Transcription:
Postpartum Depression - How to Help and How to Get Help

It's Your Health Radio, a special podcast series presented by Henry Mayo Newhall Hospital. Here's Melanie Cole.

Melanie: The COVID-19 pandemic has brought a renewed focus on mental health. And maternal mental health is a special category all its own, in that women often believe they should feel happy during that exciting time and new baby, but some are struggling with depression.

Today, we're discussing signs and symptoms and how women and their partners can get help for postpartum depression. Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole and joining me today is Joy Burkhard. She's the founder and Executive Director of 2020 Mom.

Joy, it's a pleasure to have you join us today. Tell us a little bit, I mean, I'm a mom. Though mine are 18 and 21, I remember that exciting time, but it's also a bit frightening when you've got a new baby. Tell us a little bit about postpartum mood disorders, anxiety, and really how prevalent these are.

Joy Burkhard: Well, thank you so much, Melanie. It's great to be here and thank you for this very important question. As you alluded to, we're often bombarded with the media images about how wonderful this time can be. And up to one in five women, up to 20% of women, will suffer from a mood disorder during pregnancy or the postpartum period. We often hear about the postpartum period, but we don't want to forget that these disorders can onset almost as frequently during pregnancy as well.

And we're talking as you alluded to about a range of disorders. Most often, we hear about postpartum depression, which can happen during pregnancy, not just the postpartum period, which is defined as up to one year post birth. But there's a range of anxiety disorders or post-traumatic stress disorder. We also know a lot and hear a lot more now about OCD and intrusive thoughts, which can be really unbearable for women. Of course, general anxiety and depression, which so many folks know about. Baby blues is considered to impact up to 80% of women, but resolve naturally without treatment and are not considered a maternal mental health disorder.

Melanie: So thank you for explaining all that different spectrum. There's really a range. Now, is there a screening tool? Is there something? How do we know if we are someone who is at risk for real postpartum depression or anxiety disorders or, as you mentioned, intrusive thoughts, OCDs versus baby blues, which many of us have, because we're not sure whether we're going to be a good mom. We're worried. All these things enter into this whole picture. So how do we know? Do we get screened by our OB-GYN? Is it something the new pediatrician looks at? How do we know?

Joy Burkhard: Absolutely. It's such an important question. We have a screening tool that's recommended and what we say validated, a questionnaire of 10 questions validated by researchers as being effective to detect these disorders. It's called the Edinburgh or EPDS, often referred to as the EPDS screening tool. It's the commonly used screening tool to detect these disorders. And generally, it's not a diagnostic tool, meaning it will flag if a woman is having numerous symptoms. It is still incredibly helpful and an important starting point.

And to your point who should really be doing this? Right now, unfortunately, women are kind of left to their own devices and fathers who may suffer from a new experience with an anxiety disorder or depression as well, or any of these disorders, quite frankly, during the same time because of increased stressors. Right now, many women and fathers are left to their own devices, meaning that they suffer for much too long before they feel like something might be going on that's very serious and then struggle to kind of find something on the internet, Dr. Google as we call it, right?

But we're really advocating that the obstetrician, so the OB-GYN, or even a midwife is considered an obstetrician, would be the home-base for screening and detecting these disorders even prior to pregnancies since we know so many young women, childbearing age women, may have an existing depression or anxiety disorder that's not been well-diagnosed or treated.

Melanie: What about some barriers to treatment? I mean, there's always sort of been the stigma around mental health issues anyway. And women, you know, we're the caregivers of the world, we are the ones who have to put our own masks on as it were timely now, before we can take care of those that we love. So what if families and their partners are noticing something, what would they be noticing? What are some of those red flags that our partners might see or that we might even notice in ourselves?

Joy Burkhard: It's such an important question. And the typical signs and symptoms that we would see with any of these disorders really are sort of inability to sleep, even when everything that should be in place to be able to sleep well is in place, meaning someone that you trust and care for is caring for your baby, like a partner's taking the first part of the night shift. We also see problems with eating, so changes in ability or interest in eating, that might be we generally see sort of lack of interest and no appetite. But we also have seen, particularly with depression and sometimes with anxiety, an interest in eating more, right? Just like you hear about when someone's stressed, so they might kind of binge eat. That can happen too. So changes in appetite or eating practices.

We also see cheery mothers, mothers that wouldn't otherwise be emotional, just be weeping a lot. And this is the typical sign of the baby blues. But if it persists, this weepiness, uncontrollable and unexpected weepiness persists beyond two weeks, then we know that there's something more serious going on.

