← Turning Points: Navigating Mental Health
Turning Points: Navigating Mental Health
Understanding Maternal Mental Health: Pregnancy & Postpartum | S3E4
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- [00:00]
Frances Leese
Hey, listeners, this episode talks about postpartum depression and as mention of suicide. If you're not in the right headspace right now for that sort of content, we'll see you again next week. You can also preview the episode content with the Transcript posted to globe.com turningpoints Jillian Amedillo says she has a lifelong struggle with anxiety and she has a passion for mental health.
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Jillian Amadeo
My name is Jillian Amadeo, and I.
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Am a mom of two children. I am a licensed social worker. I have wanted to be involved in the mental health field, gosh, since I was like five. A lot of kids are playing doctor and I'm playing therapist.
- [00:50]
Frances Leese
But when she gave birth to her first child, something shifted for her.
- [00:54]
Jillian Amadeo
The second my daughter was born, I had this wave of panic. The first person I looked at was my mom, and I said, is she supposed to look that way?
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Frances Leese
Though she was reassured her baby was happy and healthy, she couldn't shake the feelings of panic and anxiety.
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Jillian Amadeo
I couldn't get myself to believe that something wasn't wrong with her. There was no evidence to support the.
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Fact that something was wrong with her.
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But immediately I was like, something's wrong with my baby. Something is not right. What I came to realize later was that something was not right with me.
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I had felt this overwhelming sense of.
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Dread, this overwhelming sense of anxiety and fear and inadequacy.
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Frances Leese
Our mental health before, during, and after pregnancy can shift in surprising and dramatic ways.
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Jillian Amadeo
You have the commercials where everything is in this soft glow and the baby's peaceful and mom and dad are all smiled and real life doesn't look that way.
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I mean, childbirth is raw and real. Pregnancy is raw and real, and the.
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Infancy is raw and real.
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And there's so much support that is.
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Offered to the baby.
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There's not a lot of support that.
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Is offered to the mom. And the baby is not the only life that is being born. The life of the mother is being born or reborn if she's having more.
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Than one child over and over again. And she's new to this world as well.
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And it's important to love her and care for her and provide for her emotionally and physically. And I just really think our society does not do a great job of that.
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Frances Leese
Supporting the mental health of those who have given birth is what we're exploring. This week on the podcast, I talked to a patient advocate, a doula, and a reproductive psychologist on the many ways birth can shake our mental health. What can cause postpartum depression, anxiety, ocd, and psychosis? Who can you turn to for Help and support to pull you out of what can be a frightening experience. What happens when the doctor's office itself causes even more anxiety? This is the Turningpoints podcast, a show about navigating mental health, Sponsored by by Point32Health. I'm your host, Frances Leese. Now back to the hospital room, where Jillian's experience with postpartum depression and anxiety started to take shape.
- [03:26]
Jillian Amadeo
I remember, you know, a lot of people saying, the moment you hold your baby, it's gonna be like, all is right in the world, and you're gonna have this revelation that this is what you were meant to do. And I had the complete opposite. I was sobbing, but they were not tears of joy. They were tears of anguish, and they were tears of grief.
- [03:40]
Frances Leese
When she and her husband took the baby home, this shift became even more apparent.
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Jillian Amadeo
I was not well. I was not the same person.
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I cried a lot. I remember the first day I took the baby out of the house was maybe two weeks after she was born. I kept the curtains drawn. I kind of just hid in my house with the baby. And I walked out of my house, and I went to get the baby stroller out of my car. And when I opened the trunk of my car, her head wobbled. I didn't hit her head.
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She didn't fall. Nothing happened. Her head just wobbled, because that's what newborns do.
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But I convinced myself this was further proof I wasn't supporting my baby right. I wasn't taking care of her. So I sat down on the curb and I sobbed. And a jogger happened to pass by, and he came over and sat down next to me, and he said, you seem really upset. What can I do to help? And I said, I don't know. I'm just not supposed to be her mom. I don't know what to do. It was just a big emotional and physical kind of rollercoaster ride.
