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Dr Mini Tandon: Hi, I am Dr. Mini Tandon. I am a child and adolescent psychiatrist with St. Louis Children's Hospital, and I am a mom Doc.

Melanie Cole (Host): Have you heard of the fourth trimester? It's when a new mom is recovering from pregnancy and delivery while learning to be a mom as her baby. To life outside the womb, but for new moms, struggling with that physical and emotional changes that follow childbirth really can be a period of significant adjustment. Welcome to Mom Docs, the podcast from St. Louis Children's Hospital. Today we're talking about the fourth trimester with Dr. Mini Tandon. Dr. Tandon, thank you so much for joining us today. I'd like you to start by outlining a little bit about postpartum mood disorders. We're gonna talk about the fourth trimester, but tell us a little bit about the prevalence of these type of mood disorders.

Dr Mini Tandon: Sure. It's estimated that about 10% of women will experience postpartum depression or another more serious version such as postpartum psychosis, sometimes anxiety. And depending on your risk factors in your family, and also depending on whether you've had depression previously, you can be at an even in more increased risk.

Melanie Cole (Host): So it really is very prevalent. Now tell us about this fourth trimester. We've heard about the terms baby blues and postpartum depression. This is a little bit different than that. Can you explain what's happening with mom during that fourth trimester? What does that even mean?

Dr Mini Tandon: So fourth trimester has become a common phrase that's used for describing the first 12 weeks after a baby is born. And there's a lot of changes that occur with mom. She's obviously experienced the new baby and a new switch in her family routine and life. And there's all of the physiological changes, hormone shifts that occur with mom that can really make her tired and emotional. And baby blues is part of, a normative process the first couple weeks. But when it goes beyond that, that is when it's time to get help and get checked up.

So after a couple weeks of some emotionality and fatigue, we should have a somewhat more sense of resilience and return to somewhat normal mood. However, for a number of women, symptoms become more severe, sleepless appetite, even suicidal thoughts. People can have very sad and persistent mood ideas of harming the baby or themselves. And that is very serious and should absolutely be taken seriously and people should support this mom. Get her help, either first talking back to her OB GYN, if that's easier, and then getting referred to a professional in mental health, psychiatry therapy, psychology, all fair options.

Melanie Cole (Host): That was very good answer and really offers up what we're looking at in the scope of this issue for new moms, and I remember when I was a new mom the first time. It is very overwhelming. Speak about some of the tips that you would give new moms to cope with some of these challenges that we face. Obviously, support system going to be one of the top on these lists, but we have to also think about self-care. And all of these things because as you said, there's so many things going through our minds and fear and worry, and we're just really not sure what to expect, and especially for first time moms, give us some coping tips.

Dr Mini Tandon: Absolutely. I think one of the good things you can do as a first time mom is to try to prepare while you're pregnant and think about who your village will be, who your support network is, who will share caregiving responsibilities, if anyone. Even if you have to enlist neighbors and friends that you haven't seen in a while, because absolutely mom will need rest and breaks and friendship to get through these times. And I think after baby is born, it's I like the analogy of the airplane, which is you must put on your own mask before you can be of help to your baby.

Melanie Cole (Host): I love that one as. well

Dr Mini Tandon: I use it all the time in our field, but this is really critical, right? Because you forget that you also are human. You have brought a human into the world, but if you do not care for yourself emotionally, how will you take care of this infant? And studies indicate that well moms have, well babies, and it's a lot better for development of a baby to have a healthy bonding mom. And so it is very important that you support this mom and that you have a care plan. If you'll have med adjustments or appointments that you'll have to go to, maybe do that planning ahead while you're pregnant and enlist people to help with cooking, whatever it is to help get you through with your other toddlers or kids. But if you're a first time mom, you still need the help. and so I think getting some momentum on that before baby comes is helpful.

