1 in 5 Women Hide This: The Truth About Pregnancy Depression (Part 1)

Are you struggling with depression during pregnancy but afraid to talk about it? You are not alone, as up to 20% of women will experience a significant mood disorder during pregnancy or after birth.

Find mental health and addiction treatment near you: https://recovery.com/

In this episode, host Terry McGuire sits down with Dr. Karen Sheffield-Abdullah. Dr. Sheffield-Abdullah is a professor, a nurse-midwife of 20 years, and a researcher specializing in Black maternal stress and anxiety. We dive deep into the often-misunderstood world of perinatal mental health, breaking down the crucial differences between antenatal depression, pregnancy anxiety, and the standard "baby blues". Dr. Sheffield-Abdullah explains how the hormonal shifts of pregnancy, like the dip in progesterone, can easily mask clinical depression.

We also tackle the most searched questions on the internet regarding maternal mental health. Does crying constantly affect your baby's development? Are antidepressants actually safe to take during pregnancy? What are the real risks of leaving depression untreated? Dr. Sheffield-Abdullah provides evidence-based answers, reassuring expecting parents that treatments like talk therapy, mindfulness-based stress reduction, and SSRIs are both safe and highly effective. She also explores the "Superwoman Schema" and how the pressure to maintain a stoic exterior prevents many—especially Black women—from being vulnerable and seeking help.

Whether you are pregnant and experiencing unexplained mood swings , or you are trying to support a loved one who might be quietly suffering, this episode offers compassionate, actionable advice. You'll learn how to successfully advocate for yourself at the doctor's office , simple mindfulness techniques like body scans to break the cycle of "bed rotting" , and why it is so important to build a strong support system early on.

⏱️ Chapters:

00:00 – The Truth About Pregnancy Search History 

01:01 – Antenatal vs. Postpartum Depression Explained 

02:40 – Baby Blues vs. Clinical Depression Symptoms 

06:47 – Why Pregnancy Causes Severe Anxiety 

09:20 – Does Crying Affect My Baby's Development? 

11:05 – Are Antidepressants Safe During Pregnancy? 

14:02 – Overcoming Guilt & The "Superwoman Schema" 

21:57 – Am I Depressed or Just Hormonal? 

29:48 – The Real Risks of Untreated Depression 

36:08 – How to Stop "Bed Rotting" & Seek Help 

❓ Questions the Video Answers:

1. What are the signs of depression during pregnancy? 
2. Is it normal to have extreme anxiety while pregnant? 
3. What is the difference between antenatal depression and perinatal depression? 
4. Does crying while pregnant hurt the baby's development? 
5. Are antidepressants like SSRIs safe to take during pregnancy? 
6. How do you know if you are just hormonal or clinically depressed? 
7. What are the risks to the baby if depression is left untreated? 
8. How do you tell your OBGYN or doctor that you are depressed? 
9. What can I do to stop "bed rotting" and lack of motivation while pregnant? 
10. Can untreated pregnancy anxiety cause premature birth? 
11. How can mindfulness and body scans help with pregnancy depression? 
12. Does hating being pregnant affect bonding with the baby later? 
13. How can I prepare for postpartum depression during my second or third trimester? 
14. What is the Superwoman Schema in maternal mental health? 
15. Why do hormonal shifts cause the baby blues? 

#PregnancyDepression #MaternalMentalHealth #PregnancyAnxiety

Transcript

SPEAKER_01 0:00

If you want to know what I'm worried about or what I'm stressed about, ask me what I'm Googling.

SPEAKER_00 0:05

Karen Sheffield Abdullah is a professor and midwife specializing in black maternal stress and anxiety.

SPEAKER_01 0:10

If your search history is about pregnancy and pregnancy-related complications or things that can go wrong in pregnancy, that is anxiety provoking.

SPEAKER_00 0:22

Welcome to Recoverable. I'm your host, Terry McGuire. Today we're going to begin the first of two episodes around pregnancy-related depression. It's important to talk about because about 20% of women will experience a significant mood disorder during pregnancy or after birth. A quick note on language. While we will primarily use the terms women and mother in this episode, we do recognize that not everyone who gives birth identifies with these labels. And we want to acknowledge that pregnancy-related mental health impacts birthing people of all gender identities. Joining me is Dr. Karen Sheffield Abdullah. Welcome.

SPEAKER_01 1:00

Thank you for having me.

SPEAKER_00 1:02

Thank you for being here. Before we dive in, I'd like it if you would just give us an understanding of the different kinds of depression that can occur during pregnancy and what they're called.