- [04:43]
Frances Leese
Jillian's anxiety latched onto every little thing and told her that she was not fit to be a mother. Postpartum mental health challenges can look different for everyone. And it's not rare to feel moody during this time of Life. Up to 85% of people experience a mood disturbance after giving birth. And between 10 to 15% of people experience more intense symptoms of anxiety and depression. To understand how we can recognize the symptoms of postpartum disorders, I brought in the experts. First, we have Dr. Shari Luskin.
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Dr. Shari Luskin
I'm a reproductive psychiatrist. I'm a clinical professor of psychiatry and obstetrics and gynecology at the Icahn School of Medicine at Mount Sinai in New York City.
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Frances Leese
And we have Ebony Harvey.
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Ebony Harvey
I'm a registered nurse, a holistic health and wellness coach doula, and I'm also a student nurse practitioner with a focus on women's health. As a holistic health coach and a maternal wellness advocate, I'm just extremely dedicated to helping expecting parents and people who are trying to conceive and literally anyone who's looking to improve their overall health from providing prenatal education, maternal health information, just offering support and guidance.
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Frances Leese
Shari and Ebony help people at various stages of their pregnancy or birth journeys.
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Dr. Shari Luskin
Some people find me online doing a search for reproductive psychiatrists or women's mental health or depression and pregnancy or medication in pregnancy. Other people come to me through their ob GYN providers who refer them either pre pregnancy, during pregnancy or postpartum doulas. And lactation consultants are sometimes the first to identify that there's a problem. So I'll see people at very different stages of the pregnancy process or the childbearing process. I also see patients who come to me for any sort of mood changes that occur within the reproductive life cycle. So I see women who have premenstrual mood changes, and that's important because if you had premenstrual mood changes, you're at higher risk for depression in pregnancy and postpartum.
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Ebony Harvey
As a doula, you are there to support the person before pregnancy and then you're supporting them throughout their pregnancy at labor. So you have an in person support person and then post birth you're there to talk with them, provide them with information, extra education. You can also provide a support person who can accompany them to their prenatal visits and anything they may need. Because oftentimes a prenatal Visit may be 15 to 20 minutes, but they have something going on at home that they just really need to talk about or to discuss and just need someone to listen. So often you're providing a lot of emotional support, but you provide also that physical in person support. It's almost like having a friend to just kind of hold your hand along the way.
- [07:33]
Frances Leese
To understand what postpartum depression and anxiety actually are, we need to understand what they are not. For Jillian, she got misdiagnosed as having the baby blues at first.
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Jillian Amadeo
I remember calling my doctor with my first child sobbing and saying, I can't stop crying and I don't know what to do. And they said, well, it's just the baby blues. You'll get over it. We'll talk about it at our six week appointment. Okay, fine.
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So I go into the office at six weeks and am I still crying? Absolutely.
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Frances Leese
So what are the baby blues?
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Dr. Shari Luskin
You have seen the range of postpartum mood changes from baby blues, which is mild, affects 70 to 80% of women who've given birth and gets better on its own within one to two weeks.
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Ebony Harvey
A friend of mine, she had two kids, a boy and a girl. They tried for another. She ended up being pregnant with twins. So overnight she went from two babies to four babies. Even though she already had kids before, it's still an adjustment. And I don't think everyone understands that. Every pregnancy, every child, everything is very different. And she would always feel a lot of loneliness and sadness whenever someone wasn't around her. She didn't feel like she wanted to hurt herself or her children. She just felt like loneliness. She would be a little tearful, but it lasted for probably like one to three weeks. By the third week, she had resolved and she was feeling a lot better.
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Frances Leese
But baby blues are not to be confused by the more serious postpartum mental imbalances that require specialized attention and support.
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Ebony Harvey
Postpartum depression usually lasts a little bit longer, and the symptoms can be more severe. They no longer can take care of themselves or their child. They may start feeling hopeless, helpless feelings, feeling that they want to hurt themselves or their child.
