If I just
randomly have crying spells, I don't feel just weird. I
feel like something is completely off in my life. So
I mean, just again, I'm I'm astonished that this term
um exists because it's so obviously misleading and it's also

(08:28):
kind of patronizing. Exactly. Yeah, if a woman is complaining
of not feeling well, as has happened to women in
my life, the first thing that they're told is that
it will go away. It's nothing, it's just baby blue
or more. It won't. And when it doesn't, you can
develop postpartum depression. And you know, we are kind of

(08:49):
zeroing in on postpartum depression. But in saying that we're
zeroing in on postpartum depression today, it's a little bit
misleading because one thing that's really not often talk about
is this thing that we know as postpartum depression, where
those symptoms are so much more intense, can last so
much longer, can really interfere with your ability to care

(09:11):
for your baby and handle this daily tasks. A lot
of times those issues develop either before pregnancy, so they're
pre existing depression or anxiety, or they can be this
thing called pre natal depression. And so this is a
thing that I didn't actually know much about now granted
I've never been pregnant, but you hear about postpartum depression.

(09:34):
You don't really hear about prenatal depression or anxiety, things
that develop while you are pregnant and then affect you
after which, as I was reading up on this, and
this is a lot of the info that we're now
getting about prenatal depression, um and even pre existing depression
leading up to pregnancy. Uh, it blows my mind that

(09:57):
this is such new information and new conversations that we're having,
because how long have we known that women get depressed
and anxious at rates higher than men, Like I've never
been pregnant, but I've been depressed, I've I have clinical anxiety,
Like why why is this suddenly like oh my god? Well,

(10:17):
and the age at which a lot of women start
experiencing clinical depression or clinical anxiety his childbirth age, typical
childbirth age. Well, even think about before that, when you
start to see the gender gap and mental health start
to widen. It's when we get our first period. So
you would think that from the get go, medicine would

(10:41):
be paying closer attention to the interaction of our mental
health and our reproductive health. Well, and this is why
it's so important that we're talking about this stuff today
and highlighting the fact that more women are talking about
this UM. We read a column Kristen I believe he
sent it to me from cause Mo, where a woman

(11:01):
who had experienced UM both prenatal and postpartum depression. This
woman named Jane Marie wrote an essay in Cosmo about
how she had been managing depression and anxiety since she
was very young when she experienced with traumatic brain injury
and because of that had um been on antidepressants for years.

(11:27):
But as soon as she UM got engaged and knew
that she was getting married, knew she wanted to have
a baby as soon as possible because she was thirty four,
and UM, I just wanted to do it before, you know,
before the old cobwebs started moving into our uteruses. Um,
it's hormonal cobwebs. And it was such an eye opener

(11:49):
for me, not necessarily because I have baby fever at
the moment, but because I am someone who does take
daily medication that has totally changed my life for the
better to manage my clinical anxiety. And the thought as
I'm reading this of having to go off of that

(12:13):
and then having to go through the experience of both
pregnancy and childbirth without it. Uh, terrifies me, completely, terrifies me. UM.
And I even posted it at the time on the
Stuff I've Never Told You Facebook page, and it sparked
a really massive conversation of a lot of women saying, oh,

(12:35):
thank God, like, this is something that I'm scared about too, uh,
for people who hadn't been pregnant before and women who
had been through it and had to deal with all
of this stuff, but in the shadows, because it's taboo
to talk about, Oh you you, you're depressed and you're pregnant,
and we might have some medication mixed in there. Like, because,

(12:56):
as we've talked about on the podcast before, once you
are maignant, everybody has an opinion about you, your body,
your baby, decisions you make. It's like the floodgates open
up into every nosy person in the world. Well, and
that's a great point that Andrew Solomon raised over at
The New York Times UM magazine in a end depth

(13:19):
piece that he did looking more at prenatal depression that
develops during pregnancy, whether you had existing pre existing depression
or not, and He pointed out how often we strive
in our culture to make our mental health and particularly
depression and anxiety a private emotion, but once you're pregnant,

(13:41):
it becomes so public, not only because people are gonna
have opinions on all sides, but also you have to
be forthright about it. You know, you need a team
of caregivers from your obi gu i am, but also
to a fair pist and even um. Maternal psychiatry is

(14:04):
a developing field now, yeah, and I mean, thank god
it is. And I thought that Andrew Solomon put it
really well in describing these issues of postpartum depression and
prenatal depression. Uh. He says that for some expected mothers
and new parents, love seems to be automatic. It wafts
them instantly up to a new level of consciousness. Others

(14:25):
have to climb a very steep staircase to reach the
same heights. The fact that the exercise can be agonizing
and that some women cannot quite make it does not
dull the intent behind it. And so for a look
at what some of these women are experiencing, who experienced
prenatal and postpartum depression, you're of course going to experience

(14:47):
things like depressed or severe mood swings, again, excessive crying,
feelings of worthlessness, shame, guilt, or inadequacy. A lot of
what we read from women's first person accounts of dealing
with this were issues of like suddenly they'd wake up
at two am thinking I'm gonna be a terrible mother,
I'm gonna end up hurting my baby, or or I'm

(15:08):
I'm not going to be worthy of raising this child. UM.
You know, you might also experience insomnia, sleeping too much,
overwhelming fatigue, UH, diminished ability to think clearly or concentrate. UM.
And once the baby is here, UH, moms might experience
difficulty bonding with the baby, thoughts of harming themselves or

(15:30):
the baby. But it is worth noting that those intrusive
thoughts are very common, and so it's important to normalize
this topic and these health issues because again, it is
so isolating. If you're sitting there thinking that you might
harm yourself or your child, or that you're going to
be a terrible mother. It's okay to talk to someone,