SPEAKER_01 1:12

Yeah, so it's interesting. I am somebody who is very interested in maternal mental health. And as I've done research over the decades and reading the literature, it can be called a lot of different things. And so it's not surprising that people can get confused. So you might hear it called antenatal depression, or sometimes people will call it maternal depression. Sometimes people do call it perinatal depression. But when we talk about perinatal, perinatal really spans the time period of pregnancy and up to one year postpartum or 12 months after birth. So perinatal is really across that time period. But sometimes you do hear people talk about perinatal when we're talking about depression during pregnancy. So just want to clear that up because not technically correct. And then there's postpartum depression. Some people also call it postnatal depression. So and that's um what occurs after you've had the baby. So there are two time periods antenatal or antipartum, and postnatal or postpartum are the time periods. Yeah.

SPEAKER_00 2:23

We're going to be talking this week about during pregnancy. Next week, we will focus on post-birth. So during pregnancy, what is normal to experience in terms of fluctuations in your moods and everything else because of the fluctuations in your hormones?

SPEAKER_01 2:40

Yeah. So it varies. And so people will talk about the baby blues or the postpartum blues, and they'll say, oh, you've got the blues. And typically that can peak around day three to five or so, up to about two weeks. And typically that can involve not really feeling so much like yourself, maybe a little weepy, maybe a little excessively tired more than usual. Sometimes not feeling like taking care of yourself or wanting to take care of your baby. But if that persists, that's when we get more concerned. So if you're crying for 24 hours or longer, if you're feeling like you're not wanting to take care of yourself or take care of the baby even past the two-week mark, that's when we get more concerned about a postpartum depression. But the postpartum blues are really due to the hormonal shifts that happen after you have a baby. So as soon as that placenta is out, progesterone dips. And so when with that progesterone dip, individuals respond differently to that hormonal shift. Some people will develop a postpartum depression, some people will just have the blues. Some people will have no nothing at all, right? So really wanting to understand that there's a continuum that happens across maternal mental health that people can find themselves on. And one of the things that I really like to talk about at the beginning is not necessarily labeling people as like, oh, that's a depressed person or oh, that's an anxious person. I really invite us to reframe, to really think about this. That's a person who's coping with the symptoms of depression. That's a person who's coping with the symptoms of anxiety. So we take the label off the individual and really put it more on the symptoms and how they're managing that. Because a lot of times it's not about necessarily giving a clinical diagnosis, what we call the DSM V criteria of how we would define depression or anxiety. But the symptoms matter. Yes. And how we absolutely are impacted and our loved ones are impacted by the symptoms alone, not just the definition of meeting a clinical diagnosis of postpartum depression.

SPEAKER_00 4:53

And we're talking about a fairly significant number of women who are going to be experiencing symptoms.

SPEAKER_01 5:08

Right. So one in five, about one in five, depending on the literature that you're reading. So some will say one in seven for postpartum depression, but typically we see between 10 to 20% of antenatal depression. And for postpartum depression, it's more closer to the 20% amount. So it's very similar. There's not a lot of shifts or changes, like all of a sudden there's a huge jump. What I will say is that if you have experienced depression or anxiety prior to pregnancy, it is more likely that you will develop anxiety or depression during pregnancy. And if you have pregnancy-related depression or anxiety, you're much more likely to develop postpartum depression or anxiety. And you keep hearing me bring in the anxiety piece because I think we study depression quite a bit. Agreed. We do not study anxiety nearly enough. And oftentimes they come together. They're what we call comorbid. So they exist together. Many people who are depressed are anxious, but not everybody who's anxious is depressed. And so really wanting to remember those individuals who are working through anxiety during the postpartum period or even during pregnancy due to concerns about what's going on with a pregnancy. If they're having a pregnancy complication, psychosocial stressors, life, I'd like to say life life be life in, right? So things are happening for them that can really ratchet up anxiety. And sometimes that can lead to depression as well.

SPEAKER_00 6:47

I think in terms of anxiety, being a mother myself, and I know you are as well, it'd almost be a surprise if you didn't have some anxiety because every single thing in your life is about to change or has just changed. That would be anxiety provoking, especially a first child. It's like, I've never done this before. And we train more to drive a car and get our license than we do to have a child.

SPEAKER_01 7:09

That's a good point. Right? That is a good point. And I think you're right. I think the anxiety piece can be pretty big, especially in this day and age of social media. Right. So when we think about people being on their socials, they're they're hearing different things about different people's experiences. And more times than not, we take away the the negative experiences. We don't always hear about the positive things that have happened during pregnancy. Um, and so it can be anxiety provoking if you're Googling what can happen during pregnancy. And that's uh something that I found in my research. I asked perinatal people, are you having conversations with your healthcare providers surrounding your stress and your anxiety? Right. And it was a resounding no.

SPEAKER_02 7:58

Right.

SPEAKER_01 7:58

Right. And I uh I also asked, would you have wanted to? Right? Resounding yes, I'm guessing. Well, they said only, they said yes, but only if. Only if they're going to be able to get me into resources that are going to be available for me.

SPEAKER_02 8:14

Oh.

