Transcription:
Baby Blues and Post Partum Recovery

Deborah Howell (Host): The baby blues. What are they? And are there ways to keep them at bay? Let's find out with a mother and professional who can speak to that on many levels. Rachel Kradin is a loving mother of two toddlers herself, and is also a Perinatal Social Worker at Emerson Hospital. This is Health Works Here, the podcast from Emerson Hospital and I'm Deborah Howell. Rachel, thanks for being with us today.

Rachel Kradin, MSW (Guest): Thank you so much for having me.

Host: Really appreciate it. What are baby blues?

Rachel: Baby blues are a common, temporary experience that moms go through after delivery that are really just closely connected to the offloading of hormones now that mom is no longer pregnant. So it's really, sort of a physiological response to no longer being pregnant and those hormones leaving the body that can be tied to some increase in emotionality, kind of teariness, kind of all the stuff you see in the movies of the new mom crying out of nowhere for no reason. A lot of that is what baby blues can look like. And it can also be described as sort of more of the emotionality of up and down moods, more irritability sometimes for moms. Sometimes and the nighttime actually can be a time that can feel a little more panicky and scary for moms. And so it's really about that phenomenon of no longer being pregnant and just these up and down emotions that are, going through a woman's body at this time.

Host: So that was very well explained. So are baby blues preventable?

Rachel Kradin, MSW (Guest): Not really because there's not really risk factors for baby blues. So, because it's so connected to just the normal, you know, you're not pregnant. There's so many hormones rushing through your body when you are and because it's connected to that, it's actually not an uncommon thing. It's about, they think up to 85% of moms will experience the baby blues and some of those symptoms increased emotionality, increased teariness that can start anywhere from a few hours after a mom delivers the baby, but peaks most commonly day three to five. And it really concludes about two weeks, three weeks would be the very longest, that you would kind of be looking to qualify that as baby blues. Anything beyond that, or anything that starts after that time period, we would really be looking at potentially a diagnosis for some other kind of mood disorder, rather than something connected to a shifting of hormones. So it's not necessarily preventable. However, it is a risk factor for postpartum depression, postpartum anxiety. So, it's not uncommon, but what I really suggest is actually the best thing to do is to monitor yourself a little bit more than maybe you typically might, monitoring your moods, knowing the signs and symptoms, which well I can talk about in a minute.

And having your partner be part of that monitoring as well. We know after for anyone who's had a baby, after you have a baby, it's really hard to keep track of time. Days kind of run into each other. There's a lot of monotony, not a lot of sleep and for parents or baby and so it's really easy to lose track of time.

So one thing that I really suggest is that parents, if you have moms sometimes have an app on their phone that they use to track their monthly cycle. Kind of making a note on a day where you have part of the day, whole day, where you just kind of don't feel yourself, maybe a little more emotional. If you have a good communication and partner is good at kind of helping keep tabs and that works for you guys.

I actually think the best thing is if you have a calendar, you know, on your kitchen wall, like many of us do. Take a pen and mom can make a note of if she has a day or part of a day, just not feeling herself and partner can help in that process. And then you really have a visual timeline that helps you to know if it's gone on longer than two three weeks. The first question that anyone, in the mental health field or your OB GYN, whomever you're going back to, and if you do say, you know, I'm, I'm not sure that this is normal. The first thing they're going to ask you is how long have you been feeling this way? And it's just really nice to be able to actually pinpoint that and let someone know how long those symptoms may have been going on.

Host: Sure. Now, if I have baby blues, what can I do to feel better?

Rachel: There are a few things you can do. So self-care, you know, that's kind of a common word a lot of us are hearing these days, especially with COVID, there's been a lot more conversation just in the general public about why self-care is so important for mental health. Baby blues are also another reason to practice some good self-care. So making sure you're well hydrated, making sure that, moms are eating well. Sleep is a big thing that moms can do and partners as well to help manage moods, establishing what we call healthy sleep hygiene or just good sleep habits, are really important. Anyone who's a parent has heard that term sleep when the baby sleeps. And for some people that's easier said than done, but there really is something to that.

If you can sleep when the baby is sleeping, that is, the best. But also kind of thinking outside the box of when sleep happens, it might not be at night. It might be naps during the day. And really setting yourself up through some planning, even in the pregnancy of how can I get support during the postpartum period.

How can I really utilize those people in my life who are asking, what can I do, in a really strategic way. And so doing some postpartum planning is really helpful as well. Things as simple as putting the baby skin to skin with mom. There's actually been studies done with parents of infants in the NICU, where the heart rate and the blood pressure both go down for parents as well as physiological benefits for baby when baby and parent are skin to skin. So, that's a nice, quick way sometimes it just kind of deescalate.

