Coping Strategies for New Mothers Facing Postpartum Challenges

Navigating Maternal Mental Health: Insights on Postpartum Anxiety and Depression

Welcome to the latest episode of the Heal Your Roots Podcast! In this episode, we dive deep into the complex world of maternal mental health, exploring crucial topics like postpartum anxiety and depression. Our discussion covers a range of vital issues, from the impact of social media on raising awareness to distinguishing between baby blues and more severe mood disorders.

Timestamps:
[00:00] - Introduction: Understanding Maternal Mental Health and Social Media's Role
[03:31] - Differentiating Postpartum Anxiety and Depression from Baby Blues
[07:51] - Recognizing Symptoms, Risk Factors, and Treatment for Postpartum Mood Disorders
[16:10] - Perinatal Mood Disorders in Women of Color: Risk Factors and Relationship Impact
[24:34] - Postpartum Depression and Attachment: Bonding with Your Baby
[29:24] - Navigating Postpartum Depression and Generational Differences
[35:30] - Effective Treatment Options for Postpartum Depression
[40:02] - Coping Strategies for New Mothers: Embracing Self-Compassion

Key Takeaways:

• Maternal Mental Health Awareness: Discover how social media can promote honest discussions about motherhood and mental health.
• Postpartum Challenges: Learn the differences between postpartum anxiety, depression, and baby blues.
• Identifying Symptoms: Understand the key symptoms of postpartum mood disorders and when to seek professional help.
• Cultural Competency: Address the unique challenges faced by women of color and the importance of culturally competent care.
• Attachment and Bonding: Explore strategies to strengthen the bond with your baby, even when facing postpartum depression.
• Generational Insights: Navigate the impact of unsolicited advice and generational differences in parenting.
• Treatment and Support: Review effective treatment options, including therapy, support groups, and medication.
• Coping Mechanisms: Embrace coping strategies to manage stress and anxiety as a new mother.

Join us for an enlightening conversation that aims to provide support, raise awareness, and empower mothers on their journey through postpartum mental health. Don't forget to like, share, and subscribe for more insightful episodes!

Learn more on our website at https://bit.ly/HYRP-Strategies-for-mothers

Disclaimer: This episode is for informational purposes only and is not a substitute for professional therapy. 

#MaternalMentalHealth #PostpartumDepression #PostpartumAnxiety #Motherhood #MentalHealthAwareness #HealYourRootsPodcast #CopingStrategies #Parenting #MentalHealthSupport #NewMoms

Transcript

Dr. Brianna Bliss: 0:00

postpartum anxiety and depression is pretty common. Like, I think it's like one in five or one in sevens, women something like that span

Dr. Spencer Brown: 0:10

is one in five. I do think social media has done a really good job of giving moms that opportunity to really talk about the hardships that comes with being a mom, whereas I feel like older generations made it like, oh, it's rainbows and sunshine and butterflies, and it's just the most beautiful thing. And a lot of ways it is and in a lot of ways, it's not. And so I feel like our generation is doing a good job of like, No, this is what it is, you know, you're gonna be tired, you're gonna be sleep deprived, is not always rainbows and butterflies. And so I do think that social media has given women the opportunity to really be like, kinda like brutally honest and give other women a heads up about what this really looks like.

Dr. Katie Manganello: 0:57

Welcome back to the Heal Your Roots Podcast. I'm Dr. Katie Manganello. And in light of may being Maternal Mental Health Awareness Month, I have Dr. Spencer Brown and Dr. Brianna Bliss, who are licensed clinical psychologists that specialize in maternal mental health here with me today. So, welcome. Thank you. Yeah, yeah, I'm so excited to have you guys here. They're also some of my, my friends on top of my colleagues that we went to grad school together. So this is really fun being able to include them in on this conversation, and for them to share their wealth of knowledge with us on this. So before we get into it, can you guys both just tell me a little bit about what kind of brought you into the field, not necessarily just the field of psychology, but also what kind of inspired you to do this type of work? Sure. I can start. So I think what originally sort of led me to, like perinatal mental health was my focus on my dissertation.

Dr. Spencer Brown: 2:00

So that's when I really started to look into women's health, my dissertation focused on female infertility, stigma, that cognitive distortions, and coping responses. And so once I really started to get into that, I was like, hmm, this might be a really good field a really good niche for me to kind of explore. So that led me to my internship, which led me to my postdoc, which then led me to my full time job right now. And so that's kind of like the trajectory of how I kind of got into the field was really essentially my dissertation topic. Yeah.

