Maggie McKay (Host): Can you ever really be prepared for having a baby? It's such an exciting time, but it can also be filled with a lot of new worries, self-doubt, sleep deprivation and it can also be quite the juggling act. Happy as new moms and dads are, it's a lot. Today my guest is Dr. Devon Kienzle, a Family Physician with Obstetrics delivering at Cascade Valley Hospital in Arlington. Today, we're going to talk about safeguarding your mental health as a new parent.

This is Be Well with Skagit Regional Health. I'm your host, Maggie McKay. Welcome Dr. Kienzle, so happy to have you here.

Devon Kienzle, DO (Guest): Thank you so much for having me. I'm super excited to be here.

Host: Yeah, same here. Parenthood, especially the first time around, can be daunting and overwhelming along with all the good. So, what are some of the mental health struggles that new parents encounter?

Dr. Kienzle: Well, I think the first thing to understand about mental health and new parents is that it’s kind of all over the place. Right? Especially with new parents. It's a super exciting time. There are tons of happy emotions. And usually, that's the kind of pinning emotion that holds it all together. But mixed in there sometimes is a lot of stress, anxiety and exhaustion. There are times it's an emotional roller coaster for new parents. And that's for just the newborn period. Let alone once your kids starting to get older. I feel like that newborn period is kind of like this, the refiners for once you have a toddler and then go, my gosh, when you have teenagers, you know?

Host: Yeah, waiting for the other shoe to drop. What signs or symptoms should new parents look out for when it comes to mental health?

Dr. Kienzle: Yeah. A lot of new parents have heard about the postpartum blues and those are normal things, for the most part. Postpartum blues happen in 40% of all pregnancies and those emotions are pretty standard. They kind of come in the first few days. It's a whole mix of emotions, moments of sadness, or crying mixed with happiness and kind of a loss of what to do with those emotions.

And those last by definition, really resolve within a couple of weeks. But what I really teach our new moms to really be aware of is when those things start going beyond two weeks or when it just becomes incontrollable, right? Where those emotions start to persist you can't get out of it, of an episode of crying and tearfulness, or you start to have negative thoughts towards yourself or particularly your new child, which it’s part of what can happen when these emotions start to run wild. And this, I tell parents also to know that it’s not a bad thing, it's nothing to say about their own parenting. And it's just something to ask for help for.

Host: Is it related to hormones because sometimes it seems like it's just beyond your control postpartum.

Dr. Kienzle: Yeah, it absolutely is related to hormones. You've got a whole new shift in hormones. Something I talk about again with parents is just that they're not just hormonally going through a whole lot of changes. The oxytocin is flowing, all sorts of things progesterone's coming in. But also just their physiology has changed so much. They just lost a whole being that their body was taking care of. And then on top of that, they're exhausted. They're not sleeping the same, they're breastfeeding, every two to three hours. So it's a huge mix of things that contributes to it. And it's no fault of their own. There are certain things that definitely put us at risk of having postpartum depression or other bigger struggles. I mean, we can talk more about that, but those are things also to talk about with your provider.

Host: And you brought up breastfeeding. To me, that was so exhausting. I mean, just that alone. You're already sleep deprived because you have to breastfeed every so many hours. But it just seemed like it makes you so tired. If a new mom or dad, Dr. Kienzle is experiencing any of these symptoms, what steps would you recommend?

Dr. Kienzle: Yeah. So the first step is being on good terms with your primary OB provider, or any provider that you have close and good access to. And letting them know that you're struggling a little bit, because it's, like I said, it’s nothing to be ashamed of, is really the moral of that story.

These things can happen and sometimes we need some extra help. The other thing to know is to talk to your partner or some other close person to talk about your emotions and how you’re feeling. Not only so you have someone to talk to and someone to vent with, but also to help you keep track of where things are going.

Sometimes a close partner, close friend or family member is a little bit better at saying like, oh yeah last week you were feeling that way. And it's changed, it's either gotten better or it's gotten worse. It can be hard for us, especially like you said, when you're so absolutely exhausted of trying to keep track of one more thing.

Host: Right. I think, correct me if I'm wrong, but it seems like a lot of women don't want to admit to postpartum because they feel ashamed and you keep saying, it's no fault of your own, but I think moms can't get past that and they don't know cause it's their first time around. Sometimes, I think when you're in the hospital and you're going to be released, you have to fill out this whole form about postpartum and answer all these questions.

And I wonder if somebody just answers them just to get released, even though they are suffering from postpartum and they think, oh, I'll be okay when I get home. I just want to get out. What happens when that is an issue like they get home and then the husband calls you or the friend and says, oh, my wife does have postpartum? And now she's home.