(15:53):
it's okay to ask for help. And if you are
one of those women who experiences prenatal depression UH for
about fifty of those women, it does turn into postpartum depression,
and you might experience actually more intense feelings of sadness
and paranoia. So tracking and talking about your mental health

(16:14):
and those feelings and those emotions throughout and after your
pregnancy is so important. And if we move farther along
on the spectrum of postpartum mood disorders, you have postpartum psychosis,
which is a rare condition that typically develops within the
first week after delivery. And essentially you take all of

(16:37):
the hallmarks of postpartum depression and amplify them, so you
may experience things like disorientation, hallucinations, delusions, sleep disturbances, and
paranoia and and potentially attempts to harm yourself or your baby.
But something that's far more common, sort of back on
the spectrum a little bit than postpartum psychosis, this is

(17:01):
postpartum anxiety. And this is another one of those effective
mood disorders that we are only recently learning about and
only recently um seeing more clinical investigation. And this is
extremely important because y'all, we hear all the time about
postparm depression and in fact not enough um, so I'm

(17:22):
in no way being dismissive of that, But we need
to talk about postpartum anxiety because it is distinct from PPD,
and this emerging research is suggesting that it's even more
common than postpartum depression. But because it's not postpartum depression,
it's often written off as oh, these are just the
baby blues, Oh, you know, just worried about being a

(17:45):
good mom. Right and um. There was a study from
and Pediatrics which found that out of its sample population
of a thousand new moms, nine percent experienced postparmu depression
and seventeen per scent experienced postpartum anxiety. And they experienced

(18:05):
p P a longer term than PPD. Uh, and I
have a hunch that at least part of that longer
term effect is our lack of knowledge and understanding around it,
even terminology around it. Um. So, something that in in

(18:26):
very basic terms distinguishes postpartum anxiety from depression is sort
of the level of energy. So you might see a
lot of overlapping symptoms like a loss of appetite and
concern over your baby, but whereas depressive symptoms sap your energy.

(18:49):
You don't want to get out of bed, you're low, low,
low anxiety is all a jumble of energy that you
don't know what to do with. It's often linked to
O c D type habits, um really intrusive thoughts which
may possibly involve harming yourself or your child. So UM,

(19:09):
it's it's definitely a distinct thing that I really hope,
I really hope it's helpful for people listening UM because
I only recently learned about it because a good friend
of mine went through it. She went through post part
of anxiety, yes, yes, and it took her so long
even her gynecologist didn't get it right. It really took

(19:30):
her getting involved with organizations like Postpartum International UM who
connected with other mothers who were going through this UM.
But also, you know, are are helping to champion you know,
this all of the spectrum of maternal mental health that
we're just not paying close enough attention to. And I

(19:52):
mean it is crazy that we are not talking more
about it because non psychotic postpartum issues, depression, and anxiety
are the most common complication of child bearing, and studies
have shown that a woman has a greatly increased risk
of being admitted to a psychiatric hospital within the first
month after giving birth. Then at any other time in

(20:13):
her life. UM up to fifteen percent of women experience
that anti natal depression that we talked about, that depression
that manifests during pregnancy before childbirth uh and between twelve
and of women will develop symptoms of depression, anxiety, bipolar
disorder O c D, or a combination of these things

(20:34):
during or after pregnancy UM and ten to fient of
women might experience a major depressive episode within three months
after giving birth. But the thing is, if you have
it during one pregnancy, you might not have it during
the next, or if you don't in your first, then
you might develop it in the next one. It's there.

(20:55):
There are no constants, there are no guarantees. Well, one
thing though, that could absolutely distinguish your mental health experience
with your first pregnancy that results in traumatizing uh P,
p A or pp D, whatever whatever it might be.
One thing that could um alleviate a lot of that

(21:17):
for a second pregnancy is actually going into pregnancy understanding
more about how our bodies and respond to pregnancy. I
mean that, and that's and that's what you hear from
a lot of women who go through this, particularly the
prenatal depression where it just feels like it's out of nowhere.

(21:39):
No one ever told them this was a possibility. Like
this is also an issue of total failing when it
comes to educating women about our body basics, but also
about the range of scenarios that happened with pregnancy and childbirth.
And I mean it's not for a lack of trying

(22:03):
on a lot of male doctor's parts. In the history
of medicine. Oh yeah, guys have had a lot of
a lot of ideas. I mean, Dave old the oldie dude.
Doctors have known that women get cranky, you know, she
got a case of the baby blues for centuries um,
but they basically just thought it was our like what

(22:25):
uterus fluid getting into our heads. Yeah, so if you
go back to Hippocrates, this is the same guy that
thought that women had such gorgeous, lustrous hair because it
was just filled with semen um. He just figured in
back in the fifth century BC, that fluid from the
uterus could flow to the head after childbirth and cause
you to be delirious. And one of his contemporaries said, yes,

(22:52):
terrific idea. Let me jump on that and say, you
know why they cry so much because that fluid covers
their eyes and runs out like tears. Yeah. I actually
had to pause when I read that and was like,
I'm not a doctor, but I feel like that's not
the first thing I would go for. The idea wise,

(23:14):
my uterine or cervical or any sort of inner fluid
just leaking out over my brain and through my eye holes. Well,
I'm glad that you would be such an advanced ancient physician, Caroline. Yeah,
they probably murder me as a witch, which honestly leads
us to our next thing that does not cause postpartum depression,

(23:37):
which is witchcraft. Of course, people in the Middle Ages
viewed postpartum symptoms as a sign that you were a witch,
so there was just really no winning honestly, and um,
it's also not caused by milk suppression. A nineteenth century
French psychiatrist said insanity manifests itself most frequently among women