Dr. Katie Manganello: 2:38

And what kind of brought you to choose that topic again, like was there anything in particular that kind of like happened that sparked that?

Dr. Spencer Brown: 2:45

Yeah, so it was during the time when The Handmaid's Tale was on TV, oh,

Dr. Katie Manganello: 2:50

my gosh, yes, I remember this now. So literally, I

Dr. Spencer Brown: 2:54

was just kind of like laying in bed. And I was thinking about, like, what do I want to do for my dissertation topic, and I just remember everybody saying, you don't want to pick something that's going to be boring because you'd have to like sit with it for like a year or a year and a half. And I kind of already knew the foundation was going to be something related to like women's health. I didn't know what and then I was watching The Handmaid's Tale and I was like, infertility. You know, I think that would be like something that I would want to explore more and get into more. And so that's kind of how it kind of led me to it. And I also read the book in high school. So I had a good foundation for it.

Dr. Brianna Bliss: 3:31

I didn't know that. I didn't either. Awesome.

Dr. Katie Manganello: 3:36

Yeah, actually, I didn't even know there was a book. I thought it was just the show.

Dr. Spencer Brown: 3:41

Margaret Atwood is the Arthur.

Dr. Katie Manganello: 3:45

Awesome. Okay, and what about you Dr. Bliss? So

Dr. Brianna Bliss: 3:50

I am a pediatric psychologist. And so I work in primary care with little kiddos, zero to 21. So I see the whole the whole pediatric lifespan actually. And I'm in a pediatricians office and where I work now I have over the past two years or so been starting to work with the younger, you know, zero to five kids. And obviously with that comes parents and moms. And so I kind of stumbled into perinatal mental health through seeing little kids and what happens in primary care sometimes is moms are screened for depression or for you know, any other stressors or family stress. And so, I love to see like newborns and when the moms you know, first have the babies and so I can work with them then or any of the caregivers really so I kind of stumbled To perinatal mental health through my work in pediatrics, and I also do a group, a prenatal group for pregnant people currently focused on the fourth trimester and newborn development. So mostly seeing kids but have been working with perinatal population through my work in pediatrics. That's

Dr. Katie Manganello: 5:28

awesome. Isn't it interesting how we just kind of like stumbled into what we're doing. It's not just like, This is what I'm gonna do. And here we are, right. So that's really cool. I

Dr. Spencer Brown: 5:38

feel like that's my life. I feel like I kind of just stumbled into things. It just kind of happens that way. So I just, yeah.

Dr. Brianna Bliss: 5:47

Yeah. Never, I never really thought I'd be going into this kind of direction. But especially in primary care. It's all like preventative mental health. So it's like, if you're gonna see a two year old or a three year old, then why not just start seeing the mom to like, as early as possible. So just kind of happens that way. Right. And

Dr. Katie Manganello: 6:10

a lot of working with children is working with parents. So yeah, that makes sense. Definitely.

Dr. Brianna Bliss: 6:15

Sure.

Dr. Spencer Brown: 6:16

God bless you, because kids want to work with the moms.

Dr. Brianna Bliss: 6:23

It's fun. There's never a dull moment. They keep you on your toes. I know you fellas.

Dr. Katie Manganello: 6:33

Well, so with that being said, and knowing that you both work with this, so how would you define postpartum anxiety and depression? And how would you kind of differentiate that from like a typical just like baby blues.

Dr. Spencer Brown: 6:49

So typically, with like the baby blues, just want to kind of like prefaces that the baby blues are extremely common. About 85, up to about 85% of women will experience the baby blues. So this is essentially, you know, feeling sad, feeling overwhelmed, feeling anxious, during the first two to three weeks postpartum. If those symptoms do not start to decrease, but rather like increase or kind of like stay the same, after that three week mark, then that's when we will be concerned about postpartum depression. So I always tell my moms that when they are pregnant, and kind of like, brace them for that, because it's extremely common. And I'm always like, just because you're crying at the drop of a dime, you're feeling overwhelmed or anxious. And the first two to three weeks, that does not mean you have postpartum depression, you are in the baby blues phase. So I always kind of give that sort of like, caveat, in the beginning, yeah. And

Dr. Brianna Bliss: 7:51

also with that, like, that happens because of the drop in hormones, right. So like, right after your, you know, your body during pregnancy is developing all these other different hormones that you don't typically have, and then you deliver, you give birth, and drastically we see this drop in hormones. And that's why there are natural consequences or mood changes within those two to three weeks. So totally normal to feel that most people do feel that, and it's for us, but cific reason. But like, you know, Dr. Brown said, if that continues past three weeks, then you want to talk to like your OBGYN or your doctor or someone, you know, to get more support. And

Dr. Spencer Brown: 8:39

I will say most OBGYN are screaming at the six week, checkup postpartum. So I do I do feel like that is something that has been really helpful. And and that's how we kind of get involved, as like perinatal psychologists, is that like an OBGYN will, you know, send a referral to us or the birthing mother will reach out to us? Because maybe she had like an elevated screening? for depression?

