Scott Webb (Host): Postpartum depression and anxiety is very common and my guest today wants moms to know that help and support is available, if you need it. And joining me today to tell us more about postpartum depression and anxiety and maybe a little bit about baby blues is Kellie Nichelson. She's an Employee Assistance Program Therapist at Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Kellie, it's nice to have you here today. We're going to talk about postpartum anxiety and what that is and what that means and how you help patients. So let's just start there. Like, what are some of the causes for women to experience postpartum depression and anxiety?

Kellie Nichelson, MSW, LCSW: Honestly, some of the things that kind of cause it or, you know, bring it about really honestly depends on the person. It's one of those nature versus nurture things, which is the case with a lot of mental health conditions, really. Hormonal changes is going to be one of the biggest things that causes or is going to be kind of a link to why women may experience some of this, either during or even after pregnancy. Because that's one of the things that maybe is misleading is that it's called postpartum, but this is something that actually can be something that can start happening even while a woman is pregnant.

 So they can start experiencing some of this, what they kind of quote as "baby blues" even during pregnancy. Questioning if they're going to be a good mom, even, two or three weeks after finding out that they're pregnant. And that really does have a lot to do with the kind of rapid hormonal changes that start to occur within the body.

The other thing is with people who do experience this, a lot of times, like I said, nature versus nurture, some women are more predisposed to this than others by nature. So if they already have kind of pre-existing mental health struggles, whether that be depression, anxiety, bipolar disorder, things like that, or just naturally have kind of a more low mood in general, they may be more predisposed to this. The biggest thing is we notice a shift in hormones, therefore a shift in mood kind of right off the bat.

Host: Yeah that makes sense and as you say, it's referred to as postpartum or diagnosed as postpartum, but it can be during partum. I don't know what the other, I don't know how to, I don't know how to say that, but I get point. The point is well taken, which is it can start, for some, right after they find out that they're pregnant, and continue on, and then continue afterwards, and I just want to get a sense of like, what are the symptoms?

 I mean, I think we all get a sense of, okay, baby blues, depression, but what do women, what do patients really experience?

Kellie Nichelson, MSW, LCSW: I think one of the clarifying things I always want to point out, is actually being a difference between baby blues and postpartum depression or postpartum anxiety. So baby blues is going to be something that actually a pretty big majority of women experience.

This period overall, you know, maybe some tearfulness, maybe some experiences of like mood lability. So, you know, a little bit of ups and downs, maybe more reactivity to things that maybe normally wouldn't have a woman reacting a certain way. Mental and physical exhaustion, things like that.

 When we get to a point of about two weeks out, so two weeks postpartum, baby has been hopefully home by then, outside o f if the baby's in the NICU, obviously maybe baby wouldn't be home by then, but, we're looking at about two weeks postpartum. If mom is still experiencing these symptoms or they are persisting, they're getting worse, mom is starting to experience even more significant mood fluctuations; that's where we might start looking at the possibility of a mood disorder.

The severity of this increases. We might even start to look at some changes in like self-esteem. So it's not just, oh, I'm, you know, a little bit irritable or a little bit discontent with life. It's that I'm a bad mom. I'm failing as a mother. I'm not connecting with my child. I am, possibly even starting to lose a grasp on what reality looks like.

 Maybe possibly some psychotic symptoms start to come up. Like these are some, you know, obviously some pretty drastic mental changes from just the again, quote unquote, baby blues that a lot of people experience. So, if we start to notice things like that, especially at that two week mark, that's our sweet spot. If we get to past that two weeks and these are persisting, that's where recommended to continue to talk to your whether it be your OBGYN or even your family doctor. And if you have a therapist or a psychiatrist, talking to them and letting them know, hey, it's been about two weeks, I am still not getting back to feeling like myself. What in the heck is going on? And talking to them.