And then let me just also also acknowledge the challenges with anxiety disorders and anxiety. It could be, rapid heartbeat, just general distress, sweating. These are things that mothers often are experiencing at higher rates than they normally would. And I also just want to acknowledge that much of this is for biological change in a mother's body, both during pregnancy. And of course, we hear a lot about that drop-off in the days right after birth and that certainly can trigger much of this.

Melanie: Well, Joy. I kind of tend to combine questions and I asked you about barriers to treatment and then jumped into signs and symptoms. But do you think that women are hesitant if someone notices these signs or we notice them in ourselves hesitant to go get help? And if we are, tell us why it's important that we do get help and who do we go see?

Joy Burkhard: Yes, absolutely. There's still a stigma. And quite frankly, I think one of the most important steps and most important barriers that we need to talk about is confusion. So we often talk about stigma. There is stigma with like, "I don't have a severe mental illness. I've never had a mental health problem. What really is this? That's not me" in certain cultures. In particular, Asian cultures, black mothers, this sort of "Lift myself up by the bootstraps. Worst things have happened. You know, you should be fine." These cultural stigmas certainly play into a woman's notion of stigma and cultural issues surrounding asking for help.

But this issue of confusion, I think, is even more important. And that's because doctors and clinicians that we trust are not talking about these sets of disorders being the most common complications of pregnancy and birth if they were that much of that stigma would be wiped away, right? And we also believe there should be blood test. So that both women themselves who are screening for these disorders, doctors, others who may still not fully understand it and think, "Boy, she really does just need more sleep or just needs another walk." You know, these things are then what's wiped away, these misconceptions and confusion, when we medicalize these disorders. So we're advocating for that type of systemic change as well. Certainly, stigma is still alive and well, but confusion is even more alive and I think a greater barrier to diagnose and treat women.

Melanie: So then just briefly tell us some of the treatment options that are available and really what you want women to know about the importance of support and self-care at that time.

Joy Burkhard: First, starting with treatment. So if you know you're suffering from one of these disorders and you've taken the EPDS or Edinburg test, we've got that on our website, 2020mom.org, and it's available all over the web, and you're flagged as having a problem, then you can either go to your obstetrician and say, "Here's my positive screen." Hopefully, they're doing this for you already, but they may not be, as I mentioned. And they are likely to prescribe and recommend therapies, talk therapies, so seeing a therapist.

Cognitive behavioral therapy is a type of therapy that's most common and very much efficacious, and is as effective as medication, which is often also prescribed. We often see a lot of childbearing age women already on medication, and most medication is safe during pregnancy and the postpartum period for breastfeeding mothers. So we encourage you to talk with an informed provider about those safety issues if you're already on medication.

Definitely to your point about walking and fresh air, social support, that means friends and other parents, surrounding yourself with that support network for emotional social support is really important.

Melanie: So Joy, this is such an important topic. And as we wrap up, I'd like your best advice, but also please tell us about 2020 Mom and what is that. And how are you helping to empower women to really be their own best health advocate?

Joy Burkhard: Well, thank you for that important question. If I were to give advice to families about how to deal with these types of disorders and expect them, it really is to prepare for a maternal mental health disorder, because it's likely to happen up to 20% of women. If you're in a population that has higher stressors like living in poverty, you face a higher risk. So just prepare for these types of things. And that means knowing who your doctor is, who can you trust to have these conversations with? Hopefully, you have an obstetrician that you feel you have a great relationship with. If not, it's time to find somebody else, even when you're pregnant and make sure you're surrounded by clinicians that understand these disorders.

Also build up your network of social support and practical support. So many of us think about these things, but are embarrassed to ask for help. Find help. And you can come to 2020mom.org to find that kind of help as well.

What 2020 Mom is focused on is closing gaps in maternal mental health care. So we believe you shouldn't have to do these things. You shouldn't have to find a care professional that knows about these disorders. We believe all of them all obstetricians should be well-informed and trained to recognize, treat, and diagnose these disorders adequately. We're going to be 10 years old next month and going to be doubling down on implementing what we know works through policy change, through supporting large health systems, et cetera.

Melanie: What a great organization and really important information, Joy. Thank you so much for joining us today. And to learn more, you can visit 2020mom.org. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. For more health tips and updates, you can always go to henrymayo.com or follow us on your social channels. I'm Melanie Cole. Thanks so much for listening.