Dr. Brianna Bliss: 9:07

Yeah. Which is why it's super important to go to your six week postpartum visit. Yeah, I know, like, sometimes moms, it's overwhelming, and you put yourself on the back burner. And you feel like you have a ton of pediatric appointments because you're you have a newborn and so you're going to all your babies appointments, which is fair, but also you still you know, need to take care of yourself because that's the best way to help your baby. And so it's really important to go to six week checkup for just a variety of reasons to make sure like you're doing okay, health wise and talking about your labor and delivery and, but also if there are emotional concerns, that could be a really good time to get screened and to talk to someone and maybe get connected to mental health treatment and get more support. Yep, definitely.

Dr. Katie Manganello: 10:00

So as it relates to that timeline, so you had said that the first like, you know, so many weeks it's common, it's more baby blues. Once it hits that point, then it's considered postpartum. When is it no longer if it if the symptoms persist? When is it no longer considered postpartum? And it's considered depression anxiety unrelated? Or is it something that kind of can last for a pretty long time after birth?

Dr. Spencer Brown: 10:27

It really depends. A lot of people go by the one year mark. So in terms of one year postpartum is typically when we kind of say like, postpartum depression ends, but really, it really just depends on the woman and the symptoms of it. But typically, it's up to a year postpartum, we will call it postpartum depression.

Dr. Katie Manganello: 10:51

Okay. And so what are some of the common symptoms of postpartum anxiety and depression? And you know, more specifically, how is it different? How does it show up differently from other types of anxiety or depression

Dr. Brianna Bliss: 11:12

or you go ahead.

Dr. Spencer Brown: 11:14

So obviously, in terms of like depression, so it really is kind of very similar in terms of the symptoms of just classic depression and postpartum depression. So obviously, feeling really sad feeling tear for like, we'd be low motivation, lack of interest, not engaging with other people, but also not wanting to engage with the baby. That's like a big one. Classic, like, lack of sleep is a really big common symptom, obviously, because baby may not be sleeping, you're up at night. A lot of times, it's co occurring with anxiety, particularly with sleep, because mom may be very anxious about nighttime, having to watch baby feeling like she needs to always have her eyes on the baby at night because of different risks that happened at nighttime and sleep. And so those are some of the common ones. And then, of course, suicidal thoughts, paths or thoughts to harm yourself. I tend to see that related to when the mom is feeling like inadequate in some way or feeling like she's not being a good mom. And so then having those feelings of wanting to escape, or run away, because she's feeling like she's not being a good mom or feels inadequate.

Dr. Katie Manganello: 12:37

So it sounds like they're more I mean, it's the same kind of symptoms, but more so just focus on the baby and her mother

Dr. Spencer Brown: 12:45

and a mother. Yeah. Yeah. Okay.

Dr. Katie Manganello: 12:51

Free. Did you want to add anything to that? Oh,

Dr. Brianna Bliss: 12:53

no, if you said also like irritability, feelings of anger, right, that could look like you know, both depression and anxiety. But yeah, basically, similar symptoms, loss of interest and doing things that you wants us to like to do, right. But more so because of, you know, this experience of having a baby and caring for the baby. And anxiety tends to be like all about the baby. Yeah.

Dr. Spencer Brown: 13:26

Like worrying about the baby. Just having those anxious feelings, feeling overwhelmed. Sometimes panic attacks can occur in postpartum period because of anxiety. So yeah.

Dr. Katie Manganello: 13:40

Right. And I think that that it might be hard for someone to know if they're experiencing this or not, without going to these appointments or supposed to be going to because it's normal, like you said, the beginning like, to an extent to be worrying about your baby, right? Like, it's now your job to keep your baby alive and, and to want to be a good mom and all of that kind of stuff. So that really does kind of highlight the importance of them going to those kinds of appointments. Yeah, yeah. Yeah. Okay. So, talk to me a little bit more to about what you know about risk factors, or, you know, is there certain family history that kind of influenced these things? Or are certain things that happened during birth, maybe that could be risk factors to, to these things?