Host: Yeah. Yeah. As you say, like, you know, baby blues, very common, but when it extends beyond that first couple of weeks, and those signs, symptoms, feelings, anxiety persists, I'm assuming then, you know, that this really affects these conditions, really affect the bonding between mom and baby. And maybe you can talk about that.

Kellie Nichelson, MSW, LCSW: Absolutely, yeah. Impacting the baby and mother bonding their interactions, for sure. I think one of the biggest things is being able to have the confidence to be a mom and be a good mom, I think is a huge part of it. Having the self-esteem to say, I'm gonna be a good mom. I'm gonna be able to take care of this child. There's so much more that goes into postpartum than just, okay, I've now had a baby and you know, the quote unquote hardest part is over. I gave birth and it's like, oh, actually there's so much more to it. I mean, just navigating motherhood, the impact of society, the pressures of motherhood, the pressures of potentially breastfeeding or not breastfeeding, the decision to breastfeed or not breastfeed, possibly feeling alone, feeling hopeless, especially when it comes to mood disorders like depression.

Some characteristic symptoms of depression are feeling hopeless, feeling alone, and wanting to isolate. That doesn't always go well with needing that skin to skin contact and that need to bond with a baby. And so you kind of have this dichotomous relationship between your depression and your baby. And then on top of that, kind of feeling this guilt and shame over potentially being a bad mother and, you know, not fulfilling that role necessarily.

So it's kind of this cyclical manifestation of your mental health going into not necessarily being able to bond or feeling like you can't bond even though you have the capacity to. Your brain is just maybe convincing you that you can't in that moment.

Host: Yeah, and in terms of risk factors, you mentioned that, I don't know, maybe there be a little bit of family history, genetics there, a predisposition. So if a mom to be or a couple want to sort of get out in front of this or not self-diagnose, but you know, like, just get a sense what is my level of risk for developing postpartum and anxiety? What are some of the risk factors?

Kellie Nichelson, MSW, LCSW: Yeah, like you said, I mean, predisposition genetically is gonna be a big one. And that's for most mental health disorders. There's definitely a genetic component. Anyone who has been previously diagnosed with a mood disorder in general. So, maybe they don't have a mood disorder already diagnosed, but maybe they know that their mom suffered with postpartum, or their grandmother, or their sister, potentially.

The other thing would be anyone who has struggled previously with postpartum. So, this is their third kid, and they know that with their first kid they had postpartum, but their second kid they didn't. There's a possibility with their third kid they still could have some postpartum problems. And then the other thing would be, statistics have shown that, first time mothers specifically, can struggle with some postpartum depression more frequently than mothers who already have children who are going into having another baby. I think part of that is just that it's a lot of novel experiences and a lot of uncertainty.

 Babies don't exactly come with a manual, so there's a lot of questions, a lot of uncertainty and with that being said, just giving yourself a break, if you are a first time mother out there. I promise none of us have had a handbook. None of us have had a instruction manual. There is no secret manual on how to, how to do this.

 So that's definitely a risk factor as well. And then the other thing is, external factors. So like environmental factors, if there's a lot of external stress in your life, if you're going home to you know, inadequate supports, if you are going home to a lot of external stress in your home life, in your work life, in your personal life in general, that increases your risks as well.

Scott Webb: Yeah. It's just going to exacerbate everything, of course. So, let's talk about the treatments that are available, you know, when we think about just typical sort of mental health and now we add in the postpartum. I'm assuming that you and for moms and couples needing some help through this period, I'm assuming it's very sort of specific types of treatment, right?

Kellie Nichelson, MSW, LCSW: Yeah, yeah. So, one of the things I think a lot of moms are fearful of is the use of medication, especially with potentially breastfeeding, potentially having kind of hormonal re regulation, coming back from having an influx of hormones, coming back to a normal level of hormones.

 But medication is still one of the number one helping tools for treating postpartum depression, anxiety, and even psychosis. And so, that's gonna be, kind of number one and number two would be medication. And then, obviously talk therapy is always going to be something I'm going to recommend as a therapist. It'd be weird for me not to.

