Maggie McKay (Host): Being pregnant can be a magical time. The anticipation, the planning, the celebrations, but what about after the baby has arrived and the responsibility and sleepless nights set in? How do new moms deal with the possibility of postpartum depression? We're going to find out today with Dr. Whitney Lyn and Dr. Kristen Myhand. Welcome to Total Health Talks, your Cook County health podcast, where we empower your journey to better health. I'm your host, Maggie McKay, and today we're going to talk with Dr. Whitney Lyn and Dr. Kristen Myhand about beyond birth, navigating postpartum symptoms. Would you please introduce yourselves, Dr. Myhand?

Kristen Myhand, MD: Yeah, I'm Dr. Kristen Myhand. I am an OB GYN at Cook County Health, and I talk to women from their first visual meet, before or after puberty, all the way into the end of their life cycle.

Maggie McKay (Host): And Dr. Lyn?

Whitney Lyn, MD: Hi, yes, I'm Dr. Whitney Lyn. I'm a Family Medicine Physician. I focus mainly on maternal child health, so I deal with the pregnant women, I deal with the babies, I watch the babies grow. So I continue on with that care from cradle to grave.

Host: Well, thank you both so much for making the time. I know you're super busy, but we so appreciate you being here. Dr. Mahand, let's start with you. Pregnancy is a major stressor on a woman's body, of course, but let's talk about preparing for postpartum. What is it and why is postpartum care so crucial?

Kristen Myhand, MD: So postpartum is really that year after a woman delivers a baby. In some reports say that it takes two to four years for women to actually be back to their pre pregnancy state. But we really focus on that first full year, which we consider a postpartum time. Preparing for postpartum is a bit like herding cats.

It can be so unpredictable. There are so many changes. Even if you already have a baby; adding a second family member or a second baby to the family is a radical change that I don't think that we understand the gravity of it until we're in the midst of it. So, things that we can do to prepare, basically, trying to have a healthy pregnancy while we're pregnant, trying to help encourage those healthy goals with eating, staying consistent with our nutrition, because those same goals are going to be very important postpartum, especially for breastfeeding women.

 In the postpartum period, there are a slew of differences and changes that happen. First, there's a baby that needs to be cared for every two to three hours in the beginning. That means a change in our sleep habits. There's also changes in our emotions and our hormones that are very common and almost every woman experiences during their postpartum period.

Another change that I don't think we talk about as much is the dynamic between you and the partner. So those dynamics can change for the better. A lot of times they stay the same and we're just trying to stay above water, but sometimes we need to talk about the stressors that can cause increased tension between partners during the postpartum period.

Postpartum care is so important because we want to make sure that we, as physicians, and as patients are actually talking about all the different changes that are happening. The struggles in breastfeeding, the struggles in keeping yourself healthy, finding time for yourself in this new dynamic of someone who needs you 24 hours a day. Those changes in the relationship, the changes in your own body that you're feeling, the softness that comes to the body after having the baby that we don't always expect. It's very important to keep your postpartum appointments to talk about these things because us, as your providers, want to know what you're struggling with, what you're dealing with, so we can help you and encourage you and the things to keep you and your family healthy.

Host: I love that term, the softness, a.k.a. flab. I love it, that's a good term, I'm going to use that. Dr. Lyn, what are some ways a woman can take an active role in postpartum health?

Whitney Lyn, MD: So, like being pregnant, taking the time for you, now that the baby's out, it's kind of like now you have to find time for you. So once again, is it a walk? Is it taking a run or is it just going to Target and walking up down the aisles, even though you're not going to buy anything, but just kind of getting some time away from from the family is really what is needed, because there are so many changes, that are happening. So you definitely have to do that. And one of the biggest things that, you know, happens for mothers is, you know, baby comes out and you have all these endorphins running, like, Oh, I have this wonderful new thing.

So I have to look at it all the time. I have to watch them all the time and all those kinds of things. You know, I remind moms like, when baby lays down every two to four hours, you should be laying down, too. Because as mothers, what do we do? We get home and we're like, okay, I gotta do the laundry. They're sleeping. Now I can wash the dishes. Now they're, they're asleep. And things like that. And mothers get run down. And so after about a week or two of being home and being on that mental high of just having this baby, we hit a wall and then we get so super exhausted, which just then plays on the change of the hormones and being more down on yourself saying, I can't do this.

 And I know that probably all the mothers who are listening or watch this will say, how did other women do it? As a mother, I thought I did everything right. I did everything I needed to do. And then I feel like I'm now drowning, like I can't keep up. And then I'm looking at all these mothers like, well, how did they keep up?