Dr. Kienzle: Yeah. So the most important thing is that you get that earlier appointment and that's okay. There are two things that can happen, I think one, someone just wants to get out of the hospital or two in that moment, they do feel great, but it can change so rapidly. Or just like you said, it seems like something that's going to be okay. And then maybe it is the next day or two days or three days later where you say actually, it's not okay. One thing I love about my specific position as a family medicine physician is that I get to see mom and baby together.

I see a newborn at like a three day old visit or so, and then I see them again at two weeks old and every time I get this little bit of a check-in with mom, and it's amazing to me how things do change rapidly and that's also a normal thing to be happening. And it's just a huge adjustment, right?

Host: Right. I always kind of felt a little bad, just a little for my husband. Cause I think, oh, the poor dad is just like kicked to the curb and no one's paying attention to him and they're tired too. They don't know what's going on with the wife. They're trying to learn everything. Do you take care of the husband's or the partner's wellbeing as well?

Dr. Kienzle: I do actually. Yeah. And that's, again, sort of this kind of unique spot that I get as a family medicine physician. It’s funny that you mentioned it like that because you almost just quoted how my visits go. We talk about the baby. I spend a lot of time really talking to mom about, hey, how are you doing? How are you feeling? How worn out from breastfeeding are you? I talk about breastfeeding, total tangent here, but is its own struggle. Cause you're trying figure it out and you're like, gosh, am I doing good enough? Am I producing the milk I need to? So I, we talk about all that stuff.

And then at the end, I kind of say, dad, you matter too, are you okay? More often than not the dad's like, oh yeah, I'm just hanging on, you know, I'm here for her. And that's kind of the counsel I usually give. To remind the dad that he has mental health and can be exhausted and it's okay for to ask for help too. We don't see the same rates of postpartum depression in men, but I do always wonder in my own kind of internal processing of like, they're exhausted too. And sometimes they need help and it's important that we ask them too.

Host: So if the partner or spouse sees a change in the other person, whether it's the mom or the dad, how should they approach them so they don't get defensive or how can they get them to open up and possibly seek help if they need it?

Dr. Kienzle: Oh, my gosh. That is a great question. The first step I think actually happens before the baby's born. And first we call it postpartum depression in the postpartum period, but it can start during pregnancy too. We talk sometimes about prevention, postpartum depression prevention, and we find people that are higher risk, whether it's because of a history of depression.

Sometimes we actively treat before it even comes in before the postpartum period's even around. And that can mean different things, whether that's therapy or talking or having a plan in place or medications. But to get back to your question, like I said, the first thing with every pregnancy, every family, every set of parents so I say, hey, you remember that after the baby's born, things can be great. It's okay to talk about these things and to talk about your emotions. And that's definitely a big thing that I ask women often, is do you feel comfortable with your partner expressing how they feel about you or if they have concerns and are you going to be able to handle that conversation and making a plan?

Sometimes it's more of like a code word thing or, or it's a plan. Yeah. I just would like them to write it down for me.

Host: Excuse me. To be honest, I have to tell you when I was in the hospital and I got that postpartum form, I did not tell the truth because I wanted to go home. And my husband is watching me fill it out. And he said, come on, you got to be honest. And I said, don't worry about it. Just want to go home. And he was like, trying to convince me. There's a reason they give you this form. So I guess what I'm saying is do you stress to people how important it is, to be honest on those inquiries?

Dr. Kienzle: Yeah. I do. I do. And, and it's tricky because I think a lot of times it's really, it’s having a relationship like for me, it's I always hope anyways, that I have a relationship with my patient where they feel like they can be honest. And because I also, I get to see my patients through their prenatal care and then also deliver them typically, as long as I’m not running away on vacation or something, but I hope to always have a good relationship with my patients so that they can be honest with me. But the reality is that, yeah, you're right. I think people are sometimes just wanting to get out of the hospital and I stress the importance of answering honestly, no one's going to worry that you're not going to take care of your baby, that you're a bad parent or that we're going to keep you in the hospital longer. We ask those questions to have a plan to see, hey, this is what we need to do for the next week, right. Or for the next couple of weeks. If we ask the questions to make a plan, not to trap someone in with us because we want you guys home with it. We want the parents’ home with their babies too.

Right. We know actually that families do better when they're at home. That's why we try to get them home as soon as we can, who likes to live in a hospital longer than you have to.

Host: Especially now with, with the pandemic. Dr. Kienzle parents can read all the books, take all the breathing and breastfeeding classes and prep classes. And somehow when that baby arrives, it seems like you're still not prepared. So, how do you get parents to feel comfortable ahead of time before the baby comes? Or is that even possible? How do you prepare them?

Dr. Kienzle: Yeah, I guess I honestly say that it's, I don't know if it is possible and that's what, that's the advice I gave to people. Whatever happens afterwards, the first step is just being okay with it. Whether it's your emotional trials or just, gosh, I didn't realize how hard it was going to be to put on a diaper in the middle of the night.