(24:01):
who do not nurse, which is funny because just a
few decades later, a British physician said that it was
insanity of lactation that caused that was caused by anemia
brought about by prolonged suckling or by the mother making
undue efforts to nurse and so over taxing her strength.
So just within a couple of decades in the nineteenth century,

(24:24):
you had people who were like, oh my god, she's
not nursing enough, and other people being like, oh my god,
she's over nursing and making herself crazy. And isn't it
such a relief that there's like no pressure on women
anymore about whether breast is best from all of those that,
because that doesn't compound any any negative feelings and insecurities

(24:48):
depression that you might be having. I'm being sarcastic, folks,
But who was not being sarcastic was Freud? Yeah, what's wrong?
I mean, actually, hang on, time out here, Zach Morris,
time out. What if Freud had been sarcastic the whole time,

(25:11):
you know, he was like, oh yeah, it's an complex
and we just didn't pick it up. We thought it
was a quote when really he was putting sarcastic quotes
around things. Yeah, and so we've we've built pipes and
tunnels so many psychoanalytical uh fundamentals that really Freud just

(25:31):
meant as a flick off to our poor intellect. Well, yeah,
and I mean postpartum depression certainly was not left out
of Freudian theories. Uh. There were some Freudian inspired theories
in the nineteen twenties suggesting that postpartum symptoms were a
result of things like frigidity because you know, women suppressed homosexuality,

(25:52):
or good old and sestuous urges. But see again, what
if he were being sarcastic, like, oh yeah, it's definitely rigidity, right, guys, Right,
I think I'd like him more, but would probably grow
tired of him faster if that were the case. Yeah, yeah,
like futtle Freud. And then like ten minutes into your

(26:13):
first drink at the bar, you're like, all right, someone,
get this guy out of here. Can you just beat
Can you just say it with a straight face? Freud? Yeah,
I'm very confused as our decades and decades of other people. Um,
and after a quick break, we're going to tell you
some of the things that actually contribute to postpartum symptoms. Well,
actually I'm still Freud at the bar. Sorry, you'll go now.

(26:52):
So it's no news that our hormones spike quite a
bit during pregnancy and especially during childbirth. Um. Depending on
the hormones we're talking about levels might escalate more than
a hundred fold, especially with things like estrogen, progesterone, and

(27:12):
prolactin um, all of which are intended to help your
body get a baby out of it, also helps said
body bond to this thing. That's just put you through
a lot of physical pain. Um, which is good. That's
smart evolution, good job. But for every action, there's a reaction.

(27:35):
There's like a Newtonian post maternal law here where when
those hormones go up, they eventually go back down. Hormone
gravity total sense. Your hormones are shaped like apples. That's
that's a lie. Please don't write that down. And that's
the ovaries tiny little minor fiji um after birth. Estrogen

(27:58):
and progesterone a plummet after having spiked really hard during pregnancy,
and not so surprisingly, this can sort of disrupt your
brain chemistry a little bit. Other hormones produced by your
thyroid also may drop sharply, and that can leave you
feeling super tired, sluggish, and depressed. Not to mention, testing
positive for thyroid antibodies during pregnancy does put you in

(28:22):
an elevated risk of postpartum depression. And I have a
thyroid condition, and every time I go see any doctor
because I just turned thirty three, they're all like, so,
what are your baby plants? Do you have any baby plans?
Because you know your thyroid, you you really need to
be on lebo thyroxine if you're going to get pregnant
and testing positive for those thyroid antibodies would potentially be

(28:45):
linked to postpartum depression down the road because of the
critical role that our thyroid plays in hormone production. Yeah,
I mean, there's there's your Your thyroid is obviously a
critical part of your innocrine system, and there's all sorts
of things whether you are pregnant or not, that it
can affect. But studies have shown that, for instance, if

(29:06):
you have poorly controlled hyper thyroidism during pregnancy, you might
have an increased risk of things like miscarriage and still birth,
um preterm birth, maternal heart failure. I mean, the connection
with postpartum depression is just one factor of so many
things that potentially could go wrong if you have uncontrolled

(29:27):
fire right issues when you are pregnant. And so my,
when I went to a terrible indo chronologist who like
did all sorts of shamy behaviors. One of the things
that she did tell me was that if I, if
I were to get pregnant, I would need to go
back on thyroid medication to counteract any of those potential
negative effects that my hype both thyroidism and Hoshi Meadows
disease could lead to gotcha. Um. There's also uh potential

(29:52):
genetic component, no surprise. Uh. Some women are just genetically
predisposed to being more sense tive to hormone changes, whether
it's happening during puberty, menopause, menstruation, if you are on
treatments with fertility drugs, some of our brains are just

(30:13):
a little more like, oh whoa, hey there, Hey, they're progesterone.
Is the progester um tickling the brain, Just make it
a little nervous, Just just goose in it a lot. Yeah,
because you don't really know what it's gonna do. It's
got those pig mickey mouse hands. Who knows um and

(30:33):
yeah there. There have been a couple of different studies
looking into specifically genetic links between um our hormones and
postpartum and researchers are hoping that through this research, within
the next twenty years we might have a genetic test
for PPD, even though we've realized that this is some

(30:56):
kind of issue since Hippocrates is his day. This is
indeed that's listeners. Am I alone and being dumbfounded by that?
I don't. I don't think so at all. But Christen,
it doesn't stop there. There is more hormone fun uh
and two separate studies, levels of placential cortico trope and
releasing hormone, which is a peptide hormone and neurotransmitter involved