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Dr. Shari Luskin
10 to 15% of women have a clinically diagnosed postpartum depression. If a patient has depression, they're definitely at risk of suicide, but they're not at risk of infanticide. That is usually associated with the more severe and much more rare form of postpartum psychiatric illness, which is postpartum psychosis that affects between one to two per thousand women who've delivered the opposite end.
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Ebony Harvey
Of the spectrum, the postpartum psychosis. It can become so severe as a case that I know that a young woman locked herself in her room because the voices were telling her to harm her child.
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Dr. Shari Luskin
There's another situation where people are afraid to tell anybody about the thoughts they're having, and that's postpartum obsessive compulsive disorder. So there's a difference between people who have a longstanding history of obsessive compulsive disorder, which predates pregnancy, and women who have no history of OCD but develop obsessive thoughts after they give birth. It may affect up to 40% of new parents because it can happen to the partner also. But we'll just concentrate on the birthing parent for the moment. One thing that can happen is that the patient has ideas that they might accidentally harm the baby, a classic one is they look at the microwave and say, oh my God, what if I put the baby in the microwave? Now these are thoughts that the patient identifies as being illogical and intrusive and what we call ego dystonic. So it's different from patients hearing voices to harm the baby. In that situation, the patient doesn't necessarily recognize that the thoughts they're having are illogical. So when postpartum ocd, the patient knows something is wrong, but they're afraid if they tell you that, that you're going to call child protective services.
- [11:26]
Frances Leese
So how do we get help? Medication can offer relief for many people.
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Dr. Shari Luskin
So the vast majority of medications we use in psychiatry today have a lot of reproductive safety data available, which reassures us that they will not cause any sort of toxicity to the developing baby. Do not stop your medication. Have a consultation with a psychiatrist who's familiar with these issues and make a decision together with that doctor and your OBGYN provider so that you don't go off your medicine and risk a relapse during pregnancy. But if you're on the right drug for the right condition at the right dose, usually it's right to continue the medication and adjust as needed.
- [12:17]
Frances Leese
The FDA recently approved the first medication specifically for postpartum depression. The medication promises to relieve symptoms within three days, which is weeks faster than traditional SSRIs. Establishing a relationship with a doctor or healthcare provider can help you navigate all of the ways you can find support and relief.
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Dr. Shari Luskin
I'd say the first place to start is with your obstetrical provider, whether it's a midwife or an obgyn, because they should have some sort of a network of people they work with, who they trust. And then you can go see that person and see if you click with that person. Now, another resource you can access is an organization like Postpartum Postpartum Support International that's become the leading advocacy group for women with perinatal psychiatric disorders. And there's an abbreviation that some people use called pmad, which is pregnancy Related mood and anxiety disorders. Psi. Postpartum Support International has a network of state and local organizations that feed into it and they maintain a list of providers. It's a matter of finding somebody with whom you click good at what they do, and by the way, good at what you do is a combination of knowing what you know and knowing what you don't know. And again, an educated consumer is our best customer. So whoever you see, don't be afraid.
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Ebony Harvey
To speak up for all providers who are offering Resources. The resources really needs to be as culturally competent and inclusive as possible, because you can recommend all the resources, but if they're not connecting with me, if they don't understand the culture, the language, not saying that you have to speak the language, but it could be something as simple as body language. If I talk with my hand and I ask a lot of questions, it doesn't mean that I'm aggressive, right? It just means that I talk with my hands and I ask a lot of questions. So that's very important. And just understanding language and how different people talk and how they approach mental illness, because a lot of cultures is such a stigma and they don't know how to approach and they don't know what to say. But if the resource that you offer them is a good resource, is someone that can understand their cultural background or their ethnicity, then they would be more comfortable saying, hey, this is what I'm feeling. There are plenty of times that people won't say anything directly to their ob, or they'll tell them. They'll say, well, I'm not sure how I feel, or I'm kind of nervous to go home. And I'm like, let them know exactly how you're feeling. Just say those exact words. Those aren't scary words. Those are common words. And they can understand those things. Because people feel a lot more comfortable when the resources are helpful or they're inclusive or culturally competent, because not everyone gets it.