Dr. Brianna Bliss: 14:35

So, I guess first of all, like, postpartum anxiety and depression is pretty common. Like, I think it's like one in five or one in seven women, something like that, then it's one

Dr. Spencer Brown: 14:48

in five. One in five will experience a perinatal mood or anxiety disorder of some sort. Yeah,

Dr. Brianna Bliss: 14:54

right. That's, that's pretty common. And so like, Other people might be wondering, well, how do I know if I'm going to be one in five? Or you know, what, what factors? What risk factors, you know, do I have that would make me more likely to experience postpartum mood disorder? I think, definitely family history, right. So if you have anyone in your family that has experienced depression or anxiety, or specifically also postpartum depression, or anxiety, if you yourself has have ever experienced anxiety or depression, that makes it more likely to experience that during pregnancy. There's a lot of like social factors too, right? So if you have limited social support, or maybe you know, not, you know, not the social support that you would like nearby, maybe friends or family are distant, that could be a factor, financial resources can be a really big factor, lacking financial resources. What are some of the other ones? That's really no,

Dr. Spencer Brown: 16:10

yeah. So in particular, like women of color are also at a higher rate of developing perinatal mood and anxiety disorders. Women of Color are two to three times more likely than white women to develop a PMS disorder, and three to four times more likely to die during childbirth. And so like risk factors are really huge. And so having that knowledge, and really kind of advocating for yourself getting more information, asking questions, is something that can really be helpful during pregnancy and postpartum

Dr. Katie Manganello: 16:48

as well. That is alarming. It is

Dr. Spencer Brown: 16:51

we're definitely in a crisis right now, in terms of this, right? And

Dr. Katie Manganello: 16:57

what do you do in your roles to advocate for that, and kind of, like, make changes around that? Because really, that is scary. I think a lot of people don't know that.

Dr. Spencer Brown: 17:06

So I think one of the biggest things is talking to like OBGYN and making sure that they're like culturally competent, and being sensitive, and really being aware of, you know, this information and being really supportive and an open to listening to women of color when they have questions, because a lot more women of color are aware of this. And I do think that that does play a role in like some of their hesitancy because even though this risk is really high, women of color, do not often seek treatment for this, whether that's because of like stigma, whether that is because of like fear of like providers. They're just like a multiple of multiple multitude of reasons why, and then also, specifically, like institutional racism, and things like that, obviously come up when we talk about this issue. So it can be a lot of different reasons.

Dr. Brianna Bliss: 18:09

Yeah, I was gonna say that speaks to like access of care, you know, like, I work in a predominantly low income area in New York City, and predominantly, like black and brown population. And so one of the things that we try to do is increase access to care for all those reasons that Spencer just share. Because of the stigma, because of you know, there's not where I work very low financial resources available to people. So trying to give people access through their OBGYN access to mental health services, screening groups, where they can learn about perinatal mood disorders and learn how to like, know, the signs for postpartum anxiety and depression know their risk factors so that they can have conversations with their doctors, if their doctors aren't asking them. They can bring that up and say, This is what I'm feeling like, this is what I need to talk about. So I think, yeah, all of that is really important to make sure we address.

Dr. Spencer Brown: 19:23

Yeah, and I also think having like providers of color, whether that's like OBGYN or therapist, psychologist, I think that can also reduce some hesitancy of bringing some of these hard conversations up this, if you can prepare, maybe with your therapist before, like, well, what should I say what questions you know, should I be asking, What should I look out for? I think all of that can be helpful as well.

Dr. Katie Manganello: 19:46

Yeah, absolutely. That makes sense. Yeah. And so in talking about these risk factors, and a lot of what you're saying that you do is giving people the education around the risk factors and blah, blah, blah. would come up? How do you feel like that helps from a, you know, prevention lens?

Dr. Brianna Bliss: 20:09

I think people like so knowing the difference between baby blues and and Perinatal mood disorders, sometimes in my experience, like, the women I've worked with, they're not, they're not really sure what the baby blues are, or how you know, if they have these risk factors to get a mood disorder. So just have giving them the tools to know what to look for. And what they might be feeling, I think is super important, because then they can advocate for themselves in a system that like, won't always help or advocate for them. So I think that's really important just to give them the knowledge and the education to know like, what I'm feeling and what I need to ask for. This is when I need more help, or this is okay, this is normal.

Dr. Spencer Brown: 21:01

Yeah, I echo everything Brad just said. And also just like with anything, the more knowledge you have, the more information you have, the better equipped you are to kind of face it or overcome barriers, because you kind of can know what to do and have more resources at your fingertips.