(31:20):
in your stretch response stress respection, and the hormone beta endorphin,
which dolls pain after a traumatic event and which causes
that runners high thing experiencing those during pregnancy may predict
weather women develop PPD. But again, that's two studies, you know,
And I'm sure there are more studies prodding and poking

(31:43):
at these ideas. But I included that not because I'm
so sure of what this means, but to illustrate, like, yes,
there are possible links, we just don't know for sure
yet um. And so researchers are now looking into how
stressed during pregnancy affects these hormones that will then affect
like a domino effect. Uh. Postpartum anxiety and depression, and

(32:06):
how something like even yoga practice might protect against some
of these hormonal imbalances. And we also need to mention
how hormonal issues are extremely pertinent for transgender men who
get pregnant because a lot of the time they will
have to stop hormone therapy during pregnancy, which can potentially

(32:29):
lead to gender dysphoria UM. And since trans people on
the whole have a higher rate of depression and suicidality
UM O, B g U, I, N S and researchers
who are starting to really look into the kind of
tailored care specifically for UM trans pre and postnatal patients

(32:54):
UM are focusing on the right way to sort of
manage these hormonal transitions for them both you know, during
pregnancy and then after, like how once you segue back
onto UM hormonal treatments UM while also you know, bonding
initially with the infant. Yeah, And I mean there's also

(33:18):
so many obvious emotional issues going on too that can
contribute to feelings of anxiety and depression during and after birth.
I mean, you're already sleep deprived and overwhelmed. Uh, You're
already potentially having trouble handling even minor problems that arise.
You're probably going to feel anxious about that ability to
care for a newborn. Uh. But also you know you've

(33:40):
just had a major life shift, right, You've had a baby. Um,
I don't know, but I mean, like that throws your
identity not into crisis, but definitely into like complete reevaluation.
Uh projecting here, it would throw my identity majorly in
the crisis completely. Like you go, especially if you have

(34:06):
you know, a sexual partner who's like there with you,
like sexual for life partner who's there with you. Um,
becoming a mother and just the physical trauma that can
happen uh, and all of the difficulties sometimes with babies, uh,

(34:26):
latching on or not latching in, the pain that can
come along with breastfeeding, and just that entire shift of
transitioning into becoming a mother again. Like, Uh, this episode
honestly has made me realize a lot of childbirth fears

(34:47):
I didn't realize that I had because I just I
can't imagine like even just that conceptualizing that identity shift. Yeah,
And I mean again, that goes back to so many discussions,
even like celebrity interviews and magazines you know, you it's
so common to read these quotes about like, oh, I've
never loved like this before. You know, my life has

(35:08):
new meaning blah blah blah. So you can imagine it's
that much harder for a person who doesn't feel that
to feel that they can come forward and talk about
it because they I'm sure that feelings of shame will
come along with that, feelings of not being normal, of
of feeling something that might be taboo or just not
talked about because everyone around you is waiting for your joy. Yeah,

(35:31):
you know, I mean, there is there's a script essentially
that we could print out in hand to you for
what for the way that we expect new mothers and
new parents to be reacting. And it's very it's a
very limited role, yeah, exactly. And the thing is, I mean,
postpartum depression and anxiety can just like a depression and

(35:52):
anxiety can really strike any woman of any age, ethnicity,
socio economic background, education, whatever. It doesn't discriminate, but there
are some things that put you at higher risk. UM
if you have a personal or family history of depression
or bipolar disorder. UM, if you've experienced stressful events in
the past year, maybe you've had pregnancy complications, illness, financial problems, UM,

(36:15):
if you're having problems with your significant other or have
a weak support system, or if you've had difficulty breastfeeding. UM.
There's also a lot of links between an unplanned or
unwanted pregnancy and postpartum depression. Or if your baby is
experiencing health problems or other special needs, or if your
doctor made you go off all of your antidepressants and

(36:38):
mood stabilizers. Yeah, well yeah, exactly. So the good news
in this is that screening is starting to be a
more common and even required practice. But when we talk
about screening, we're only talking about postpartum depression. There still

(36:59):
is not enough screening um, if at all, for postpartum anxiety.
And I mean, you've got to keep in mind that
screening can be difficult because a lot of the symptoms
that we've talked about also overlap with just having a baby.
You're tired, you're anxious, I mean, your whole life has
just changed, your identity has shifted. UM. And also it's

(37:22):
worth noting that screening tools in general poorly represent the
diverse cultures that exist in America alone. UH and studies
have traditionally been on white women. So again, yeah, childbirth, motherhood,
mental health, they all are thought about and talked about
differently around the world, but even here in America, these

(37:43):
issues are thought of and talked about differently. You know.
We read some pieces from women of color who had
experienced either postpartum depression or anxiety, and their friends told
them that's a white woman's disease, Like get over it.
You need to be a strong mother. Um. And so
screening for postpartum depression specifically is mandatory in just one

(38:05):
state in the United States, it's New Jersey. But research
on this mandatory screening that was following low income women
shows that it didn't really contribute to higher rates of treatment,
which you would think would be the goal of Like, Okay,
we're screening you, you have some risk factors. Let's get
you monitored and treated. But all of this feels like

(38:26):
too little, too late. Um. Not not to discount the
importance of screening, but I'm just saying there is more
screen that we should be doing before the baby even
comes out. So The New York Times reported in January
that a federal panel recommended that all pregnant women and

(38:47):
new moms or dads should be screened for depression. Um.
But here's the thing that piece in the Washington Post
noted is that the postpartment depression screening is usually conducted
with something called the Edinburgh Postnatal Depression Scale, which is