- [15:06]
Frances Leese
So what happens when going to the doctor's offices feels intimidating or frightening? This could be because of racial or gender dynamics in addition to compounding mental health concerns. When Jillian took her newborn to the standard six week appointment, her medical providers screened her for postpartum conditions.
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Jillian Amadeo
And they give you this piece of paper and, you know, it asks you all these questions. Are you having thoughts of self harm? Are you having thoughts of harming your child? Are you crying often? Like all of these questions, and the.
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More I thought about it, I'm like.
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Well, what happens if I check yes? Do they take my baby away? Do they put me away? Like, what happens? I don't know. And I asked, what happens if people check yes to these questions? And they just said, it depends.
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And I was like, okay, well, depends on what? I don't know. So I'm not gonna answer honestly. With my first child, I really hid it.
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I was ashamed. What kind of mother feels that way?
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What kind of mother feels like she shouldn't be the mother of her child? What kind of mother feels like there's something wrong with their baby? What kind of mother is not overwhelmed with love and gratitude and instead overwhelmed with fear and anxiety and worry and grief? So I hid it for a really long time.
- [16:18]
Frances Leese
These doctor's appointments can feel intimidating. The stakes around bringing a baby into the world can feel high. There are all sorts of cultural reasons why patients can feel uncomfortable in the doctor's office, too, before the baby is even born. Black women are almost three times more likely than white women to die in childbirth, according to the cdc.
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Ebony Harvey
Most black people are like people of color and people that have called me, they're always so afraid to say exactly how they feel because they are afraid that someone would take their child away. I feel like when people get pregnant, they have another level of sensitivity, they have another level of fear. Because what I've seen most often is when someone objects or they have a different opinion. The words that are used are, well, you want to protect your baby, right? You want to make sure your baby's safe, right? You want to do what's best for your baby, right? So that can kind of take them into a different frame of mind of, okay, well, I have to do this because I want to keep my baby safe. Of course they want to keep their baby safe, but they may still have questions, and that can do something to you. Mentally, you feel uncomfortable in your heart and your gut about what they're telling you to do, but you're still going against what you want to do because you want to do what they say do because you want to keep your baby safe. It's such a mental fight for people who are pregnant. And imagine this fight throughout your pregnancy. This is consistent, terrible. I think that's something to think about.
- [17:45]
Dr. Shari Luskin
As providers, I have always found that the skill that doulas bring to the mix for the patient is the ability to listen, really listen, and facilitate communication with the various healthcare providers. And that is so, so important. And you have patients who just are afraid to speak up. And doulas have been great advocates for them. Wanting somebody there who can say to the nurse or the ob, hey, this patient needs pain medication at this point is really important.
- [18:20]
Ebony Harvey
We have a whole entire session prior to their visit and then after their visit to debrief. Because most people don't want to say anything. They don't want to ask questions, not to mention body language. Like, doctors get up and they start walking towards the door as they're still asking them questions. Doctors are so busy now, they have about 15 minutes per patient, but sometimes it can be even shortened. So they're trying to get in, get out, and they're kind of like out the door.
- [18:42]
Frances Leese
Doulas can be a fantastic advocate. You can bring a trusted friend, family member, or partner into the room too. Getting overwhelmed with all of the things you're dealing with, especially at such a vulnerable point in your life, makes a lot of sense, but you still shouldn't do it alone. Reaching out for the support of family, friends, and others experiencing similar mental health struggles can bring relief as well. When Jillian had her second child a few years later, her postpartum depression and anxiety continued to worsen. Heads up. We'll be talking about suicidal ideation. If you prefer not to hear these details, Please skip ahead 60 seconds.
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Jillian Amadeo
With my second. The depression side was much worse than the anxiety side was, and I couldn't.