I mean, that's what happened with my first kid. My wife found me the next morning and I had a diaper wrapped around the kids' knees and she said, don't you know how to put on a diaper? I forgot at some point in the middle of the night. But yeah, just being willing to say that yeah. Parenting is different every single time for every parent and we're all just doing our best. We do all the little extra things. So, you have the breast pump in place and have a plan in case emotions don't go the way that we're hoping to. We have all our the parent bag, basically of all the newborn supplies ready to go.

And all those things help to decrease a little bit of stress. Having a support person at home, if you need them ready for you. But in the end that's the whole thing you don't know when baby's coming and, and you just have to be willing a little bit to say we're just going to go with the flow.

Host: Right running on faith, I guess like that Eric Clapton song.

Dr. Kienzle: Exactly.

Host: What's the most common misconception do you think about being a new parent?

Dr. Kienzle:  That is a great question. I think the most common complaint is that we can plan at all out. We want to plan everything we possibly can. I mean, you're talking to the guy that was really just saying like, oh, have a plan in place. But, but I think that's our biggest misconception is that we think we can control things and we have to be willing to do that common thing, if I can say it right. But let go of the things you can't control.

Host: Right. And those books.

Dr. Kienzle: Go with that.

Host: Those books, What to Expect When You're Expecting, I read it cover to cover. I'm like afterwards, why'd I even read that I mean, I'm not putting the book down, obviously it's helpful, but like you say, you never know until that baby has arrived and you figure it out as you go along. And I know we're focusing on new parents, but just out of curiosity, what about parents who are having their second or third baby? Because that must come with a whole new set of challenges because you have other kids at home, do you them the same way, mental issue wise?

Dr. Kienzle: I treat them the same way as, as first-time parents. And I tell them is that every pregnancy is a little bit different. Every kid, baby's a little bit different. I have two children and what I say to everyone is our kids are only apart by two years and I totally forgot by the time the second kid came, I had already forgotten how to be a parent. Or how to be a newborn parent anyways. Right. And so I, I tell people that you forgot everything and that it's okay. And that this is all for the first time, all over again.

And I feel like that's hopefully helpful because sometimes the emotions might be different and we can beat ourselves up for saying it wasn't like this before or what's wrong with me? Why wasn't, I don't remember it like this before or whatever it is. And that's one of the things on how to safeguard our mental health is to have a lot of patience with ourselves and a lot of self-compassion and, and knowing that, you we're just all doing our best here. And it takes a village.

Host: That's great. It's so true. So when families grow older, since we're on that, what positive mental health strategies can parents model for their children?

Dr. Kienzle: Yeah a lot. I talk to a lot of parents. We see every kid every year and have all these well-child checks. One of these things that is a frequently recurring thing is consistency. So, consistent disciplinary methods. And that we've talked about for kids, but it also means for parents and with each other.

It's kids, children thrive on consistency. Anytime we introduce variables and that can be also our own emotional health. The way we talk, the way we discipline, the way we interact with each other, as parents or partners, I think that is a huge thing that helps to be a good example for our children.

And to always act with love and patience. We talk about different disciplinary methods that don't work. Anger doesn't work. And we forget that again with parents and how they interact with each other, everything about kids learning, how they're going to behave is really not, I don't want to say a hundred percent of the time, but a lot of it is reflective of how their parents act with each other.

Host: True. Dr. Kienzle, this has been so helpful. Is there anything else you'd like to add that we didn't touch on? I love the part you said about being compassionate with yourself.

Dr. Kienzle: Yeah, probably just put more emphasis on that, honestly. Compassion with ourselves, with our partners, with our situation. I mean, for me as a physician, that's probably my biggest thing is having compassion and empathy for everyone's different situations. And then to reflect again on that thing of gosh, I would just wanted to get out of the hospital.

I was willing to fill out those sheets. However, it happened. It however, I felt like would help me get out of there. I think you should be filling out those sheets at every one, the newborn visit, the well-child visit. And sometimes we have this expectation of filling them out in a certain way and I can't emphasize to me the most, the most important part for me. I guess, as a physician, the most important thing to me is that I have a relationship with my patients where they can trust me and know me and, and be totally honest. I would emphasize that. Ah, everyone that's listening today please just be sure to be as open and honest as you can be with yourself, with your partner and with your providers, because everyone just wants to be on that same team.

Host: Right? It'll make it go much smoother. Don't you think? Yeah. Thank you so much, Dr. Kienzle, this has been great, very helpful information. I appreciate you being here.

Dr. Kienzle: Yeah. Thank you so much. It really was fun.

Host: Great! To learn more, please visit SkagitRegionalHealth.org. That's S-K-A-G-I-T. This has been Be Well with Skagit Regional Health. I'm Maggie McKay. Thank you for listening.