(39:09):
uh ten item questionnaire that only assesses symptoms for the
past seven days. Uh. So that doesn't take into account, uh,
the length of your mental anguish you might have been
going through discomfort, nor does it account for symptoms severity.
So even even with this screening, there could be a

(39:34):
lot a lot of people who are being missed. Yeah.
And then of course you have issues of insurance and
coverage and support especially that are arising now with the
changing administration and calls to dismantle Obamacare. I mean, Obamacare
has called for more funds for postpartum depression research, education

(39:57):
and support services, but Congress didn't appropriate them, and frankly,
if I get a little editorially, I doubt that they
will appropriate them now. But one of the consequences of
being screened for postpartum depression is that life and disability
insurance providers have sometimes penalized women with these mental illnesses

(40:20):
by charging them more money. Uh. They might exclude mental
illness from coverage or decline to cover them at all,
And so basically, life insurance companies are like, are you
going to kill yourself? And disability insurers are trying to
guess your likelihood of being unable to work because of
mental illness, and like, another layer of terrible in all

(40:42):
of this is because pregnant women who are experiencing symptoms
of depression or anxiety tend to get lumped in with
the larger pool of people in general diagnosed with these issues,
which means that people with mild or moderate cases or
cases that have already cleared up might be facing higher rates.

(41:02):
And what is contributing to all this is really part
of why we're talking about it today. It's the underdiagnosis
and really under discussion of postpartum depression that means that
insurance companies simply do not have a ton of long
term data to base their rates on. There basing their
rates on all of the other people in their networks

(41:24):
that are depressed or anxious and have to go on
medicine or seek therapy or or whatever um and so
these companies are just not really sure what has happened,
what has gone on to happen with pregnancy related mental
health issues down the road. And if there are any
listeners with expertise on this who could phillis in on

(41:46):
on why this could or could not be a question
that I have is why more innovative, say insurance companies
aren't looking into treating this more as preventative care, both
for the person giving birth and also for the baby
that was just birth. And you have to wonder if

(42:07):
it's not linked though that particular issue. And again I
would love to hear from listeners too, but you have
to wonder if that's not linked to earlier studies and
standard advice telling women to get off all medications, whether
it is an antidepressant or whether it's like cholesterol medication,
you know, like um. The standard advice has been don't smoke,
don't drink, don't take any drugs, whether they're illegal or

(42:29):
prescription or freaking coughs, r up or whatever, um. And
so many women are so understandably anxious about not wanting
to harm their fetus that a lot of them are
willing to go off even if it does mean experiencing
these horrific consequences. And after we come back from a
quick break we are going to get more into that
issue of pregnancy and antidepressants. So the prevailing advice for

(43:08):
women wanting to get pregnant who have been on antidepressants,
SSR eyes, mood stabilizers, et cetera, is that they gotta
get off them. The best thing for the fetus is
a medication free body, and ultimately in terms of completely

(43:31):
and totally mitigating risks, yes, um, getting off medication can
do that, but logic around that is changing because of
all of these issues that we're talking about in terms
of the very real issue of needing to manage moms,

(43:51):
moms to bees mental and maternal health. Yeah. So again,
you know, we mentioned earlier in the podcast that research
between mental health, S s R eyes and pregnancy and
PPD has been stymy because again, you can't do these
blind tests on pregnant mothers. So even though there have

(44:15):
been a lot of there has been a lot of
research into S s R eyes, some of the questions
are like, is it the S s R I causing
potential issues with the fetus? Is the depression itself causing it?
The erratic behaviors that can come along with severe depression,
things like risky behavior, smoking, drinking, uh, not treating yourself well,

(44:36):
missing appointments, sleeping irregularly, just a stressed body. Yeah, exactly,
and so um they do know researchers, do you know
that S S R, E, s UM don't cause a
clinically significant risk of major birth effects? Your risk from miscarriage,
preterm birth, and low birth weight are somewhat heightened, and
they slightly increase the risk for pulmonary hypertension in newborns.

(44:59):
But here's the thing, ing like, what's worse because untreated
depression and anxiety during pregnancy has also been linked to miscarriage,
pre eclampsi, a pre term birth, neonatal complications, and smaller
newborns in general. And Elizabeth Fiddleson, who is over at

(45:20):
Columbia University, said that for about ten percent of my patients,
I can readily say that they don't need medication and
should go off of it. Another absolutely have to stay
on medication people who have made a suicide attempt every
time they've been unmedicated. For the remaining seventy percent, it's
a venture into the unknowable. That's frightening, that almost feels

(45:43):
chilling to read that that, like, we don't know enough,
because again, everybody is different, every hormonal makeup is different,
every pregnancy is different, and so the fact that like, yes,
you can go off and be safe, you have to
stay on to stay safe. But for the most of you,
anything could happen. And I'm not surprised at all that

(46:07):
in it's still a venture into the unknowable UM, because
a like, I think that for us to even get
to this point to where women would be afforded the
possibility that their mental health might um deserve as much

(46:29):
attention as fetal health, say, UM, is a reflection of
and had to be preceded by gender equality, you know,
and women's rising role in society and also in medicine
in general. UM. I don't think that we would be
talking about this if it were still the old days
of only dude doctors who thought that it was just

(46:49):
like you know, uterus juice in our eyes causing all
of this. UM. Because also up until now, up until
you know, women have of really become more of their
own health advocates more loudly, UM, and also doctors speaking
out on our behalf as well. UM. Again, part of

(47:12):
that motherhood's script is that you will sacrifice everything for
the good of your baby. I mean, it's it's it
goes to um. The conversation that we had a while
back with Longest Shortest Time host Hilary Frank and how
women who are experiencing anxiety, trauma, or depression around their

(47:35):
birth are helped in no way by people saying, well,
at least the baby was healthy. The only thing that
matters is that you have a healthy baby, And that's
been the prevailing mindset. UM. But the more we are
now learning and destigmatizing these kinds of health care issues,
we are having to question how true that really is.