Host: Really good tips there. What about our partners? Can they get the baby blues?

Rachel: Partners wouldn't get baby blues because like I mentioned, it's very closely connected to this offloading of hormones. And now that the pregnancy is over, so the partner wouldn't necessarily experience baby blues. But partners absolutely can experience what we call a postnatal depression or a postnatal anxiety. What we know about partners and most of the studies have been done with fathers, but partners, baseline with no other risk factors there can experience a postnatal depression, about 10% of the time. postnatal depression looks similar to what we know as postpartum depression but a little bit less of the sadness, teariness more, increase in irritability, disconnection from family life. And so that's more what it looks like for a partner. What's interesting is that we see how closely the connection between how a mom is doing with her mental health in the postpartum and how a partner is doing.

So what they find is that if a mom is not managing her mental health during the postpartum well, and experiencing some postpartum depression, anxiety, Dad's likelihood for postnatal depression actually jumped to more like 40 to 50%. So a real close tie there, which makes it all the more reason to kind of look out for each other during this time.

Host: Absolutely. Now, what are the signs Rachel that what I'm experiencing has gone beyond baby blues and is something that I should seek support on and who could I contact?

Rachel: Yeah, this is an important question. So, the tip I shared earlier about tracking your moods, even from the get go before you even leave the hospital, because we're really looking at a pretty small window that the baby blues can occur in just really those first two weeks, three weeks at the very, very most, that tracking your moods to see am I still continuing to experience symptoms beyond two, three weeks? That's your first sign that this may be beyond the baby blues and being more like postpartum depression, anxiety, or another mood disorder. The other things that you will see are a little bit different symptoms. So, there are things like the sadness, the teariness, those things we see from movies and Hollywood, but also things like anxiety that looks like a lot of panic and worry, phobias about going out of the house. A lot of sleep disturbance is a telltale sign that there's maybe something going on. That's a little bit hard when you have a new baby to know is this a sleep disturbance or am I just having to wake up a lot? But if it's taking more than about 20, 25 minutes to fall asleep, that's something that would be a sign if you're outside of those first two weeks, that there might be something more going on for moms during that time period.

Host: And Rachel, I'm curious, are there long-term impacts on me or my baby if I experience any mental health concerns after baby is born?

Rachel: There are. Yes. We know that postpartum depression in particular, is something that pretty persistent and doesn't typically resolve without treatment. So it is most common in the first three months after childbirth, but can continue. Likewise it's also I think, nice for people to know that after a mother begins weaning if she's breastfeeding or pumping to feed, that can be another time that depression can start again or when the menstrual cycle returns. So those are other times that I always like to mention to moms when they're here in the hospital, because sometimes we sort of stop looking out for those symptoms after the first few months, and then are kind of blindsided if they should show up.

But sometimes the long-term impacts on poor maternal mental health, are really things that can impact the child and the family. So difficulties in relationships with your partner is one, and they've even connected unmanaged and poor maternal mental health with a decrease in longterm, successful outcomes for a child in school, and into adulthood. So, absolutely it would be really important for anyone experiencing any kind of postpartum mood or anxiety disorder to reach out for help.

Moms would certainly find support from their OB GYN. Typically a mom who had a vaginal delivery would be seeing their OB GYN for a followup appointment during the postpartum at about six weeks. A mom who experienced a C-section for delivery would be seeing their provider a little bit sooner to check on that incision and oftentimes would be receiving a phone call even earlier than that, just as an initial check-in. Really any provider in your life, your primary care provider, if you're someone who's linked with a therapist or a counselor, is a great start for who to seek out for support, if you're thinking that something's not quite right and you're questioning whether or not you might be experiencing some postpartum depression, anxiety, or other types of mood disorder.

Host: And also your own family, you know, talk to your mom.

Rachel: Exactly, your own family, your mom, your friends, anyone who you trust. That's a great place to start. People want to feel like the person they're talking to about these types of things really cares about them. And so, that's a great place to start. There's lots of support groups out in the community as well. And I think one of the silver linings to COVID I have to say is that virtual opportunities to connect from the comfort of your own home. You don't have to find childcare. You don't have to go through the whole rigamarole of getting yourself ready, getting baby ready, getting out the door. Those things are not that easy in the first few weeks and months of parenthood.

So connecting with a support group online, even connecting with a mental health professional online. There are mental health professionals that specialize in this perinatal period and what that experience is like for moms and most of them will take appointments via Tele-health. So it's actually made it a lot more accessible for new parents to reach out for support.

