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Helen Dandurand (Host): Welcome back to The Well Within Reach podcast. I'm your host, Helen Dandurand. And today, I'm going to be joined by Tammy Mylcraine, Labor and Delivery nurse, to talk about perinatal mood disorders.

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Host: And we are back with Tammy. Thanks for joining me today.

Tammy Mylcraine: Thank you for having me.

Host: Of course. So, this is your first time on the podcast. Could you tell us a little bit about yourself and your background?

Tammy Mylcraine: Sure. I've been in the nursing field for over 40 years. First working in Medical-Surgical, then Long-Term Care and Obstetrics, and eventually centering on Obstetrics here at Riverside, where I've been for almost 33 years.

Host: Wow.

Tammy Mylcraine: I have worked postpartum and developed and participated in the role of perinatal staff educator, though most of my years have been worked in Labor and Delivery. I also served as faculty for Olivet Nazarene University, where I obtained my Bachelor's and Master's degrees in Nursing and served as a clinical instructor for Olivet nursing students.

Host: Wow, you've got so much great experience. What's your favorite part about where you've settled here in our family birthing center?

Tammy Mylcraine: I like our team. I love our team. We have a great, great group all the way around and our patients. I think there's something to be said about helping out with the birthing process and trying to make their experiences the best ever.

Host: Yeah. Well, that's great. I think that might be one of the most fun, nursing jobs. When I interview and talk to different people, it just feels like one of the happiest, that's for sure. Well, today we are here to talk a little bit about perinatal mood disorders, as we said. And I guess my first question is, can you tell us what that is? It sounds like a big, big term, and how does something like this differ from baby blues?

Tammy Mylcraine: Let's start with talking about the baby blues. Baby blues are very common with some research showing that up to 85% of women can experience the blues. They're not a psychiatric disorder. They're very self-limiting, meaning that they're going to resolve on their own. The blues can occur within the first few days of delivery and, usually, lasts around 10 days to two weeks. And symptoms for that can include some mood lability, difficulty sleeping, crying really easily, easily irritated, appetite changes, those types of things.

Perinatal mood disorders can actually be expanded to say perinatal mood and anxiety disorders. These are complications of pregnancy and can expand to around a year after delivery. There are several disorders surrounding pregnancy and other mental health conditions that can develop or worsen with or after pregnancy. But the main ones that I'm going to talk about are the mood disorders, anxiety disorders, obsessive compulsive disorders, post-traumatic stress disorder, and postpartum psychosis.

Host: Okay. So, what are some of the common signs and symptoms of those different disorders that new parents should be watching for?

Tammy Mylcraine: Anxiety and depression often present together, and many people already have anxiety and depression, unfortunately. Left untreated, mood and anxiety disorders can lead to increased maternal morbidity, failure to adhere to medical care, substance use and abuse, failure to bond with the infant after delivery. ,And in severe cases, lead to suicide. Literature shares many perinatal mood disorders can be preventable through self-care, some therapy, and support groups.

The main perinatal mood disorder, I think, people really are thinking about is postpartum depression. Baby blues can turn into postpartum depression, or postpartum depression can develop on its own shortly after delivery, or even up to a year afterwards. Signs and symptoms of postpartum depressions are really more exaggerated symptoms of the blues, such as irritability, inability to stop crying, lacking sleep. You cannot perform basic tasks or care and have no emotion at all. Sometimes even looking at your baby doesn't bring out any types of emotion.

Another mood disorder to talk about is perinatal anxiety. Postpartum anxiety can last several weeks or more, and it can be generalized, it can be a panic, it can be a social, some of those symptoms can include fear, shortness of breath, anxiety, even fear of mingling in public.

Another one to discuss is the post-traumatic stress disorder, which PTSD is something that a lot of people know of, but it can also go around pregnancy time too. And sometimes pregnancies and the outcomes aren't what you expect. And so, that can be part of that. But anybody that has preexisting PTSD also can be triggered by certain events. Symptoms of that could include avoidance of the situations, changes in the mood and more. And so, it can be triggered or it can start with pregnancy itself or delivery.

And then, obsessive compulsive disorders can occur during pregnancy or after. Symptoms can include repetitive rituals such as hand washing, which is a lot of people think of that. But excessively checking on the newborn, can't even take your eyes off or leaves for several seconds and then have to go and check on the baby again. That could be a sign of that.

Postpartum psychosis though is a psychiatric emergency and that needs to be addressed immediately. Bizarre activities, hallucinations, delusions, or even acts to kill self and/or the infant. So, anyone with preexisting mental health, depression, anxiety, or other conditions need to monitor their health, keep appointments, and take prescribed medications, as any of their conditions can potentially change.

Host: Okay. Yeah, I think it's interesting that there are so many different disorders. And, like you said before, the one that everyone thinks of is definitely the depression. So, it's good to be educated about all of these different things. And then, you just kind of mentioned this, that those who already have things like anxiety or depression are most at risk. But how prevalent is this? And other than that, are there other risk factors?

Tammy Mylcraine: Perinatal depression, which is during or after pregnancy, can occur to some degree in one out of every seven women. The percentages of the other disorders are very low. They can be 0.02% up to 10%, just depending on what that disorder could be, except for postpartum psychosis, which could occur in one in every a thousand women according to research literature.

