Intro: Duly Noted, a health and care podcast, is the official podcast series of Duly Health and Care. Each podcast features physicians or team members discussing groundbreaking topics and innovations that help listeners re-imagine and better understand an extraordinary health and care experience.

Amanda Wilde (Host): A woman's body goes through significant changes after the baby is born. Postpartum depression is common, and it's a natural complication of giving birth. On this episode of Duly Noted, we're talking about how to take care of your mental health in the fourth trimester with Madeline Enervold, licensed clinical social worker with the Behavioral and Mental Health Department at Duly Health and Care. I'm Amanda Wilde. Madeline, thank you for being here.

Madeline Enervold: Yeah. Thank you for having me.

Host: According to the CDC, one in nine women experience symptoms of postpartum depression. First, how do you define postpartum depression? How is it different from other types of depression?

Madeline Enervold: So, postpartum depression can occur during a pregnancy or following the birth of a child. It can impact really any parent regardless of sex or gender. In terms of symptoms, it's very similar to other depressive disorders, but the only qualifier for postpartum depression is that there has to be a pregnancy and childbirth. But symptoms can be generally similar.

Host: What are the most common symptoms to be aware of?

Madeline Enervold: Some of the most common symptoms of postpartum depression are low mood, feeling generally down, sad or upset, difficulty sleeping, excessive tearfulness, feelings of guilt, worries regarding the health and safety of your baby, worries about your ability to be a good parent. Symptoms can be physical and mental, similar to other depressive disorders. But with some treatment, symptoms can go away after a few months. But if they're untreated, symptoms can last for multiple years if we let them keep going.

Host: Well, what are some of the treatment options available to someone who may be struggling with this condition?

Madeline Enervold: Thankfully, there's a lot of great treatment options for people going through some of these challenges. Most times, physicians will suggest some form of antidepressant or medication to assist with just the physical changes of the body following a pregnancy. So, antidepressants tend to be a pretty common path to take. However, there are some other options, including hormone therapy. As we know, following a pregnancy, the woman's body takes a drastic drop in estrogen and our levels are all over the place. So, the goal with the hormone therapy is to balance some of those estrogen levels to feel a little bit more comfortable physically, which then can help us feel more comfortable mentally.

But in terms of therapeutic options, there's a lot of great options for people to go through, including cognitive behavioral therapy. Interpersonal therapy is one that tends to have some pretty great results, mainly because when someone has a baby, when someone becomes a parent, there's so many different things that come up in terms of changing our roles, changing our responsibilities within life.

You now have a new, infant to take care of. You now have a new relationship with your partner. You now have a new relationship as a whole within the household. And so, interpersonal therapy can be really helpful in exploring this role. And the relationship she has with baby and their partner, and then possibly processing any sense of grief or loss associated with this role change.

I think one thing that isn't talked about a lot in terms of postpartum is this feeling that things are different than what we expected, that some things we had an idea of what it was going to look like after we gave birth and it didn't turn out that way. And there's a sense of grief there. There's a sense of loss of, "I wish it turned out differently. I wish it looked differently." And so, interpersonal therapy can be really helpful in processing that sense of grief or loss and trying to see what that role can look like moving forward and how we can find some acceptance or find some joy and comfort within that role.

Host: Well, speaking of the kind of support women need with postpartum depression, is there anything we can do prior to giving birth to set ourselves up for success physically and mentally during the fourth trimester?

Madeline Enervold: Oh, absolutely. I think one of the most important aspects of setting ourselves up for success in that fourth trimester is asking some really difficult but important questions. Some of those questions could be, "How many hours of sleep do I need each night in order to function?" As we know, with an infant, sleep is a thing of the past. So, things change so rapidly when you're dealing with an infant that wakes up every few hours. However, sleep is such a physical need. We need to be able to sleep in order to function naturally. And so, some people function on less sleep. Some people really need to have a decent amount of sleep in order to get moving in the morning. So, what we know about that is we need to have at least four sleep cycles. And a sleep cycle is defined as 90 minutes of uninterrupted sleep. And so as long as we get those four sleep cycles within a 24-hour period, then that is proper functioning, that is proper physical health. However, that can be really difficult to get when you have a newborn.