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Hide it because I had an intense.
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Desire to self harm.
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I had an intense desire to end my life. I wrote a plan on the things I needed to do to make sure that my children were taken care of, my husband was taken care of, everything was lined up so that I could take my own life. Because the only way my children would have any chance in this world is if I was not in it. That was when I knew I really needed to do something.
- [19:55]
Frances Leese
She started to open up to her medical provider and family.
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Jillian Amadeo
The second time around, I felt more.
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Comfortable with my provider.
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So I did tell them that I was feeling suicidal. I only had thoughts of harming myself.
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That they would be better off without.
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Me, you know, and they told me to go make an appointment with a psychiatrist, make an appointment with a therapist. Honestly, at first it was just so.
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Overwhelming to even make that phone call though. So I really confided in my husband. I really let him know how deep and dark my thoughts were getting.
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And it scared him. He was very scared. And it's intensely terrifying. They don't want to lose you. So my husband really started to kind of support me. And a lot of check ins, a.
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Lot of, you know, how are you feeling? And I want you to be honest. I'm not going to say anything or do anything.
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I just need you to be honest. My sisters, I have two sisters. And one of my sisters would call it your stupid mental health check. She would text me and be like, it's just your stupid mental health check. Just asking how you're doing. And just that little bit of humor was like, you know what this is like. There is a level of comedy to this. My older sister would come by and hold the baby or sit with me. I had some really great friends who.
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I would call in my worst moments.
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And they wouldn't offer advice, they wouldn't offer solutions. They would just offer validation and they would just offer support. Just the validation and just hearing me and not being judged for it. Saying these awful thoughts out loud and just being met with compassion was so healing.
- [21:26]
Frances Leese
Jillian also started working with a therapist. She then began reaching out to her community in Maryland to connect with other moms like her.
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Jillian Amadeo
I was just struggling and I just wanted to meet for coffee once a week with a few people, you know.
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And I just posted, I don't know.
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On a mom's group or something, was like, I'm struggling with some mental health stuff. I just really could use some like minded people, some people who understand. Does anyone want to meet for coffee once a week, once a month?
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And the post got something like 60.
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Comments in like an hour. And I was like, oh my gosh, there's like a lot of people.
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So we created just an event and.
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A few of us met up for coffee.
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And then within a month, I just.
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Created a Facebook group just so we could have a space to talk.
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And that grew to 600 people in a week, 1,000 people in a month, 3,000 in a year, and we're up to, I think 5,000. But it really just showed how much we just need support and there is no judgment in that group.
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Frances Leese
The group is active, running strong online, and is named Moms for Mental Health. Jillian also advocates for policy change. She actively supported passing laws for suicide prevention and mental health days in schools.
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Jillian Amadeo
Moms, societally speaking, are kind of the emotional caretakers, the emotional healers for so many people. We tend to be the first line of defense for our children. We tend to be the first line of defense for aging parents, first line of defense for neighbors who are going through a rough time. We're the ones bringing dinner and checking by. We're the ones who rally and step up. And I kind of just had this thought of like, well, what happens if we step up for each other? Because oftentimes the last person a mom takes care of is herself. But what if together as a group of moms, we take care of each other? And it kind of just unfolded really organically. Moms have a deep desire to help and nurture and care for. And in caring for other people, we ended up caring for ourselves because we're healing our own hurt and we're healing our own traumas and we're healing our own uncertainties about what is it like to not be okay. So by creating a network of moms who are there to support each other. We pick up the slack where it's needed. And if we're having a great day and someone else is having a bad day, we support them. But then when it's our turn, when we're having a bad day, someone else is right behind us to pick us back up. So together we're a super mom. But it's taking a big community to make that happen.
- [23:56]
Frances Leese
I asked Jillian what she wished people knew about postpartum depression and anxiety.