(47:56):
And this is nothing against babies, y'all. I'm all for
healthy all the babies listening. You're okay, but don't write
us letters. But the healthier, the healthier parents can be
as well, the healthier that baby is probably going to
be developed mentally, I would I would think, I mean,
generally speaking, broad strokes, I mean, that's that's literally true.

(48:17):
Christina Hibbert, who's the founder of the Arizona Postpartum Wellness Coalition,
calls PPD a familial disease because when it's untreated, it
can interfere with bonding and cause massive family stress. Uh
and mothers to start. Untreated PPD increases the risk not
surprisingly a future episodes of major depression. Moms might be
less likely to initiate or maintain breastfeeding. Infanticide, though of

(48:40):
course it's rare, can occur because of neglect or abuse.
UM In partners of women with PPD, the risk of
depression increases. If we're talking and heteronormative couple terms. Up
to ten pc of new fathers may experience pp D
along with their female partners, and in the children children

(49:01):
of moms who experience untreated PPD can experience emotional and
behavioral issues like sleeping and eating disorders, excessive crying, a
d h D, and language development delays. They're all more
common than in children of mothers without depression, but the effects,
though negative, are really long term, usually only if the

(49:22):
mother's depression is chronic or entreated so she gets the
help she needs. If she gets the support she needs
and can be a better parent to her child, UM,
that child's negative effects are are likely to be UM lessened.
And this reminds me of of that Facebook conversation that
was sparked UM that I mentioned earlier around the essay

(49:46):
in Cosmopolitan about the struggle of having to go off
of in a depressants UM during pregnancy and how to
go back on them. And one thing that really struck
me in a number of comments that I saw UM
from women was that, hey, you know what if if
you know that you have a mood disorder, don't get pregnant,

(50:08):
don't pass that along potentially to your child. And I
wanted to raise that issue, UM, to to open this
up to listeners, because UM, that's that's not a that's
not a solution in my mind too, I think it's
unrealistic and unfair and also like I don't need your

(50:32):
opinion about my body. Yes, and again it also seems
to reinforce this hierarchy of you know, good mothers versus
all the way down with like unfit mothers women, you
have no business being pregnant, UM, And that kind of
pregnancy shaming UM is absolutely interrelated with all of these

(50:55):
mental health issues. So UM, I just wanted to toss
that out there for listeners, whichever side of of that
argument you might be on, UM, because I I don't know.
To me, it was just a really it seemed like
a really cruel thing to say. But I'm also sitting
here as someone who has a mood disorder, and I, uh,

(51:19):
I don't know, I would just I would never like,
why why are you telling me what to do with
my uterus? But recognizing my own bias, I am saying
this as someone sitting here with a mood disorder. Well, again,
as we said, pregnancy is what sparks everybody to have opinions.
So and you know we mentioned earlier that UM pp

(51:44):
D and p p A can really strike anyone um
of any background. But there have been some studies looking
at different groups in America. There was a a New
York study looking at Asian Pacific Islander women and found
that these women were more likely to receive a diagnosis
after their providers talked to them about their depressed mood,
but they were less likely than other groups to have

(52:06):
had this conversation UM. And the significance is that Asian
and Pacific Islander women who were between fifteen and twenty
four have the highest rate of depression and suicidality compared
to any other ethnicity, gender, or age in this country.
And when it comes to postpartum depression, researchers have found
that they seemed to have higher rates than black, White,

(52:27):
and Latina women and are more likely to have had
pre natal depression. Um. There was another study from Arizona
State psychologist Linda Leeueken who was researching low income Mexican
American women and the health disparities that they experienced compared
with white, middle class women, and they found she found

(52:50):
that the Mexican American women experience particularly high rates of
postpartum depression, as much as thirty three percent of new mothers.
And you know, we mentioned those those average stats earlier
in the podcast, which hovered around like ten to fifteen,
and so this is significantly higher. But lou i Can
found that despite these high rates, this population also sees

(53:14):
certain protective factors like strong family ties, which keep depression
rates lower than they would be otherwise among low income mothers. So,
I mean, yeah, we talked about how there are these
emotional aspects, not only hormonal and physical going on, but
also emotional aspects tied up in PPD and p p A,

(53:35):
and having those strong family supports and ties are so important,
I mean when it comes to childbirth in general and
raising children in general, and having a strong family to
help you but also to support your mental health in
this case, to quote Hillary Clinton, it takes a village,
and that's especially true. I've stopped quoting Hillary Clinton at

(53:55):
this point. That's especially true for low income women. There
is some ongoing research looking at the connections between postpartum
depressions specifically and its prevalence among lower income women. UM.
So the research has found so far that there tends

(54:16):
to be a higher incidence rate, which makes sense because
you're coming into this pregnancy likely with more financial stress
um than you would otherwise. UM. But at the same time,
like when that's also compounded by ethnicity, Black and Latina
women had the lowest rates of PPD treatment initiation, which

(54:41):
didn't necessarily mean that they didn't need it, they simply
weren't accessing it. And when they did initiate treatment compared
to white women, they had lower rates of follow ups
or lower rates of refilling antidepressant prescriptions. UM. And all
of this is not necessar severally saying like, oh, they're
so irresponsible. No, this is when we have to pull