Melanie Cole (Host): I agree with you to plan on some of those things. And I'm a planner and probably before that baby was born, my lists were, had their own version of their own lists, and it went on and on. So tell us a little bit about warning signs, because we can think to ourselves, okay, this is just hormones right now, or, oh gosh, I just feel a little bit overwhelmed. Okay. And it's okay to feel these things, but What are some of the warning signs? You mentioned a few earlier, feelings, these intrusive thoughts, and moms, we get a lot of these. Tell us some of those red flags that signal, you know what, reach out now for help?

Dr Mini Tandon: Yeah, if it's gone beyond two weeks since you've had your baby and you're having very persistent, pervasive thoughts of sadness, irritability, low mood that are not really remitting, and that you're still having very big problems with sleep and appetite changes. If you're having any thoughts of wanting to harm yourself or thoughts of harming the baby or you're getting obsessional where you just feel like you can never even turn your head and something will happen to your baby.

These thoughts can be very risky. They are signs of a potential serious mood disorder, and they need to be evaluated by a professional who sees women who understands what normative postpartum blues is from and can distinguish that from what is pathological or need psychiatric and or mental health help.

Melanie Cole (Host): What are some of the things that if you do reach out, can be tried? I mean, are we looking, some women might be afraid to take antidepressant medications. If they're nursing, what are some of the tried and true methods that you would work on with people and new moms? And do you involve the spouse or the partner or other members of the family to help with that type of therapy?

Dr Mini Tandon: Yes, absolutely. There are many options. We do try to enlist the help of a partner because again, that's part of the village that's helping this mother get through. And people are often worried when I talk to them about medicines, especially if they're going to nurse, and that is not always the first and only option. In fact, it can be delayed, but I think at least talking to a therapist and planning and seeing how you do with a diotic established therapy for mother infant for example, there's also just depression treatments like cognitive behavioral therapy for mom.

There are supportive therapies that can be tried, but we do also have a larger and larger evidence base as time progresses that common antidepressants can and will treat postpartum depression like they will treat major depressive episodes when you're not postpartum. And so with careful management and a doctor, these medicines are adjusted. Baby can be tracked by pediatrician. and people do well, and people are very afraid of medications, but I would say at least be willing to talk and consider the whole treatment plan before deciding. It's absolutely not right for you.

Melanie Cole (Host): That's great advice, Dr. Tandon. Really, really good advice. So tell us just a little bit about some of those self-care. We've talked about the support system, we've talked about all of those things as we think to ourselves. Trying to keep that positive thought process, trying to keep that enthusiastic look to the future. Being excited. As we said, you and I both use the phrase, put your own mask on. I'd like you to reiterate as we wrap up here, your best advice for this fourth trimester for women. How we need to take care of ourselves because otherwise we can't take care of our loved ones. And how also reaching out for help, there is no stigma to that, and it's really what we have to do to be our own best health advocates.

Dr Mini Tandon: Absolutely. So one, I would say the first thing is to try to plan ahead while you're still pregnant about who you're gonna enlist in your village, who's gonna help care for baby and take turns while mom rests, food planning and as soon as baby's born, as soon as you're feeling up to it to start engaging in their lifestyle behaviors like walking. Start slow, exercise as tolerated and advised by your doctors. Getting out and about with baby in the stroller, making sure you're not stuck in the house all day long.

Making sure you're not isolated. making new friends through different support groups in the community, all of that can contribute to a healthier postpartum life. And to help you enjoy a good time rather than getting demoralized and exhausted and overwhelmed. That doesn't mean you couldn't still have postpartum depression, even when you're doing everything well. And so that's why it's important to think about those risk factors and seek treatment.

Melanie Cole (Host): I agree with you completely and what great advice this is. It's such an overwhelming. Time as we've stated, but it's also such an exciting, happy time when you're having that baby and it's new and cute and just, it can be very overwhelming. So moms, listen to what Dr. Tandon said. Reach out if you do need help and remember the importance of that self-care. Dr. Tandon, thank you so much for joining us today, and for more advice and articles, please check out the Mom Docs website at childrensmd.org. That concludes another episode of Mom Docs with St. Louis Children's Hospital. I'm Melanie Cole. Thanks so much for joining us today.