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Prakash Chandran (Host):  Perinatal mood and anxiety disorders also known a PMAD affects women from all walks of life. It encompasses things that appear anytime during pregnancy up through the first 12 months after childbirth and we are going to learn about it today. Let’s talk to Natalie Mendenhall, a lactation consultant and Brooke Treanor an RN and PMAD Nurse Champion. I’m Prakash Chandran. So, Brooke, let’s start with you. What are perinatal mood and anxiety disorders and when do they occur?

Brooke Treanor RN (Guest):  Perinatal mood and anxiety disorders can occur anytime from the very first day you realize you are pregnant up until we say around the first year after the baby is born. And these different disorders; it’s an umbrella of disorders and what people usually think of is post-partum depression, but what really, they include perinatal depression, post-partum depression, perinatal anxiety and panic, perinatal obsessive compulsive disorder, post traumatic stress disorder and post-partum psychosis. And I can get into the different disorders briefly just so that we’re aware of the differences.

Depression can include irritability and guilt and anger, lack of interest in the baby. When somebody has anxiety or panic; they start getting very nervous, they have extreme worries and fears around their baby. They can go into panic attacks and dizziness, numbness to hands and tingling to arms and limbs. And perinatal obsessive compulsive disorder is an aspect of anxiety where the individual might start doing repetitive or they might feel the need to start doing things repetitively; cleaning, touching, locking doors to reduce their anxiety. 

And perinatal post traumatic stress disorder can be caused by a traumatic birth or it can be somebody might have experienced a past traumatic life event and that could be triggered during somebody’s birth. Symptoms of that include flashbacks, somebody can become extremely anxious, have difficulty sleeping because they are thinking about this traumatic event that was triggered during childbirth. 

And post-partum psychosis is something that’s heard of a little bit more. And that is always an emergency. Somebody might have auditory hallucinations or visual hallucinations where they are seeing something or hearing somebody tell them to do something. And that’s pretty much a brief overview of these different disorders. Baby blues is something around 80% of women will get and that’s considered normal, not a form of depression at all. It’s just moodiness, tearfulness, very emotional, but their predominant mood is happiness. And so that’s a big – a common occurrence. But the mom is usually very happy and that one will typically go away at about two weeks. 

Host:  Okay, that’s good to kind of know about the gamut or the spectrum of everything that PMAD covers. I want to just focus a little bit more on it and really speak to what are some of the risk factors that attribute this kind of behavior? Is it like previous mental health issues? I’ve heard before that if you have a perfectionist type personality this can help contribute to that. Can you speak to that a little bit?

Brooke:  Yes. Every individual, every mom is at risk no matter if she has had depression or a history of a family history of post-partum depression or psychosis. All moms no matter what walk of life, age, they are at risk. Now a family member or a mother that’s had the family members or she’s had a history; they are at a higher risk. But I want to just mention and touch on that, that all of us are at risk no matter what. Somebody that’s had a history of abuse, physical, emotional; those people are at higher risk as well. Like I mentioned before, a traumatic delivery; that definitely puts somebody at a high risk for developing these disorders, unplanned pregnancy. Sleep deprivation is a risk factor for all of these disorders. It plays into any mental health issue if somebody is not sleeping, that’s going to make everything worse. 

And a history of an eating disorder is something that’s not touched upon very often, but I did want to mention that. That that kind of stems from anxiety and so somebody if they’ve had a history of that, that can kind of trigger anxiety during pregnancy or post-partum. 

Host:  Yeah, it seems like your body is going through so much that anything that’s pre-existing there is just magnified and in fact my wife is pregnant right now. So, I’m even kind of experiencing a lot of these things, a lot of things that were maybe smaller kind of issues for her in the past bubble up a little bit. So, I’m just trying to be as supportive as possible. I want to shift over to what you do specifically at Sierra Vista to help women cope and recover from some of the PMAD things that they’re experiencing. 

Brooke:  So, what we do here at Sierra Vista is we screen all of our post-partum moms before they go home. They are screened with an Edinburgh depression scale and that is something that screens for current depression. But what we added into, we have another screening tool that we use, and it touches on these perinatal mood disorder risk factors. So our moms are being screened for current depression, and then they also are screened and made aware of look this is – you marked yes on this and this and so this is a risk factor for you. We educate them on their risk factors and on PMAD in itself. And so they can walk away from the hospital being more aware of what to look for. We give them a PMAD brochure with a list of all the different disorders and some resources on the back of it to kind of help them. And resources include all of our support groups here that we offer at Sierra Vista as well. So, we hold their hand through it and then afterwards we are there for them as well. 