So, that is a good question to ask, is how can I operate with this amount of sleep that I'm going to get and how can I set myself up for success for small amounts of sleep throughout the remainder of the day if I have that time and ability to do so? With that being said, that means leaning on some of our support systems. So, asking ourself the question of, "Who are the people that we can reach out to during this fourth trimester, during this postpartum period? Who are the people that can be there for us if we need to keep an eye on baby while I take a small nap or help us around the house, being able to set ourselves up for success in household chores, meal planning, any other daily activities that feel really important?" Taking a shower, that is one of the most common things I hear from folks dealing with this postpartum period in the fourth trimester in general. "How can I take a shower? How can I take care of myself? How can I put myself in a position that I can feel good and feel comfortable so that way I can take care of my baby in the best way?"

Host: So, it's a matter of coming up with a plan for fitting in sleep, showers, how the household chores will be taken care of and identifying who you can reach out to. Those are all things you can do before the baby is born. In rare instances, postpartum depression can evolve into something called postpartum psychosis. Can you explain what that is and how common is it and the warning signs for that?

Madeline Enervold: Postpartum psychosis is considered a medical emergency. It happens in approximately 0.1% of all childbirths. So, this is 1 to 2 out of every 1,000 deliveries. So, it is pretty rare, but the onset is usually sudden. It happens pretty quickly following the childbirth within the first two weeks of postpartum, but it can include delusions, hallucinations, the feeling very irritated that seems out of the norm, paranoia or suspiciousness about others around us, the decreased need or inability to sleep, some sense of mania can come up, rapid mood swings, difficulty communicating, getting the words out of our brain and into the communication, and just feeling overactive, hyperactive. Those are some of the symptoms of postpartum psychosis.

Host: That sounds completely natural for a new mother, even though it is a rare condition.

Madeline Enervold: In some senses, yes, the inability to sleep, that would be pretty common to have a newborn. And yet it's more so drastic, if we're getting multiple hours of sleep at night one night, and then zero hours of sleep, because we can't fall asleep due to racing thoughts or just feeling like we can't turn our brain off. That would be a cause for concern.

Host: The biggest thing is to identify that you are having these issues too when you are having them. If someone suspects they may be experiencing postpartum depression, what steps do you recommend they take to seek professional care and get help with sleep cycles and that list we talked about, you know, plans and identifying who can help?

Madeline Enervold: So, most obstetricians and midwives and doulas really want to set up new parents for success following a childbirth. And so, they tend to set up certain milestones of check ins with the new parents to check in on symptoms, how you're feeling. Most professionals in this sense will have the mother do some type of depression screening questionnaire to ask if any of these symptoms have come up or if anything has changed. And so, that can be a really great start to make sure you're attending those followup appointments with your providers. With that being said too, those providers can provide referrals and resources out to mental healthcare, meeting with a therapist or a psychiatrist to work with medication management, but ultimately know that there's a lot of resources out there.

One really great resource to use is through Postpartum Support International. They have a lot of great resources for any parent with a lot of different specializations. If there's specific things happening within the upbringing of the child or with just dealing with the postpartum period in general. There's support groups, there's online chats for moms and dads, different resources for military families, queer and trans parents, any parents dealing with loss and grief or even adoptive and birth mothers meeting together to chat for support in that way too.

Host: I think one of the biggest takeaways from this discussion is that we don't have to cope with postpartum depression alone, that there are lots of options for support and resources that are available. Madeline, thank you so much for explaining postpartum depression and how we can understand and manage it.

Madeline Enervold: Thank you so much for having me. I'm glad to share some of this information. Again, I think a lot of people are unaware that this is such a normal occurrence. And so, we want to be able to give some support and give some acknowledgement that there's other people going through what they're going through and get the resources that they need.

Host: That's Madeline Enervold, licensed clinical social worker with the Behavioral and Mental health department at Duly Health and Care. For more information, visit dulyhealthandcare.com. And if you found this podcast helpful, please share it on your social channels and check out our full podcast library for additional topics of interest. This is Duly Noted, a health and care podcast from Duly Health and Care.