Dr. Katie Manganello: 21:20

Yeah, so it certainly sounds like it helps a lot in at least in healthcare, right. And that also just kind of is a segue for me thinking about how this impacts so many aspects of a woman's life or right, like it obviously impacts them in their health. But also, can you talk a little bit about how it impacts their relationships with people, their relationship with their baby, relationships with partners, family, all of that.

Dr. Spencer Brown: 21:53

I think one of the biggest things that I have seen come up and I was like, really not aware of this, when like just being just like a regular person. But becoming like a psychologist and working in this field is how often people do not talk about like gender roles within their relationship and like what that is going to look like when they have a child. And I think that is a big source of stress in our relationship. Like, am I going to be a stay at home? Mom? Am I going to be a working mom, if I'm going to stay at home? Is it my responsibility to take care of the child 24/7? And then what is my partner's role in that. And so I think gender roles is a really big issue and can be a role sort of like transition within itself becoming especially for first time parents, it can be like a really huge source of stress. Just kind of,

Dr. Katie Manganello: 22:53

like what are some examples of that I'm really curious about like, how that shows up. So

Dr. Spencer Brown: 22:59

like, for example, so let's just say the woman is like a stay at home mom, she may feel a lot of responsibility to be the one to take care of the baby 24/7 Because she's a stay at home moms. And typically, let's just say her husband is the one who goes to work. And so she may feel a lot of guilt or shame to have to get an x her husband to wake up in the middle of the night to get the baby because she's a stay at home mom, and her role is to take care of the child. And so I think having these conversations, you know, in pregnancy, or before you decide to have a child can definitely shed a light on to like so is this going to be really truly 5050? Or is this going to be more 6040 8020. And if you can decide that, you know, and everybody sort of like be somewhat okay with that it can reduce a lot of stress, because you might go into it thinking like, Oh, we're partners, and my husband is going to be in this 5050. But really, it may look more like 6040. And that's okay, as long as you can kind of prepare for that and plan for that kind of early on versus now we have a newborn and I'm up and I'm breastfeeding and I have to keep getting up and my husband is just sitting there snoring and sleeping. That causes a lot of resentment, and some anger, you know, sometimes because you're constantly the one waking up and quote unquote, responsible for the child. So that is something that I have seen come up so much. That's why I kind of wanted to just throw it out there.

Dr. Katie Manganello: 24:32

Yeah, no, that's a good example.

Dr. Brianna Bliss: 24:34

Yeah. So everyone you're saying everyone tried to like, put out there what the expectations are? Yeah. Originally and then.

Dr. Spencer Brown: 24:48

You can't like especially like, you know, like we're planning to get pregnant. That can definitely be something to kind of talk about like so. What are your expectation like? What do you think this is going to look like? Ya know, like when the baby comes, because often it doesn't look like what both of them thought originally. So you have you both are coming into it with expectations, regardless if you talk about it or not. But if you talk about it, at least you can prepare for it.

Dr. Brianna Bliss: 25:16

That's good advice. Thank you. I also, to answer your question to Katie, I wanted to talk about the mom baby relationship, like how that's impacted with attachment. Because that is a lot of what I talk about in my role at my job, too. There is a concept called serve and return. I don't know if you guys have heard of this concept. So it's kind of like a tennis match, you know, so compare it to that. So like with attachment and newborn babies, you think of like, the babies serving up, like a gesture, like a battle or a cry or something, and then the mom returning that serve. So like in tennis, you know, you hit it over, you hit it back, right, serve and return. And so when we talk about like, moms who are experiencing postpartum depression or anxiety, it can make it really hard to return that baby's battle or sort of bed for like attention or need or cry if mom is kind of experiencing her own emotions. So it's super important, because whenever we have that serve, and return interaction between mom and baby, or any caregiver and baby, the, it's like, so important for brain development. So the baby's brain is like, millions of neurons are firing, right. And it's learning so much in such a short period of time. And whenever there's like, you know, the baby laughs and the mom serves that back and laughs to that. Neurons are like going crazy firing. And they're making that bond and that connection together. So if we think about moms who are like, you know, struggling with depression, and not able to last with their baby, or pick their baby up when their baby's crying, because they're going through their own emotions, that could really impact the bond, of course, the attachment, but also the baby's, you know, the way the baby's brain is developing to, because they're really looking for that attention, and that secure attachment from the caregiver. So I think from like, neuron level, all the way up to like attachment. It's so important when we think about when moms have postpartum anxiety or depression, because it really can impact like, the baby's development and their secure attachment.