And kind of giving yourself some grace to say, I'm not going to be able to be superwoman. I was superwoman by having this child and giving yourself that, you know, as we were saying before, grace of saying, I can do as much as I can do. And that's all you need to do. You have to give yourself a little wiggleroom of not being able to do it all.

And you know, you watch TV and you watch other people outside of the home and you're thinking, well, if they can do it, why can't I do it? Not everybody's the same. And so you have to know what your limits are, but you also need to know that you need time for you to really take a breather, a mental break from everything that's going on outside of being a mother.

Host: It's so true not to compare, because you know what? Some people have nannies, some people have their moms helping them. You never know, and it looks effortless for some people, but you never know how much help they're getting. Dr. Myhand, are there warning signs to look for after giving birth for mom and for baby?

Kristen Myhand, MD: Yeah. So for mom, we'll start there. For moms after giving birth, immediately in the hospital, of course, the physicians and the nurses, or if you have a home birth your midwife, doula will always be there to try to watch those first few days. The things that we're watching for that you want to continue to watch for when you get home is your bleeding. It's expected that women will bleed four to six weeks. The bleeding should be getting less over time.

If a woman is noticing that she is bleeding through pads, soaking through pads, she should come to the hospital immediately. Another thing to look out for is any fevers, chills, any signs of infection, because it can happen after giving birth. The uterus can be infected. There could be other infections at IV sites or other things like that.

So if this starts to happen, we want you to come to the hospital immediately. One other physical thing I want us to look out for is basically our blood pressure. Preeclampsia is very common, especially in our patient population that we serve. Changes in blood pressure where blood pressures can get very high very quickly, headaches that don't go away with Tylenol or ibuprofen, flashes of light in the vision, feeling a lot of nausea or vomiting after delivering the baby, pain right under the right breast.

Those could all be signs of preeclampsia, which is very, very dangerous for our mother. So it'll be imperative to come to the hospital immediately if you start to notice those signs. Lastly, not a physical sign, but our mental health signs that can kind of tell us that we need to look out for help or support is feeling down, depressed, feeling like hopeless, you don't want to interact with the baby, you want to be away from the baby. You don't want to feed the baby, or feeling like I'm very excited about the baby, but when the baby's sleeping or you're away from baby, you feel hopeless, guilty, like you don't really want to be here anymore. Those are very, very important signs to tell you, oh, it's time for me to speak to someone, my provider, my partner, my support system, to try to get some help on what's going on with my mental health postpartum.

As for the baby, signs for the baby to look out for, especially in those first few days, is eating. Is my baby actually eating? Is my baby consuming nutrition? Now for breastfeeding moms, it can be a little bit harder to know, especially for first time moms, if their baby's actually getting the nutrition from the breasts, unlike formula or women who pump and provide the milk in a bottle, it's very easy to see, oh, my baby ate two to three ounces or four ounces in the setting.

For women who are directly breastfeeding, it can be a little harder, but for all women, the things that we can look for in our babies is their wet diapers. So on the first day of life, baby should have one wet diaper, second, two, third, three, four for day four, but after that, they should have about six to eight wet diapers a day.

If babies are making those six to eight wet diapers a day, babies are getting plenty of nutrition. The poopy diapers here and there, but the wet diapers is really what we're looking for to make sure that babies are getting great hydration and nutrition. Another thing to look out for babies is things that just like mom, signs of infection.

Fevers, chills, babies red, the activity of the babies. It can be a little harder in those first few days because babies, they wake for about an hour and then they're asleep. So there's a lot of sleeping, but if you notice that they seem more lethargic, sleeping all throughout the day, baby doesn't want to feed, doesn't want to eat, you need to bring baby in immediately.

As far as looking for a baby, honestly, sleeping, eating, pooping, and peeing is what we're looking for our little ones to be doing. And as long as they're doing those things, then they're doing well.

Host: Dr. Lyn, what should somebody expect at the first postpartum appointment with their doctor?

Whitney Lyn, MD: So, just like with our first prenatal appointment, right? So, we're taking our vitals, making sure that blood pressure is good, vitals are looking good. We are checking for you know, our PHQ 9, which we're looking to make sure that mom isn't showing signs of postpartum depression.

 You know, when we're looking at our physical exam, we're looking to make sure that there's not any swelling. If they had a vaginal delivery, if they had any type of stitches or anything down below, we're definitely going to take a look down there to make sure that they, you know, all that area is healing well.