(55:04):
the lens back even farther and look at the barriers
to care, such as social stigma, communication problems, logistical issues
like insurance coverage, time constraints, transportation. Um, sometimes mental health
is simply not accessible. I mean it just you. You
cannot make it happen. Yeah, And previous studies have suggested

(55:28):
that addressing those types of logistical challenges and cultural beliefs
about mental health and addressing communication between patients and providers
can be helpful in meeting mental health treatment needs in general,
but also of course that applies to seeking treatment for
PPD and p p A. And the good news with

(55:51):
all of this is that we're actually knowing, you know,
the things that we've just talked about for the past hour.
You know, it is becoming more common and knowledge clinicians
are paying closer attention to it. Um. Women are now
being set up, when possible, with teams of not just
your delivery doctor, but also perhaps your maternal psychiatrist or

(56:17):
and and your duel and whoever else it is. You know,
everyone really needs, like a childbirth squad. It seems like,
can mine have a dog on it? I'm not going
to give birth, but I feel like if I had
a childbirth squad, it would include like a golden retriever. Oh,
a golden retriever, like a sensible one named like Dr Barbara. Yeah,
like a therapy golden retriever named Dr Barbara who has

(56:38):
UM some like thick like Warby Parker style glasses Yeah,
and a clipboard yeah, because she's I mean, she might
write with crayons, but she knows what she's talking about. UM.
And in addition to Dr Barbara's groundbreaking research, UM which
is just mostly digging holes behind the hospital, but there

(56:59):
is treatment for PPD and a lot of it starts
for it, and UM Prenatal and postnatal anxiety as well
is uh just the awareness and education. It starts with
having someone that you can talk to or being even
aware that these are symptoms of something other than oh

(57:22):
they're just the baby blues don't go away. UM because
talk therapy and support groups like Postpartum International and Postpartum
Progress are extremely, extremely vital to helping new parents who
are dealing with these issues. UM. In fact, medications are

(57:45):
certainly available and certainly UM vital for some folks. UM.
But in addition to that, a lot of doctors suggests,
you know, talk therapy being the first line treatment even
even if medication and is necessary, you still want to
include some of that more cognitive behavioral therapy and just

(58:08):
hanging out and being able to talk to and share
with people who are going through the same kind of
thing you are, because it's so isolating. Oh sure, yeah,
Like I had every Thanksgiving my aunt it was like, so,
I your mother told me you're in therapy. What do
you need to go to therapy for? And I was like,
what what? Everyone needs to go to therapy because I'm

(58:34):
not just like radically changing the subject. Talking with a
therapist can really help you find ways to cope with
how you're feeling, to help you solve problems, set realistic goals,
and learn how to respond positively. Um And of course,
don't forget the benefits of couples therapy because, like we
pointed out earlier, postpartum depression and anxiety can really rattle

(58:57):
the whole family. And that's right if you're doing the work,
whether it is therapy or medication or a combination, but
if the people around you are unaware of how they
can be helping and changing their behaviors as well, it
might not be as effective. Um And I did think
it was interesting slash unfortunate that the United States actually

(59:18):
lags behind Europe in Australia and creating these things called
mother baby psychiatric units, and those allow the moms to
deal with the hormonal and mental health fallout of giving
birth UM, but it allows them to continue breastfeeding. It
permits direct doctor observation of the mom and baby interacting,

(59:39):
and it allows for immediate and constant support. And I
have a feeling that the type of support that the
US would need in order to catch up to Europe
in Australia is um subsidized healthcare, especially if we're talking
about support for everybody UM. And one bit of advice

(59:59):
that just came to mind Caroline, that I heard when
interviewing a few months back a maternal psychiatrist is get
off the ENDT. So aside from specific organization sites like
Postpartum Support International, which is at postpartum dot net or

(01:00:20):
Postpartum Progress which is at Postpartum progress dot org, a
lot of what you will find if you are experiencing
what you think might be uh postpartum anxiety or prepartum
anxiety or depression. UM, you're gonna want to stay away
from those message boards and comment threads. They're bad enough

(01:00:42):
for like my stomach aches, you know, I can't imagine.
I mean, the stuff about pregnancy and postpartum issues and
fetal development. Like there's a lot of judgment in there,
and there's a lot of very biased and personal opinions,
and so it is I'm passing along to you doctor
recommended advice, um to stay off the internet and you know,

(01:01:05):
really seek out those support groups you can offer more
face to face support for you. And having talked to
people who are part of both postpartum support and national
and postpartum Progress, I can also tell you, um, from
from my experience with them, they are so so so

(01:01:26):
passionate about what they do because most of them have
been through this and have seen so many women in
particular go through this and feel so lost and so alone,
and they realize that this is just a vital part
of our health care that's often so inaccessible, even invisible. Um.

(01:01:47):
So I'm so grateful to the women out there who
have been through this and are saying not again, never again,
who are using their traumatic experiences to energize them to
become advocates and educators for other women, you know, and

(01:02:08):
also the folks in the medical community who have made
this maternal health care you know, really a cornerstone of
their work. Yeah, and I would just add, like kind
of jumping off your earlier points about the Facebook conversation
that was happening, I would just add, UM that whether
you have been, will be, or will never be pregnant ever, UM,

(01:02:32):
it's you're not helping anyone by passing judgment. UH. You're
not helping anyone by saying that someone should or should
not have kids, or is going to be a good
or a bad mother, or you know whatever. UM. I
would argue to just be an empathetic, real and kind
human UM, so that we don't have to deal with

(01:02:53):
so much mental health stigma and shame. And with that, UM, listeners,
we would love to hear from you and UM if
you would like to remain anonymous, of course we will
always respect that. Just make a note of it in
your letter or message. UM. You can email us at
mom Stuff at how stuff works dot com. You can
also tweet us at mom stuff, podcasts or messages from Facebook.