Dr. Spencer Brown: 27:56

Yeah, just piggybacking off of that really quick in terms of like the bond, I think there is a huge misconception that women have in terms of feeling like I'm going to be bonded to my baby, as soon as I see them. Like this is a huge misconception. And so when that bond is not there, it definitely leaves women to feel like inadequate, or like, there's something wrong with me, I don't feel bonded to this child. And so something that I like to tell my mom's kind of when that does happen is like, this is like any other normal relationship, like when you met your, your partner or your husband, you might not have you know, liked or loved him right away, it may have took, you know, some time, a couple of weeks. And so think of it like any other normal relationship, it may take time for that bond to really grow by baby loves you regardless. But you know, this is like any other relationship. And so give yourself that time to have that bond really, like flourish. And so like breastfeeding is a really good way to increase bonding time and skin to skin is a really good way to increase bonding and attachment. And specifically like in those early stages, but it may not happen right away like a lot of women think.

Dr. Brianna Bliss: 29:13

Yeah, that's such a good point. I feel like media, social media, it's all portrayed as like, you're just gonna instantly fall in love with your baby, right? Yeah, that's not always the case.

Dr. Spencer Brown: 29:27

I will say since we brought up social media that I do think social media has done a really good job of giving moms that opportunity to really talk about the hardships that comes with being a mom like if just following different women. A lot of women out there that are on social media are really like doing a good job of like talking about No, it's hard to be a mom like

Dr. Katie Manganello: 29:51

that's what I'm saying. Yeah.

Dr. Spencer Brown: 29:54

Yeah, I will say that I feel like Millennials like us and like Gen Z moms are really like doing a good job of telling the harsh truth about being a mob, whereas I feel like older generations made it like, oh, it's rainbows and sunshine and butterflies, and it's just the most beautiful thing. And a lot of ways it is, and in a lot of ways, it's not. And so I feel like our generation is doing a good job of like, No, this is what it is, you know, you're going to be tired, you're going to be sleep deprived, is not always rainbows and butterflies. And so I do think that social media has given women the opportunity to really be like, kind of like brutally honest and give other women a heads up about what this really looks like.

Dr. Katie Manganello: 30:38

Good points, I, you know, what I also am really curious about is, you know, we talk a lot about partners, and it may be even like, parents or the grandparents of the babies. And obviously, the relationship with the, the baby and the mom. But I'm really curious about how giving birth to maybe a second or third or whatever child impacts a relationship with the mom and their other children? Like, is that something you guys ever see? Or talk about with people? I don't know if that's really relevant to your work, but I'm curious about it.

Dr. Brianna Bliss: 31:11

Oh, yeah, for me in pediatrics, because sometimes, I'll be seeing like a two year old and they're jealous of a newborn baby. And, you know, parent, the parents can only do so much, you know, if the mom is one person. And so that does come up a lot. So sometimes, like, Well, how do I cope with this adjustment of having a second baby when the first one is not a fan. So we work, we work through that. And sometimes that means like, developing like special time with mom, and then materials like one on one so that they can still feel valued, and just other different strategies that we talked about. But that is very much a real thing. And it really just depends on your, your child, if they're going to have that reaction. Some kids are perfectly excited and like, take on a big brother or sister role, and it's great. So it really just depends.

Dr. Spencer Brown: 32:21

Yeah, I would say for me, in terms of like what I do, a lot of times women will have an expectation because they already have a first child and already had a first pregnancy and that pregnancy went really well. And then they get pregnant a second time. And it's not like that. And then so there's a lot of like comparisons of well, this experience was like this, but this experience is is not like that. And so, you know, really getting them to stop making those comparisons and letting them know like, you know, each pregnancy is going to be different and come with it different challenges. And each baby is going to be different and have different challenges. And so kind of setting that foundation

Dr. Katie Manganello: 33:05

can Yeah, that's a really good point. That's interesting, actually. Also, I want to circle back to because when I brought up for the relationships, I was talking about, like potentially, like grandparent relationships and stuff that you kind of giggle that I want to know what you were thinking. Yeah.

Dr. Spencer Brown: 33:23

In terms of like grandparents, so if it's the, let's just say it's the mom, and it's her parents a lot of times, and even even like mother in law's can give unsolicited advice, right. And so I think it can be really hard on the mom, particularly if it's a first pregnancy, when like, your mom is like, Oh, I have five kids, you only have one, it can be really hard to kind of like manage that it can feel very, like undermining in a sense of like, Well, what I'm going through is not hard enough, or I should be kind of like grateful innocence. So I think all again, like older generations, it can be you know, kind of like grin and bear it, you know, like, it's not that hard. And so it can really impact the postpartum period where you kind of feel like you're being judged or criticized, because you only have one child or two or two children. And the women, the older women in your life are like, Oh, kind of get over it. Or if they even don't even feel like postpartum depression exists. You know, you're, you're gonna feel tired, you're gonna feel, you know, maybe bad, like it's going to be okay. And so it again, kind of leaves the woman feeling like inadequate. So that can be hard. Yeah.

