Transcription:
“Baby Blues” & Postpartum Depression

Deborah Howell (Host): Hello, and welcome to the show. I am Deborah Howell, and today we’ll be talking about postpartum depression, often referred to as the baby blues. Our guest is Michelle Gentle, a licensed clinical social worker, working as the clinical supervisor for the Welcome Baby Program at Miller Children’s and Women’s Hospital, Long Beach. She’s responsible for the clinical aspects of the Welcome Baby Program, including providing supervision, education and training, and staff development. Welcome, Michelle.

Michelle Gentle (Guest): Thank you, so much, for having me.

Deborah: Our pleasure. Anywhere from 40 to 80% of new mothers experience the baby blues, but the feelings often go away. About 15% of new mothers develop postpartum depression. What are the baby blues?

Michelle: That’s a great question. The baby blues is really just a term that we use to categorize mild depression that is interspersed with happier feelings that occurs for a lot of women -- up to 80% of women -- after they deliver a baby. This could be symptoms like fatigue and exhaustion, feelings of sadness, crying, anxiety, mood swings or irritability, feeling overwhelmed, or over sensitive, maybe even an inability to sleep, and loneliness. They typically go away about two weeks postpartum, and most of the time people don’t need any intervention to get rid of the symptoms.

Deborah: You say two weeks is roughly average?

Michelle: Yes, so the peak is usually around seven to ten days. Women can start feeling symptoms within a couple of days of delivery and then up to two weeks.

Deborah: Okay, now, there’s a difference between the baby blues and postpartum depression, maybe you could speak to that?

Michelle: Wonderful, thank you. Yes, so postpartum depression is a mood disorder that actually impacts -- we don’t know the exact percentage, but the estimates have been anywhere from 20 -50% of women who deliver children will experience a postpartum mood disorder.

Postpartum depression symptoms are more extreme than postpartum blues. Postpartum blues, again, doesn’t need intervention, will typically go away by itself within a couple of weeks. Postpartum depression can happen at any time up to two years postpartum. How would you know your loved one or yourself was experiencing more of a depression? It’s really more like a deep sadness, feelings of hopelessness, excessive worry, excessive crying, intense irritability or anger, inability to sleep even though you’re exhausted and even when the baby is sleeping and taken care of. There’s a lack of joy and oftentimes feelings of shame, guilt, or inadequacy.

The estimates estimate up to 50% of women, especially in high risk populations -- just at our hospital we deliver over 6,000 babies a year, that could be anywhere between 1,200 to 3,000 women a year that are experiencing a postpartum mood disorder after they deliver a baby.

Deborah: That is staggering.

Michelle: Yes.

Deborah: What are the causes of the baby blues and postpartum depression that we know?

Michelle: There’s a few different things. Biological factors -- we know that after we deliver a baby our hormone levels significantly drop, so there’s going to be naturally just some adjustment because of that. We also know there are some social and environmental factors. We have this idea of what motherhood quote unquote should look like after we deliver a baby, and that's reinforced by our media, by social media, and what people decide to share with others on their social media accounts.

Some other factors that can contribute are stress or lack of support for the mother. Women who are in either violent relationships or come from a low socioeconomic status are at higher risk. We know that stress is a contributing factor, and sleep deprivation is a contributing factor, too. It’s a bunch of different things.

Deborah: Yeah.

Michelle: But they’re definitely things that put women at a higher risk --

Deborah: It’s a big, complex puzzle.

Michelle: versus women who are maybe at a lower risk.

Deborah: Sure. And how is postpartum depression screened and treated?

Michelle: We are getting better. As a society, the stigma of postpartum mood disorders is slowly fading, which is a wonderful thing. It’s things like this that are bringing such important information to the public and taking away the stigma for these moms. Oftentimes women will be screened by their physician. We are hoping that in the future every woman will be screened in the physician office -- either the Ob/GYN or family practitioner, whoever she’s seeing for her prenatal and postnatal care. There are a few questionnaires. PHQ9 is a standardized questionnaire of nine questions that can screen a woman for different symptoms that she may be experiencing.

Early detection is the key. The women who have better outcomes are detected early, have arranged social support -- so either their partner, or extended family, or even friends -- and then plan for practical support. That could be just arranging childcare for their other children or having meals delivered so it frees up their time and they can rest more, especially in the first few weeks. And then, ultimately, if they need intervention, support groups are a wonderful way to meet with other moms who might be going through something similar. Therapy can be great, also, and then medication management through either your Ob/GYN or a mental health practitioner like a psychiatrist.