Host: That That would be ironic.

Kellie Nichelson, MSW, LCSW: Yeah, it would be, right? You know, building some skills around working through some of those negative thoughts in a healthier way. The other thing would be, there are specific support groups that are exclusively created for moms with postpartum depression, moms with postpartum anxiety.

 The knowledge of, okay, I am not alone in this. I, this is not a unique experience. Yes, I am unique in the sense that, yeah, my, my child might have this unique experience or, I'm not not just another patient, it's more so having that camaraderie around me and having that support network of like-minded individuals and moms who can relate and be a shoulder to either cry on or just kind of, you know, almost complain to some extent and say, Oh my gosh, like, I am exhausted, I'm overwhelmed, I'm stressed, I don't really even know if I need meds or therapy.

I might just need to kind of sit here and process through this one experience with you guys.

Host: Right. Just a sort of an impartial ear, you know? Yeah,

no doubt, like the first one was harder than the second one and complaining to each other about how tired we are. Yeah. Kind of preaching to the choir a bit, you know, so I can, we can see the value in talk therapy or just talking to someone who isn't your partner in this thing. Right?

Kellie Nichelson, MSW, LCSW: Right, right. And even with therapy, you know, sometimes, I mean, I obviously am a big proponent of working through things and coming from a therapeutic approach and building coping skills. But sometimes, you know, people come in and sit on my couch and really just be like, can I just sit here and vent for a second?

And I'm like, yeah, that is 100 percent okay. That's, that's catharsis and it's a form of getting kind of your, your feelings out. And that is 100 percent a therapeutic and beneficial way of dealing with your stuff, so I'm totally okay with that.

Host: Right. You know, we talked about risk factors, went through that whole list there. And, and so I guess I'm wondering, can moms-to-be and couples, can they sort of prepare for this? Is there any way to kind of I don't know, like lay the foundation or the groundwork or begin, like do you recommend like beginning some conversations at least about this in the event that you know that someone does suffer from postpartum or anxiety?

Like, how does that work? Is that possible? Can you just be like, I don't know if this is going to happen to me, but I want to be ready for it, right.

Kellie Nichelson, MSW, LCSW: Right, yeah, and I think definitely a conversation. I would always rather be prepared and not need the information than to, you know, wake up one day and realize I have not even been close to being prepared for this and have no clue where to begin. So, talking to doctors about not only preexisting conditions ahead of time.

So, you know, talking to your OBGYN about hey, you know, I have a preexisting bipolar disorder. What's this going to look like for me as far as, first of all, staying on my medications, if I have any, as far as safety for baby, safety for mom, and for the reality of, of breastfeeding if that is something that you're interested in, right? Or, or capable of.

The other thing is being kind of aware, again, of those risk factors, knowing that I already have a bipolar or depression diagnosis. Is there a possibility of me developing this? You know, potentially. Do I need to go to therapy ahead of time and talk to my therapist if I'm not even seeing a therapist yet? Kind of talked to a therapist about some of my fears and anxieties around the potential for developing this. Yeah, that is 100 percent appropriate and is something that I think is totally a great use of time. Because the thing is, is that a lot of times when we're looking at what can cause or what can precipitate some of the postpartum depression and anxiety is some of our fears of like being a bad mom or fears of I'm not doing the right thing.

Well, then maybe talking to whether it be a therapist or maybe just some supports in your life about, I'm fearful of not doing this right. Well, then let's talk through those things and see if any of those feelings or emotions are actually grounded in fact, or if they're grounded in some maybe some dysfunctional thinking in the first place.

And I think the other thing is staying connected with supports in the first place. You know, the first person who's gonna notice that you are acting not yourself, is probably the people who are closest to you. You look in the mirror every single day, you're not gonna necessarily notice little tiny changes about yourself, as much as maybe like your significant other, your close family who is around you all the time.