Dr. Brianna Bliss: 34:46

That's a good point, like, from generation to generation, right, as we've gotten more open about mental health and less stigmatized, although it still is but maybe grandparents don't They don't see postpartum anxiety or depression or they didn't. They didn't have that experience, or if they did, they weren't going to talk about or weren't aware of it. So that's a really different challenge for generationally to even, like, meet. Alright, I on that and understand what's going on there. Yeah,

Dr. Spencer Brown: 35:22

yeah. And malls and grandparents do come up a lot, especially mother in laws. But that's a different conversation. Yeah, I

Dr. Katie Manganello: 35:30

feel like we can have a podcast on that. Not even just the mother laws, but just like, parents have the new parents. Yeah. And like, cultural changes to, you know, it's not just generational incense in the sense of like, well, I'm a millennial in there or whatever. But also, just knowing that like, at least in America, this might be a really interesting dynamic, that's different. I don't know if it's different in other countries, but you know, a lot of our parents or grandparents are, you know, first generation second generation and the differences that kind of come with that. That's really, I think, an interesting thing. But you're right, that would probably be a whole other podcast, we should probably table that one.

Dr. Brianna Bliss: 36:14

That'll be next time. I have so many ideas.

Dr. Katie Manganello: 36:20

Send them over, you know, I get very excited about all the ideas too. But bringing it back to this one. So we already talked about how, like, let's talk about how we can help the new moms right, like, what are we going to do? So you talked a lot about psychoeducation, giving them information about all of this, the advocacy piece, and being able to have them advocate for themselves as well as your work and advocating? Tell me more a little bit about like, other treatment options, once it's established that okay, there is postpartum happening here, like, what kind of treatments do you use? What kind of treatment options are there? Like medication, individual therapy, support groups, maybe couples? Like those kinds of things?

Dr. Spencer Brown: 37:02

Yeah, so all those things that you name, I can't answer the question. More about them, though, like, what does it look like? Kind of like we said, like, so like, if we take it all the way back to the beginning, like screening tools, so then we get the referral, they meet with us. So obviously, we do like the intake and all of that. So essentially, if I see a woman for several sessions, and I feel like her symptoms are not really, you know, getting better or decreasing, then that's when I would have the conversation in terms of like medication. And so that will often say, you know, like, some people can do really well with just therapy alone. But a lot of people do really well with therapy and medication. And so then I talk to them a little bit about, like, how do they feel about medication, because one of the big sort of misconceptions is that when I'm pregnant, I have to come on all of my medication. And that is not accurate. It's important for a lot of times for women to stay on their medication, depending on what the medication is, I'm not a psychiatrist, by any means. But a lot of times when the woman comes off of all of her medications, we really see a drop in her mood, and then all of those symptoms really come back with a force during pregnancy. And so then they come to us, and they're really distressed. And then we have to then manage that and kind of say, Okay, let's get you back on your medication, because that was what was helping you during this time. And so I think that's a big piece of it. And then, if they've never been on medication before talking to them about how they feel about being on medication, a lot of times women don't want to start medication because of breastfeeding. And so then that's when I would send them to a perinatal psychologist who couldn't really ask psychiatrists, sorry, who couldn't really talk to them about what medications are really saved for breastfeeding. And I know just offhand a big one that a lot of perinatal psychiatrists recommended Zoloft, because it is pretty safe for breastfeeding.

Dr. Katie Manganello: 39:15

I do think that that is a big pressure that people feel without knowing that they have to go off of medication when they're pregnant.

Dr. Spencer Brown: 39:23

But obviously talk to your psychiatrist when you are, you know, pregnant because some medications may have different side effects and different risks, but it's important to get that information and not just assume that I have to come off of everything, because I am pregnant in some OBGYN. I don't even like to prescribe to pregnant women, which then is another huge problem. Because then it's like okay, now, I don't have access to my medication because my OBGYN doesn't want to prescribe to me because they're, they're afraid, you know, to do it during pregnancy. But that's why we have perinatal psychiatrist now Because it sounds, yeah.