All women are at risk, and women with preexisting mental health conditions are vulnerable. It's important to seek healthcare assessments for conditions other than the baby blues. While the mother is in the hospital, a screening tool called the Edinburgh postpartum depression scale will be used to evaluate who may be at risk for postpartum depression. It asks 10 questions for the new mom to answer. The same tool used at the two-week visit for follow up, and most of the pediatricians will also use this during the new baby appointments. But the key to remember is this is only an assessment. It is not a diagnosis.

Host: Great. What factors kind of contribute to the development of these disorders?

Tammy Mylcraine: There can be many contributing factors that go into mood disorders: lifestyle changes, lack of partner, family support, finances, socioeconomic and lifestyle changes and conditions, age, fatigue, pains and discomforts, preexisting mental health conditions and hormonal changes to name a few.

Host: Okay. So, it sounds like it really depends on the person, on their experience. It's really not a one-size-fits-all thing. How would you say that these disorders affect parents' overall wellbeing and their ability to bond with their baby?

Tammy Mylcraine: I think inability to bond with a newborn infant is a large concern for all women. Whether or not you have anything going on, they're tired, they're sore, they might have discomforts, disrupted sleep patterns. those long sleep patterns are now gone. But having a mood disorder further complicates that bonding process. New parents can feel inadequate to meet the baby's needs, not sure how to proceed with what they feel like they're struggling with, and they're struggling to meet their own needs. So, it's important to know that support's available. Accepting help from others they trust, getting adequate amounts of rest, choosing healthy foods and snacks, drinking water, stepping out for five minutes, enjoying the sunshine, seeking assistance from healthcare professionals. Individual or group therapies. sometimes medications are needed. These are always to help adjust to the mood disorders. But what's important is the followup. Up to 30% of women with some mood disorders don't go for their appointments afterwards. And so, it's key for us to support, and to, encourage them for followups.

Host: Awesome. We are going to take a quick break to talk about primary care at Riverside.

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And we are back. So, can you tell us, Tammy, a little bit about what role hormones kind of play in triggering these mood disorders?

Tammy Mylcraine: Oh, hormones, yes. Hormones play a huge role. Estrogen and progesterone levels, they rapidly decrease as soon as the placenta is delivered. And so, these changes in levels continue for several weeks postpartum, which can contribute to postpartum mood disorders.

Host: Okay. Yeah, that makes a lot of sense. There's so much going on. What would you say resources, treatments, or therapies are available if there's someone struggling with these?

Tammy Mylcraine: Well, I think part of it is, you know, figuring out what the type of struggling that they're going through. If it's the blues, family and friends support, social media group support, and time is really is important for that. If one has a pre-existing mental health condition, such as bipolar disorders, anxiety disorders, depression, or other mental health concerns, they need to continue with their healthcare professional recommendations for followup.

If postpartum psychosis occurs, which is a mental health emergency, medical attention must be sought immediately for the safety of both the mom and the infant. It is often a loved one or friend who notices the changes in the women first.

One of the support groups, also mention is the National Maternal Mental Health Hotline. That number would be available. It's confidential. There's just a whole host of resources available also for people to reach out for help.

Host: Okay. You mentioned friends, family, partners, and the support that they can provide. What would you recommend to those who might be in the situation where they would like to help someone else?

Tammy Mylcraine: I think support and understanding is so important. A phone call, a visit, a meal, offering to do tasks, those are a few things that can help. But listen and be there when applicable. Don't say, "I know what you're going through," because you don't. You may have similar experiences, but without being physically inside the person, you don't know exactly what they're going to go through or what they're experiencing. Sometimes they can't express exactly what they're feeling or they need. They just need someone. So, don't abandon them.

Host: That's really, really good wise words. And what would you say are some practical self-care tips for the new parents, any new parents, to manage their mental health, just in the postpartum period whether they are or not experiencing these disorders.

Tammy Mylcraine: I think all parents, not just new ones, all parents could use a little help sometimes, but take the help when offered. The house doesn't have to be pristine, clean. The laundry doesn't have to be done exactly the same way every time. And every meal doesn't have to be cooked by you. Like I mentioned before, step out for five minutes, take a walk, do a little yoga, some deep breathing exercises, eat clean, get rest, and find joys in the moments. Don't feel like you have to do it all or be it all. Recognize you're enough.

Host: In the last question, I said that those were wise words, and I think those are even more wise words. So, thank you for sharing them. And kind of moving into why is it important to seek professional help early if someone thinks that they're doing these self-care things and it's really not cutting it, something is off?

Tammy Mylcraine: I think there's sometimes still a stigma with mental health with some women feeling they have to get over it alone, or they may have an elder or someone else tell them that it's normal to feel that way, whatever that way is.

But no one needs to suffer alone. And waiting too long into the disorder can hinder the potential treatment. And I keep saying disorders, you can call them conditions, but they're treatable things that you don't have to experience all by yourself. There's many treatments, again, the yoga, the walking exercises, refocusing, therapies and support groups, both online and in person, and a number of excellent physician services available in our community that can help. And sometimes medications are needed and that's okay. And I think that's what people need to know, is it's okay. Talk with your provider to see what help you need the most.

Host: That's great. Thanks for being here today. And thank you, listeners, for tuning into the Well Within Reach podcast brought to you by Riverside Healthcare. For more information, visit riversidehealthcare.org