 If they had a C-section, we definitely want to make sure that there's no infection or any signs of infection of where the incision was for where the C-section cut was. So those are basically the big things that we're looking for at the first couple of visits.

Host: And Dr. Myhand, most people will have strong emotions after having a child, it's just the way it is, like feeling anxious, afraid, or guilty, as we've been talking about, and could actually even experience crying episodes and fatigue or restlessness. Is that normal? And when should somebody worry?

Kristen Myhand, MD: One thing I started after having my own child and going through my own postpartum course, as well as a interesting pregnancy. Um, one thing that I've started doing is speaking with my patients while they're pregnant about the emotional changes that happen during pregnancy. So for example, when I was pregnant, around the end of the first trimester, the beginning of the second trimester, I started to experience so much anxiety.

And when I spoke to other mothers about it, everyone experienced this anxiety, but no one spoke about it. So during the pregnancy, I started to talk about mental health, anxiety, depression, things that can be very common for women to feel. In the postpartum period, it can be even more of the anxiety, depression.

A lot of times, women have what's simply called baby blues where for after about the first 2 or 3 weeks of postpartum period; they start to feel a little down. They cry a little bit more. That's completely normal. It's completely normal to feel all of those emotions and to go through those emotions.

 What's not normal is when we don't want to interact with baby. When we don't want to interact with people. When we want to withdraw and not be around, even our support people who are helping us take care of the baby, of ourselves, and make the transition. Another thing that's not normal is not eating, sleeping all the time.

Yes, we're tired as mothers, of course. Being up with a baby every two to four hours, 24/7 is exhausting. But when it comes to sleeping to the point where you don't want to wake up to feed baby, to interact with baby, those are really big warning signs that we really need to seek help. Be that a partner or a provider, a doula, I love doulas.

Doulas are checking in all the time postpartum and actually help a lot with a mother's recovery. It's good to check in with those people to figure out what's going on with me. I know for me personally, after I delivered my son about a month or two later, I think it was around two months. So even after my postpartum visits, I had a C-section.

I had many visits to look at my incision. I had many visits to talk to the doctor. Two or three months afterwards, I remember being on Facebook on a mother's group and I just put in the post is like, does it always feel like this? And that's all I can say. And immediately the mothers came together and like, no, it does not always feel like this.

We need to get you some help. And I went to my husband in just tears. And he's like, I've already set you up an appointment. And of course, being a woman who is a physician going through medical school, residency, seeing patients all the time, doing surgeries, delivering patients, like taking care of very sick patients at times, is very odd to not recognize in yourself the things that are changing and the help that I needed so much during that time that I could not verbalize. So having support people around you and seeing the changes that are naturally going to happen, but also there could be a little bit more of a struggle. Not that we can't take care of our children, not that we're not being good mothers, because I was doing everything for my child.

So aside from my child, when it came to myself, it was so many changes that I just couldn't put my finger on what was wrong. And those changes are what alerted my support people that I need to have a little bit more time with the therapist to help me get through these very normal feelings, the feelings of being overwhelmed, the anxiety, the very normal feelings I was having to help me not to get to the dangerous point of wanting to harm myself or not be around anymore.

That is very important to have those support people and people who are there questioning and making sure that you're okay and checking in with yourself and make sure you're okay. We do have a questionnaire, like Dr. Lyn mentioned, the PHQ 9, which we do immediately before a woman leaves the hospital, as well as the six week visit.

Immediately after leaving the hospital, it can be questionable how women feel. It's so much going on. You just had a baby, or you just had a surgery where you had a baby through your abdomen, and two hours later someone's asking you to feed something after you had a major surgery. In no other circumstance do we do that to people.

And so, it's a lot going on immediately postpartum in the hospital. So that PHQ 9 questionnaire during that time can be a little iffy, a little higher than normal. But at the six week mark, we really look at that one to say, okay, what's going on? Are you feeling hopeless? Are you feeling guilty? Are you feeling those feelings of depression, anxiety, where you don't want to be involved with the baby?

Those are things that we're really looking for. We really want you to be honest about because that's the only way we can help you overcome these barriers that sometimes plague us as new mothers.

Host: Dr. Lyn, how can someone get help for postpartum depression? Can Cook County Health help?

Whitney Lyn, MD: Yes, we certainly can here at Cook County. We have a lot of options out there, you know, to help women and, you know, as Dr. Myhand said, we're asking especially with the population that we serve, we're asking while they're pregnant, when they're done pregnant, and even when they are coming, to their well child visits.