They may be the ones who are going to point out your mood changes a little bit more, than you are. I mean, you're going to maybe notice it as well, but it's nice to have other people in your corner who can be like, hey, I've noticed you've been a little snippier than usual, in a loving way, maybe don't be like, Hey, you've been, you've been acting really, really rude recently. Like, I wouldn't do that to a woman who just gave birth.

Host: No, definitely not.

Kellie Nichelson, MSW, LCSW: Unless you want to lose a finger. But I think that, you know, having that support during before and after pregnancy is gonna be a huge advantage to preparing for that birth for sure.

Host: For sure. Let's talk about some of the resources that new moms can turn to. You know, like you said, there's no, well, there are lots of books, but in my experience, they didn't help me, cause they just weren't, you know, speaking specifically about the kid that I was trying to take care of, right. And our home and our family and all that, but what are some of the resources just broadly speaking for new moms?

Kellie Nichelson, MSW, LCSW: I mean, number one is your delivery team, and when I say team, I mean the entire team, so it's not just your OB, it's not just the nurse that is the one that's watching you, you know, day and night; it's every single person that is part of that team. So that's your family, that's your friends who can come and support you. It's the people who you maybe not, don't even think of who are, hey, let me know how I can help. I know you just had a baby, you probably don't wanna cook. Thinking even ahead of time, like you said, how can I prepare in advance? It might not be preparing in advance for the birth, per se, in regards to postpartum, but like it's preparing and saying, hey, I know that I'm going to be out of commission for a little while, and, there's a possibility that I may have some mood instability for a little while, just while I'm, you know, dealing with everything. I know that I probably am not going to cook for a little while, let's make a plan for having a couple people run some food by this week, specifically. Preparing that in advance, because in the moment, you're not going to be thinking about that, likely, you're going to be thinking about potentially taking care of the baby, or God forbid, potentially in a headspace where you can't be thinking about that.

The other thing is we have lactation specialists at most hospitals and that's something that I think a lot of people either don't recognize, don't know about, or don't realize how much lactation specialists can actually help and assist. If that is something that is an anxiety that you have around either breastfeeding, pumping, either a fear of like not wanting to breastfeed, or are able to, anything like that; the lactation team can be such a good support for kind of alleviating a lot of that anxiety that can just be a part of prolonging those baby blues, if you will, or prolonging some of that postpartum depression.

And then the other thing, like I said, is that support group any support groups. So Postpartum Support International is a huge organization that does a lot of like support. So they have like an entire website that shows support groups in the area that you live, you can search for support groups, you can search for actual providers whether it be, like, therapists who specialize in postpartum depression. It's a really cool organization that specializes in this entire kind of like niche category.

And then also just therapists in general. We're all pretty well versed in handling depression in general, but then, you know, anything that has to do with postpartum and also recognizing that sometimes there's postpartum even if baby doesn't make it. I think that's something also that's really important to note is that therapists, we are understanding that sometimes we get moms who come in and it's not postpartum with baby on hip too. It's sometimes postpartum with mom coming in after losing the baby as well.

Host: As you say that there's just a, a wealth of trained professionals, starting with the you know, the birth team, extending out to folks like yourself. There's lots of help and resources available. And, you know, sometimes maybe I'm guessing it's not necessarily the new moms and new mothers that sort of diagnose themselves as you say, the folks around them, their support system, their partner, family, friends, whomever. Say it in a nice way, of course, right, you said but encourage them, you know, it, you don't seem like yourself and maybe, you know, you need to speak with someone, or you know, just start with your primary and move to whomever. But yeah, I get your point. I want to finish up today.

It's so difficult, of course, having had two kids of my own, finding any time for yourself, even now, my kids are 17 and 21 and I still have trouble finding time for myself. So for those new moms to prioritize self-care and their own health, when do they do that, how do they do that? What are your recommendations?