Dr. Brianna Bliss: 40:02

Yeah, that's such a good point, even if your OBGYN doesn't want to prescribe it, or your primary care physician doesn't want to prescribe it, yeah, don't give up hope, that doesn't mean that you can't get it, it just means that they don't want, they don't see you often. And so when, when our providers not seeing you, like weekly or every other week, they, they can't monitor how the medications are going. So it just might mean, you see a psychiatrist or, you know, a therapist who can get you connected with a psychiatrist to get the right medication. So if at first you don't succeed with the right provider, that doesn't mean you shouldn't do it, just to figure out the right, the right person, who's going to be able to work with you, over time to make sure that like, once you start taking these medications, they can look like observe you and make sure things are going okay.

Dr. Spencer Brown: 41:01

Okay. And then also in terms of like couples work. Concerns do come up during therapy, when just working with the woman, obviously, we are not couples counselors. So I do talk to my women, we do talk about like the stressors, and then the relationship dynamics, but I will often refer to like a couples counselor, because I'm just working with one half of the equation, the partner also needs to be involved, because what I will often say is that, when you are in therapy, you are going to get better or have a lot of knowledge, but your partner is essentially staying the same. And so then how is that going to work if you now have all of these different tools, but your partner's staying the same, it's not really gonna work that so having a support person who can see both of you and talk to both of you, and you talk about, like the communication, I think can be really helpful.

Dr. Brianna Bliss: 41:59

Make sense? Yeah. And I think I'm beyond like, a therapist or psychiatrist, you know, other kinds of therapy, a couples counseling, I think it's also really important to connect to community resources. So that's a big focus in the group that I that I run. Like, things, resources, like dual was maybe like a Healthy Start program, which they have in a lot of, it's a national program. So they kind of have like, visiting nurses that can help moms or they provide you with a doula, they can give you access to Formula diapers. So there's a lot of programs out there that can be of like, concrete support that people might need. Rather than just like emotional support, which is really obviously very helpful. But sometimes, if you know you're struggling with finances, or like any other social factors, it could be really good to have a support and like a doula or just know where to get diapers or a food pantry, things like that. So sometimes when you connect with a therapist, they can also have access to those resources for you. So it's important.

Dr. Katie Manganello: 43:27

Awesome, do you have any other just kind of general or practical advice for it doesn't even have to be like a mother struggling with postpartum depression or anxiety, but any kind of new mothers, do you have any kind of advice for just how to kind of like cope with the typical changes that are happening?

Dr. Spencer Brown: 43:48

I just, you know, I just feel like, this is such a huge transitional period. So there's gonna be ebbs and flows that naturally kind of come along with that. But you are doing a great job, you are a good mom. And so the fact that if you, you know, are concerned that you may not be doing a good job, says that you, you know are a good mom, because if you you didn't care, then then we would have pause for concern. But if you are questioning that, then you are definitely being a good mom.

Dr. Katie Manganello: 44:20

And being gentle and nice to themselves. Yeah, self compassion.

Dr. Spencer Brown: 44:24

Yes, yes. 100%.

Dr. Brianna Bliss: 44:26

And I would say to add to that, you will have bad days, and that's normal. And that's okay. And that doesn't mean you're a bad mom. It just means you're human. And sometimes, you know, like we talked about this a little bit in my group. It's like balancing your thoughts, right. So if you're saying to yourself like this is really difficult, but maybe you could balance that out with like, and I'm doing the best I can right So you can just kind of think about little ways to balance out your thoughts because sometimes when it weighs too heavy on one side of the scale, that's when we can start feeling kind of down. So I think it's about balance, knowing you're gonna have the bad days having the bad days, and tomorrow will be better. So

Dr. Katie Manganello: 45:24

awesome. Well, do you have any final statements or pieces of advice or anything that you would want to leave us with? regarding any of the things that we had talked about today?

Dr. Spencer Brown: 45:40

I feel like that pretty much covers it, but I will say you know, just look out for me and Dr. Bliss in the future. We have some things up our sleeve. So just before

Dr. Brianna Bliss: 45:55

I your maternal and child wellness needs.

Dr. Katie Manganello: 46:05

Okay, Dr. Bliss, do you have anything?

Dr. Brianna Bliss: 46:09

That pretty much sums it up?

Dr. Katie Manganello: 46:13

Okay, amazing. Well, this was so fun. I actually yes, we definitely have to do this again. And yeah, we'll definitely come up with some more ideas. So thank you so, so much for joining us today. And for everybody out there listening. Please remember to like, subscribe and share this episode wherever you find your podcasts.

Dr. Brianna Bliss: 46:33

Thanks for having us. Thank you.

Dr. Katie Manganello: 46:35

Bye bye