Host: Right. No need to go it alone for sure. Lots of support out there. My final question to you, Rachel, is other than baby blues, postpartum depression, and postpartum anxiety, what are other mental concerns that could come up after delivery?

Rachel: There definitely are, you know, well, postpartum depression or postpartum anxiety. And I want to take a minute to pause here and just say, we actually use the term now, perinatal depression or perinatal anxiety, because we know that moms can be experiencing mental health concerns, even in the pregnancy, and continuing through the postpartum, or not during the pregnancy and continuing in the postpartum.

In addition to those more commonly known mood and anxiety disorders, there's also something called perinatal post-traumatic stress disorder that can occur for a parent who may have a trauma history in their past to begin with. So it was sort of reactivated and we know that trauma is experienced, in a lot of different ways by people, very commonly. So, that's just something else to be aware of are what are your triggers and what are your best coping skills? Birth being experienced as a trauma is also not that uncommon. And it's something where I'm talking a lot more about in the perinatal mental health field these days, about 35% of moms experience their birth as a traumatic one. And when you talk about a traumatic birth, it's really in the eye of the beholder. Anything that happens too much, too fast, not what you expected, can feel traumatic for someone.

So that's important to be aware of if you experienced, infant loss or multiple miscarriages, difficulty becoming pregnant, infertility issues, if your baby had to spend any time in the NICU or special care nursery, any of those things can actually result in a postpartum or perinatal PTSD. And can also, increase depression and anxiety for a mom. A couple other things I'd like to mention, because I like to kind of shed some light on them. They're not as well discussed, but they're also not that uncommon. So one is called something that people refer to now lovingly as mommy rage or postpartum rage. We actually categorize that as something of a anxiety symptom and moms describe that typically as feeling uncharacteristically angry. The mom might say I'm not usually an angry person, and I just feel so angry lately, having a bigger reaction than you may have to something in the past, or getting upset about things that you may not have beforehand.

And that's kind of compounded by the fact that often that's followed up by feelings of shame or guilt that you got that angry to begin with. And so it's not something that everyone wants to chat about to the person next to them on the train or tell their friends. And it's something that I like to mention, cause it's not that uncommon to experience.

And then the other thing I just wanted to mention is something called intrusive, unwanted thoughts. That's something that can start in pregnancy and continue into the postpartum. Intrusive, repetitive thoughts that are kind of scary and disturbing and don't really make sense because they're not something that are congruent with your values or anything else you're normally thinking about.

It can it be something like, what if I fell down the stairs right now and I was holding my baby, or what if I threw my baby right now? It's not something that a mom wants to do or there's any voice in her head telling her to do, but it's just this intrusive thought, almost like an obsessive compulsive thing. And it's upsetting and it's definitely something many moms don't share with people because they worry that it means that they're gonna do it, or what will people think about me? So it's definitely something to get some support around, but to know that you're not alone, if that's something that you're experiencing. The very last thing I just want to talk about and connect on is, the idea of something called postpartum psychosis.

Postpartum psychosis is very rare and very serious. It's a sudden onset of psychotic symptoms following childbirth. It's increased risk with unmanaged bipolar disorder. But it's something that's, it's not common, but it's very dangerous if it's not treated and I like to mention it because people worry about that as something that could happen and of course it can happen, but it's very rare. And it's something that I like to mention only because if it does come up, it's very serious, but the idea of postpartum depression is not one in the same. There's a whole spectrum of different mood and mental health concerns that can come up.

But postpartum depression is pretty common. One in five moms experience it. Postpartum psychosis is pretty uncommon. It occurs like one to two people in every thousand moms. So, it's sometimes a barrier, I think of people talking to those in their life, if they are not as familiar with post-partum concerns that they think it's going to mean something really bad. Cause we hear these scary stories on the news and things like that. But it's really actually quite uncommon. Whereas postpartum depression is actually quite common.

Host: Well, thanks for shedding light on that and all the aspects of pregnancy. We want to thank you so much for your time today Rachel. Such good information.

Rachel: Thank you so much. Thanks for having me.

Host: That's Rachel Kradin, a Perinatal Social Worker at Emerson Hospital. Please visit www.Emersonhospital.org/baby for information about giving birth at Emerson Hospital's Clough Birthing Center. And if you like what you've heard, please share it on your social channels and be sure to check out the full podcast library for topics that might interest you.

This is Health Works Here, the podcast from Emerson Hospital. I'm Deborah Howell. Thanks for listening. Have yourself a terrific day.