(01:03:17):
UM and also partners of people who have experienced this,
family members of people who have experienced this. UM. This
affects you as well, and there are often questions of
how to be the very best support that you can
be for someone who is going through UH. Post or
prepart um anxiety or depression. UM, so we would love

(01:03:37):
to hear your experiences and insights as well. You can
also tweet Caroline and me directly if you prefer. I'm
at Kristin Conger, I'm at the Caroline HERV and we've
got a couple of messages to share with you right now. Well,

(01:03:57):
I have a letter here from Lindsay in response to
our charitable Burnout episode. She said, your recent episode on
nonprofit burnout really spoke to me. As I spent ten
years in nonprofits, working my way into a senior position
at a small arts institution for the last four and
a half years with an operating budget under five hundred
thousand a year, I felt compelled to write to share

(01:04:18):
two things. First, regarding the lack of diversity in many nonprofits.
From my albeit anecdotal experience, this problem starts with many
internship programs. A number of programs, such as the one
I administered, are unpaid. Even as it complied with federal
law for unpaid internships and was part time, many college
students and recent grads of color did not go after

(01:04:39):
the opportunity or turn it down when weighing it against
paid positions. I also saw this with white applicants who
came from lower income backgrounds. When those individuals did become interns,
I noticed some of them had less external support emotional, personal,
or financial than other more affluent interns. This is wildly unfortunate. Second,
I wanted to share with you ladies that I was
the first woman to have a baby while at this nonprofit.

(01:05:02):
At the time, the nonprofit was thirty six years old.
The organization had to dust off a maternity leave policy
from the nineteen eighties and bring it into the twenty
one century. I ended up with twelve weeks off, partially
paid thanks to New York State disability, and saved vacation time.
As my salary could not nearly cover full time daycare,
I negotiated what I thought, while pregnant would be great,

(01:05:25):
bringing my son to work with me two days a
week till he was six months old, and working from
home two days per week till he was ten months old.
My boss agreed. I look back at this time and say,
what I so appreciated this extra time to physically be
with my infant son, but it was an insane time
for me, my husband, and I'm sure my co workers.
As I primarily worked doing educational public programming, I had

(01:05:47):
extra work and life challenges. Once a baby was in
the mix, I realized about a month after returning to
work that a change was necessary. It took me about
a year of emotional soul searching and feeling like I
was privately divorcing my career, but I ended up trans
asitioning to a job at a tech company when my
son was just over a year old. This was terrifying
and in many ways heartbreaking, but was necessary for my
own well being in that in my family. Two plus

(01:06:09):
years out of nonprofits and at that tech company, and
I cannot believe how happy and fulfilled I am. I
do miss nonprofit work sometimes do I miss wearing thirty hats,
the long hours and never really being able to leave work.
Absolutely not. Thank you for your wonderful work and keep
it up. At lindsay you keep up your wonderful work.
And I have a letter here from Ashley, also about

(01:06:30):
our charitable burnout episode. She writes, as I sit here
in my office at a nonprofit listening to your charitable
burnout episode, I can't help think but yes, yes, yes.
Having spent my entire career thus far in the nonprofit sector,
it's several different organizations. I've seen everything you've discussed on
the podcast. In my first full time job out of

(01:06:52):
college at a nonprofit helping families in poverty, I was
paid actual minimum wage. The irony of working at a
poverty fighting organization for poverty level wages was not lost
on me, but it was expected that employees would be
okay with it because of the opportunity to quote help
the kids, and I completely bought into it as a

(01:07:12):
new graduate with storry i'd hope for the future. I
was willing to expect far less than I was worth
for the experience and the chance to help others. Looking back,
I was completely being taken advantage of the level of
burnout I saw employees experience there as well as in
my subsequent organizations is so high, and I have to
think that feeling devalued financially or otherwise is a big

(01:07:33):
part of that. In my current role managing a volunteer program,
I also see race and gender play out in my
pool of volunteers. While there may be equity between men
and women and volunteerism here anyway, our volunteer pool is
overwhelmingly white. My manager and I have been trying to
increase the number of people of color serving with us,
but it's an uphill battle. I would love to see

(01:07:54):
an episode on the race, class, gender politics of volunteerism
one day. Thank you again for all you do you
and for thinking of us in the nonprofit sector. Well, actually,
thank you for all that you do and UM that
episode suggestion on volunteerism is a terrific one. UM, and listeners,
if you have thoughts experiences that you would like to

(01:08:17):
share with us, Mom stuff at how stuff works dot com.
Again is our email address. And Caroline, do you have
anything you want to plug of how people can get
in touch with you? Well, if you don't want to
tweet me at the Caroline herv, you can always go
over to my personal website at Caroline Irvan dot co.
Because I'm too cool for the m Caroline, too cool

(01:08:39):
for the m Irvin. That's right, that's what people call me.
Maybe that's the r L I'm gonna buy awfully long.
If you want to keep up with me, yeah, you
can find me on Twitter at Kristen Conger and you
can also go to tiny letter dot com slash Kristen
and that's Kristen c R I S T e N.

(01:09:01):
I spell it because it's often misspelled, I understand. Um.
You can sign up there for a weekly newsletter I've
been doing, called the Do Better Dispatch. It's pretty cool
And if you are interested in learning more about stuff
Mom Never told you and want to find all of
our social media blogs, videos, and podcasts with our sources,

(01:09:21):
the one place to go for all of that is
stuff Mom Never told You dot com. For more on
this and thousands of other topics, visit how Stuff Works
dot com