Kellie Nichelson, MSW, LCSW: Number one is giving yourself a break. Like you literally just grew a human being, like it's amazing. Like you acted as a slow cooker for nine months or a little less or a little more and that is like the most amazing thing in the entire world, and you're going to likely have some kind of emotions.

Even if the emotion is joy and happiness, you're still going to probably have emotions, and they're probably going to be pretty intense because of your hormones, and that's understandable. And I think that in today's society, I think emotions can be demonized, and they can be seen as too much. They can be seen as like you got to get it together, like why are you showing so much emotion. And the reality is is that it

 is all part of the healing process. There comes a point where those emotions might become too much for you to feel like you can handle, and that's also okay, and that's why there's several resources that exist, where you can get assistance in coping with those emotions. You don't have to cope alone. You are not meant to cope alone, if you need assistance in doing so, that's also not to be demonized.

And I think the other thing is making sure that you at least do some research on postpartum depression. And when I say that, I don't mean WebMD yourself into having, you know, a cancer diagnosis accidentally. Like, I'm saying doing some research and just having at least a basic understanding of what some of the symptoms and some of the warning signs might be, so that you can at least recognize it in yourself, and maybe so that maybe a trusted person in your life, whether that be your significant other or partner or the person who's having this baby with you or potentially just like your, your parent, loved one, whomever, has some of those warning signs as well. Again, to keep tabs on you, being able to not only have that frame of reference on when are things not just, oh, this is just hormones, this is just baby blues, when has it turned into something a little bit different, and when is it that I, feel like I need to seek help. Because everyone's threshold is gonna be different too.

Mine might look different than yours, yours might look different than hers, hers might look different than, you know, his. And that is the other thing that I, I wanna, you know, point out, and this is something that is very rarely talked about is men can experience postpartum depression too. Very rarely talked about, but it is a thing.

It has a lot less to do with hormones and a lot more to do with just kind of the, the fears of you know, fatherhood.

Host: Taking care of this little human, you know, yeah, yeah, sure, yeah, I mean, there's no doubt and I absolutely agree with you. It's not something that I experienced per se as far as I know, but there's no doubt. Like when I just stood there and I looked at this little human being that I helped bring into the world, I was like, well, what do I do now? You know? And I began to doubt myself. Is this how you put a diaper on? My wife had told me to wrap them like a burrito. I'm like, well, is this, is this a good burrito? I don't know this is right, you know?

Kellie Nichelson, MSW, LCSW: You're like, I didn't train, like, train for this. Yeah, so I think it's just important that, you know, you have again, going back to that idea of support. I mean, it took nine months to get you here, potentially, and you don't have to do this alone. No one is expecting you to do this alone, and that's why, you have all of these different support networks and support options.

 It's just a matter of hopefully having maybe either yourself to recognize those things, or, maybe someone else in your corner backing you up. But really making sure that you are you know, taking the time and also not feeling, trying your best not to feel guilty when you do need to take a break.

You're allowed to do that. You are a human being as well. You didn't just become a mom and lose your identity as a human as well.

Scott Webb: Though it does, for all of us parents, it does begin to feel like that at some point. You have a hard time remembering who and what you were like before you became mom or before you became dad, but it's the best job I've ever had, the hardest job, the most tiring job, all of that. And it's good to hear you say that, you know, that there just isn't the stigma maybe that there used to be around mental health struggles to, you know, broadly, but also specifically about postpartum, anxiety, even baby blues. Like these are things that we can talk about, we need to talk about. New moms need to recognize or those around them need to recognize to get them the help they need so that they can bond wonderfully with the baby, skin to skin and so forth. So, I really appreciate your time today. Thank you so much.

Kellie Nichelson, MSW, LCSW: Yeah. Really appreciate being here. Thank you.

Host: And for more information, visit franciscanhealth.org and search postpartum depression/ anxiety.

And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.