Deborah: Are there groups now, where -- when a woman is so busy, and maybe has multiple children including the infant -- are there things like GoToMeeting, or places where they can do it online?

Michelle: Yes, so I’m going to give -- and actually, I can give them right now. There’s a few different sites that a woman can go to. We’re actually really lucky here at Long Beach Memorial, or from Memorial Health System, is that we have a few things in place here. There’s a weekly group -- it’s not online, it is in person -- but there’s a weekly group run here by a licensed clinical social worker called Nurturing the New You. It’s a free support group for new moms that’s held every Tuesday, I believe, from 10 to 12, in Miller Children’s Pavilion. And I’ll give you my contact information if anybody would like to contact me to get more information about that.

But then there’s also a lot of online resources through MaternalMentalHealthNow.org, and Postpartum Support International. MaternalMentalHealthNow.org is the LA Chapter for Postpartum Support International. The phone number for Postpartum Support International, for the listeners, is 800-944-4773. But yes, there are online forums, and there’s actually even home visitation programs that do everything virtually. There’s one though USC, right now, that has support for new moms virtually. They even provide iPads to do it through, so there’s a lot of different options.

Deborah: Fantastic, I’m so glad to hear that. There’s no reason to go it alone?

Michelle: No.

Deborah: Are there other postpartum mood disorders that we should know about?

Michelle: Yes, so the most talked about is postpartum depression, we’re finding that a lot of women are experiencing high rates of postpartum anxiety -- sometimes depression actually manifests as anxiety, but there are postpartum mood disorders that are classified a little bit different. Some women actually experience postpartum panic attacks. A panic attack feels like a heart attack, so some women feel pressure in their chest, they have difficulty breathing, they have palpitations, dizziness, and numbness and tingling sometimes in their extremities, sometimes they’re even woken up out of their sleep with a panic attack. That is a postpartum anxiety disorder.

There's also postpartum obsessive compulsive disorder, which oftentimes women mistake for something called postpartum psychosis. Postpartum psychosis is typically what we see when we see that a woman has hurt her children, and then we see on the news -- the news will say it’s postpartum depression. That’s most likely not accurate. It’s most likely a postpartum psychosis at that point.

There’s similar symptoms with postpartum obsessive compulsive disorder and postpartum psychosis, such as intrusive thoughts, were maybe the mom has thoughts of harming her child, but with postpartum obsessive compulsive disorder, these thoughts are very scary to the mom. She might have these intrusive thoughts including images of hurting her children. She often will do things, compulsions, to alleviate that anxiety. For example, if she has these vivid images of the baby being stabbed by the knives in the house, she will go to great lengths to get rid of that threat, so she’ll get rid of all of the knives, or she won’t let anybody touch or hold the baby because she’s afraid something’s going to happen. She knows that her thoughts are scary. That’s more of an anxiety disorder -- the postpartum obsessive compulsive disorder.

Women who truly have a postpartum psychosis will -- well, first of all it’s very, very rare. They estimate that only about 1% to 2% of all births -- but we call it egosyntonic. It’s not scary to the woman. Her bizarre thoughts make sense to her at the time, so she may harm her child believe in that she’s actually helping her child. That, again, is very rare, but what we see a lot, now -- now that we’re talking and educating women about these different disorders, is that the women who have maybe had the obsessive compulsive disorder with a previous pregnancy, didn’t say anything because they were so afraid of being labeled crazy and so afraid that people might fear that they were going to harm their child. The more education we can get out about these different disorders, hopefully the barriers will come down for these women, and the stigma will be removed, and these women can get the mental health and the support that they need.

Deborah: Absolutely, Michelle. I have a final question for you. Where can listeners go to get more information about the Welcome Baby Program?

Michelle: Great. Welcome Baby serves LA County. We’re a home visitation program for parents with new children or even prenatal, sometimes. Go to First5LA.org, and you can search for the Welcome Baby Program in your area. If you would like to call our office here at Miller Children’s Women’s Hospital, Long Beach, we’re at 562-933-2410, and I just want to make sure that every woman out there, if they are experiencing a postpartum mood disorder know that you’re not alone, it’s not your fault, and with the right treatment and support, you will feel better. Thank you, so much, for having me.

Deborah: You are just a gem. We appreciate you, so much, taking this time. You do such important work, Michelle. Thank you, for being on the program.

Michelle: Thank you. Thank you, so much.

Deborah: For more info, or to listen to a Podcast of this show, please visit MemorialCare.org, that’s MemorialCare.org. I’m Deborah Howell. Thanks for listening, and have yourself a wonderful day.