Host:  Yeah this is a good segue for us to move over to Natalie. Natalie, maybe talk a little bit about the support groups offered kind of prior to pregnancy leading up to the birth and then what you do afterwards as well. 

Natalie Mendenhall (Guest):  Okay so, we offer a couple of support groups here at Sierra Vista. Our first one that we can talk about is our NICU support group. This support group is aimed more for our current and former parents of babies that are in our NICU. Our group meets weekly. It meets every Tuesday from 1:00 to 2:00 p.m. and this is just a way for the parents to come and connect with one another and kind of share their experiences. Really, we can relate as much as we can so when you have another family that’s going through the thick of it with you at the same time; it’s really valuable to come and share those experiences with one another and they can form those bonds and give each other encouragement and ideas and help each other through it. 

We also offer topics at our support groups where this month is adjusting to at home life, managing sleep, post-partum depression, family communication and feeding issues. 

Our other support group that we offer here is called Building Villages. It’s a newborn and parent support group. It meets weekly as well. And what we have found is having a baby is amazing but at times, it can be very challenging, and it does help to have people to share the highs and the lows especially those who can again, identify with what you’re going through. A newborn and parent support group it can help you get through those rough patches and help you feel less lonely and even meet new lifelong friends. It’s a casual meeting. We include support, weight checks, health information along with breastfeeding support for mothers by a board-certified lactation consultant. 

Host:  I think it’s amazing that there are so many support groups that you offer. All the way from the NICU support group which is the new infant – what does NICU stand for again?

Natalie:  It is the neonatal intensive care unit. 

Host:  Brooke, I want to shift over to you for a minute. I think one of the things that I notice a lot is that many women might feel alone in experiencing some of the symptoms of PMAD that we are discussing here today. And they don’t go to look for those support groups that Natalie has curated at Sierra Vista. Can you speak to a little bit about how many women PMAD disorders actually affect?

Brooke:  Yeah, there’s a lot out there that’s supporting this where I feel like maybe in the past there wasn’t as much information to have on it and now there is a lot of support for maternal mental health that’s growing. We say one in seven I think is the current statistic on – one in seven post-partum moms will develop post-partum depression and one in ten dads or spouses can also develop depression or any of these mood disorders as well. And so I wanted to mention that too. It’s not just our moms, it’s spouses as well, family members as well that are affected by the mom’s depression. If mom is not feeling well, she’s not taking care of the baby and her and dad’s relationship or her and her spouse’s relationship is going to be affected as well so it’s kind of a triad of trickle effect I will say. So I wanted to mention that. 

Host:  Yeah. Brooke I’m so glad you mentioned that because it’s something that I often think about a lot like what is my role going to be when the baby comes because I’ve heard that that baby really is just very sufficient on the mother or they take everything they need from the mother for the first couple weeks and I’m just kind of left with my shoulders shrugged being like I’m not sure what to do. So, Natalie, I’m assuming that the Building Villages and the new parenting support group that you offer that there are dads in there too, is that correct?

Natalie:  Correct and there’s also other siblings as well. 

Host:  Great so yeah, I think one thing that I’m taking away from this is that it’s really a family affair here that the whole family can get involved in helping the mother kind of cope with a lot of things that she might be going through and even for yourselves, if you’re a father or you’re a sibling, you have a lot of support around you as well. So, I really appreciate both of your time today. Brooke, we’ll start with you. Is there anything that you want to leave the audience with before we wrap up here today?

Brooke:  I just wanted to add just we have the perinatal emotional support group as well. I don’t know if we mentioned that one but I just wanted to add that’s more of the PMAD support group and that’s on Tuesdays and myself or our support group or another lactation consultant, we facilitate that and it’s just there for moms, dads, family members, spouses for support if they are having current issues, they are not sure if it is a PMAD issue or if it’s a coping issue or sleep deprivation. It’s just we’re here to support them as best we can and it’s open to whenever anybody wants to come. They don’t have to come every week or sign up. But it’s just another additional support group here offered to our patients. 

Host:  That’s wonderful that you have that community resource there for them, Brooke. Natalie, what about yourself? Do you want to leave the audience with anything today?

Natalie:  Yeah. Being that I could be your first baby or your fourth baby; every baby brings its own set of joys and also challenges. And it really does take a village to raise a child and so we would love for you to come and join our village and let us help you and grow with you. 

Host:  Wonderful. Well that’s a great place to close and I really appreciate the insight from you two. That’s Natalie Mendenhall and Brooke Treanor. Thanks so much for checking out this episode of our podcast series. I’m Prakash Chandran. Thank you so much for listening. 

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