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Jillian Amadeo
I really just wish that people would tell you that childbirth and parenting can be really ugly. Not everyone will experience maternal mental health struggles, but it is a very real possibility. And I just want everyone to know that it is common, it is treatable, it is not shameful. So just be ready and just be prepared. It's important that those who are caring for people with maternal mental health struggles or those who might be at risk for maternal mental health struggles, that they just know what are the warning signs? What are the risks? Who in my community is available to help? What's my first line of defense? And your first line of defense might be your OB gyn, It might be the nurse at your OB gyn, it might be your neighbor next door, it.
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Might be your mom or your mother in law.
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But just know, know who that support system is and just keep everyone in the loop. And if everything goes great and everything goes smoothly and you know you don't need any support, which you do need support, you still need meals and back rubs and cups of coffee, you still need those. But if you don't need any additional support in terms of mental health help, that's great. But if you do, hopefully you'll be ready for that.
- [25:23]
Frances Leese
Ebony Harvey has words of wisdom to both the patient and the provider.
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Ebony Harvey
To the providers, please. If you are treating people who are pregnant and they are on medication or antidepressant medications and you are not familiar, please do not keep those patients. Please, please refer those patients because they need to be with someone who truly knows the medications and can balance and regulate and manage and adjust as needed throughout the pregnancy, please. Because a lot of providers do not refer. Secondly, I would just like to tell any person who is pregnant or thinking of becoming pregnant to understand that, yes, there's a lot going on, there's a lot of things that you hear, but to do the best that you can to drown out the noise and filter and just get the correct information and be as open as you can, as flexible as you can, and be as honest about how you feel as you can and understand that your voice matters. And I want people to know this is your body and this is your baby. So please speak up. Please.
- [26:28]
Frances Leese
Dr. Shari Luskin will wrap us up.
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Dr. Shari Luskin
Healthcare providers are people too. They bring their prejudices, their biases to the table. It's okay to ask questions. In fact, it's essential. My dad was a surgeon, an orthopedic surgeon. So he used to say, when all else fails, examine the patient. And if that doesn't work, try talking to them. And I add, and if that doesn't work, try listening to them. Your voice matters. Use it and that will help get you the best outcome for you and your baby.
- [27:13]
Frances Leese
If you're experiencing a postpartum condition, I hope this episode gave you even more reasons to offer yourself some love and compassion. You can find more stories and resources@globe.com maternalhealth we covered a lot of great wisdom and received some powerful advice this week. Firstly, find someone you trust to talk to. Maybe that's your partner, a neighbor, a medical provider, or a therapist. You could even start by sending that friend a link to this episode. But don't keep these thoughts to yourself. You deserve to be validated and heard, especially during this difficult time. Make it a priority to connect with a medical provider. Reproductive psychiatrists specialize in postpartum conditions and there are medication options that don't harm the baby if you choose to breastfeed. And lastly, find that support system. Perhaps, like Jillian, you can meet up with other parents in the area to talk about the ups and downs of mental health and motherhood. You're never alone on your mental health journey. Find your people. Thank you so much for listening. Join us Next week we'll have a brand new episode with an honest conversation about destigmatizing medication and your mental health journey.
- [28:43]
Unknown Guest
So it's one thing with the stigma because the more I talk, the more I feel less alone. I'll have so many people be like, that's the exact same thing that happened to me. And the same thing with the medications. You kind of hear all these horror stories, but once you actually start to share what has happened, like with individual people, you'll find so many connections and be like, oh wow. And now I'm learning for them. They're learning from me.
- [29:06]
Frances Leese
If you found this episode helpful or meaningful, please leave us a rating review or even tell a friend about the show. It really helps get the word out. Follow Turning Points wherever you listen to podcasts so you never miss an episode. Visit globe.com turningpoints for more information on mental health care and resources. Thanks to our production team at Pod People, Ann Fuse, Amy Machado, Brian Rivers, Danielle Roth, Shay Waditz and Adam Raymonda. And Special thanks to Point 32 Health, the Studio B team at Boston Globe Media and hill holiday. Point 32 Health is committed to connecting the community to personalized solutions that empower healthier living.