So, because I take care of children, up to one year of life, we are actually checking when mother comes in to bring baby in for the well child visits at one week, two weeks, two months, four months, six months, nine months. All those visits, we are actually giving mom the PHQ 9 there, so that they're able to tell their emotions.

Because, as Dr. Myhand said before, postpartum can happen up to one to two years after having a baby. So we need to make sure that we are checking for it because just because you didn't have it for the first two months, we're actually seeing most women who have postpartum depression; it's actually after four months and it starts around that four month period.

And so, for us to actually see that, we have to be asking the question at all visits, of how you're feeling and what you're doing. So here at Cook County Health, we have behavioral social workers in all of our clinics. So when we're giving these PHQ 9s and seeing mom and like something doesn't seem right, then we have to, you know, we give warm handoffs in real time.

So we have our therapists come in and talk with them and say, okay, how can we help? What is it that you need? Maybe we need to start therapy so that you can start expressing these various symptoms that you're having that are normal to not normalize having postpartum depression. I'm pretty sure every mother does not want to admit that they have had, at some point in their life, some type of postpartum depression.

Because once again, being the mother is the hardest job you're ever going to have. And so to say, it's okay, let's see how we can help you. And that's really the conversation that we really need to be having because we don't want mothers to feel bad because they're not feeling okay. Because it is okay not to feel okay.

So we want to make sure that we are able to support them. And a lot of times, even if a mother doesn't screen where the PHQ 9 is elevated, a lot of doctors know, they've seen their patients for many, many months, or even many, many years, and they will know something's off. I have been, I don't know, in countless encounters with patients, and their PHQ will be a 6, which is not elevated, but I will see them and I will say, no, you're not being the person I have known you to be for the many of years. And then when you really get to talk to them, they will break down or say, you know, this is going on at home. What do I do? I need this. I can't figure out how to handle these various situations. And that's what I'm saying.

Okay, let's get you to talk to someone so we can talk about the various coping skills, because with what is going on in today's society, especially for African American women, throughout pregnancy, it would be completely normal for someone to feel anxious 24/7, with knowing the risk that they have about, you're at a higher risk, you're four times more likely to potentially die in natural labor than any other population. While you're pregnant, that has to have some kind of effect. That has to have an effect of, okay, are they going to have some kind of bias against me because, um, I'm the color I am or the income value that I have and the implicit bias and the racism that is in medicine that everyone needs to recognize.

And so that makes mothers on high alert at all times. And so that anxiety, we have to normalize it to say, I understand that feeling. So even though I'm a doctor and you know, my income level is pretty good, I am anxious all the time of having two young black boys. So when mothers have that anxiety, we have to say, we understand and let's see how we can help you.

Host: . Dr. Myhand, what's the best advice you can provide new mothers?

Kristen Myhand, MD: The best advice I can provide to new mothers, is have grace with yourself. Have grace. The only thing that you have to do as a new mother. You don't have to shower every day. You don't have to work out. The only thing you have to do is take care of yourself, whatever that means, and take care of your little one. That's it. Make sure they're fed and they have on a clean diaper, clean t-shirt. That's it. That's all you have to do. Don't have any unrealistic expectations for yourself, especially with the weight loss and trying to get back to pre pregnancy weight. Have grace and patience with yourself. It's been, my child will be two this year.

And I know that going through breastfeeding, I had to maintain a certain weight to keep my supply up, which was 20 pounds above my normal weight, but we're working on it. We're getting there. And it's grace, because parenting and mothering is just an adventure of the unexpected. So have grace with yourself.

Host: Well put. Dr. Lyn?

Whitney Lyn, MD: So, you know, for mothers, basically everything Dr. Myhand said, but you know, just getting through everything that you need to get through. But once again, letting someone know when you need help. There's nothing wrong with asking for help. Motherhood is hard. So when you need help, or you're sure you're not sure about something, you want to ask questions or just say, I need help, ask for help. No one will think you are any less of a mother by not asking for help.

Host: Thank you both so much for sharing your expertise and this invaluable information. I mean, I have learned so much. I wish I knew all this before I was pregnant, but too late for that. But, it's just great to know all these points of view and advice. It's very, very helpful. Thank you again for your time.

Whitney Lyn, MD: Thank you for having us.

Kristen Myhand, MD: Thank you.

Host: Again, that's Dr. Whitney Lyn and Dr. Kristen Myhand. As we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast, share and connect with us on social media. Stay tuned for more engaging discussions. This is Maggie McKay signing off from Total Health Talks.

Stay well.