SPEAKER_01 8:14

Um, if I'm going to be able to get into a healthcare provider in a timely fashion and that there's not a three-month wait for me to be seen. Are they going to take my insurance? Things like that. So there were there was a caveat, if you will, of don't ask me just to ask me. Ask me and make sure that you have the resources that are needed for me to be able to get better. And so it is not uncommon for people, as you said, it's more common than not for people to feel anxious. One of the things that one of my participants said was if you want to know what I'm worried about or what I'm stressed about, ask me what I'm Googling. And so really think about that. Like if people want to know what's on our mind, what's on your mind, what's on my mind, look at our search history, right? And if your search history is about pregnancy and pregnancy-related complications or things that can go wrong in pregnancy, that is anxiety provoking, right? And so that's, but if I ask an individual, what are you Googling? and then they tell me, then we can have a conversation, right? It's a nice way to open that up.

SPEAKER_00 9:20

It is also a nice way to segue into the most asked question and the most searched thing on the internet about depression during pregnancy, antipartum depression. Does my pregnancy and crying all the time affect my baby's development?

SPEAKER_01 9:35

Yeah. So that's a really interesting question. And what I would say is, why are you crying all the time? Right. So we'd want to get at that, but crying itself doesn't impact the baby. Babies are pretty resilient. They get what they need during pregnancy. But I think if you're crying all the time and you're having feelings of hopelessness, helplessness, worthlessness, not able to take care of yourself, not able to take care of maybe other family obligations or work obligations, that's a more concerning pattern and a conversation that we would want to have about your stressors. Because indeed, what we do know is that if you're also stressed from crying is caused is caused by the stress that's going on for you, then we're worried about cortisol levels, right? And we know that increased cortisol levels can impact a pregnancy. And we do know that depression can impact preterm birth and low birth weight. We know that anxiety can impact preterm birth and low birth weight. So crying itself will not impact the pregnancy, but we need to dig deeper into what the crying is about so that we can know whether or not it's actually impacting or could impact the pregnancy in some way.

SPEAKER_00 10:54

So if the crying is related to depression and or anxiety, and it can cause complications, doesn't that make it all worse?

SPEAKER_01 11:05

Um it can make it all worse, but I I would say that we have lots of um resources, right, for for folks. And so there are different ways that we can um get people hooked in and wraparound services that will be able to impact um their depression, right? So we know that medication during pregnancy is okay. There's a lot of um people who get counseled off of their medications during pregnancy. And what I will say is that for the most part, we have medications that have been tested, tried, and true that are absolutely okay to take during pregnancy. And we should not be counseling women off of their medications during pregnancy. Because what can happen is they stop their medication and then they have a 50% chance of relapse or it getting worse. So I'd rather have somebody on their medication than off their medication and then having to deal with the repercussions of that. Now, many SSRIs are safe during pregnancy. So that's one thing. Talk therapy. We know that therapy works well. We know that medications work well, we know that medication and therapy work even better. So making sure that we put hook people in to both is really important as well. I'd be remiss if I didn't mention that I'm a mindfulness instructor trained in mindfulness-based stress reduction. And so certainly thinking about integrative health approaches like mindfulness, like yoga, like tai chi, whatever it might be for an individual to get involved with to help with their mental health as well. So there are different things that we can be doing to improve people's mental health during the pregnancy period.

SPEAKER_00 12:50

In that answer, you mentioned SSRIs. I just want to say those are antidepressants for somebody who may or may not know.

SPEAKER_01 12:56

Selective serotonin reuptake inhibitors, right? So they are antidepressants that people can take, for the most part, very safe, things like Zoloft or Prozac or Lexapro or Solexa. Certainly, I'm not telling you to go out and take those, right? But to have a conversation with your healthcare provider because those are thought to be quite safe during pregnancy. Um, and we're not wanting to have people stop. You know, I'd be remiss if I didn't mention that because I can't tell you how many times I talked to individuals who have been told to stop their medications during pregnancy. And that's surprising in 2026 to be hearing that.

SPEAKER_00 13:32

So we talked about whether crying and the cause of the tears, of course, can affect a baby's development. So many mothers or mothers to be feel guilt or shame because they think we're supposed to be a certain way, which would be like thrilled that we are are pregnant and going to have a baby. How does that complicate things when we're maybe less likely to share what we're feeling because we think we're supposed to be feeling something different?

SPEAKER_01 14:02

Yeah. So I think that's an important point to bring up that society puts this label on the way that we're supposed to be feeling when we get pregnant. And certainly there are individuals who have unintended pregnancies that are wanted, unintended pregnancies that perhaps they feel ambivalent about, pregnancies that were intended, but they still feel a little bit worried or concerned about how am I going to provide for this child or how am I going to be as a mother? What how am I going to be? How are we going to be as a family unit, perhaps with partner? So certainly that all can be complicated, but not necessarily detrimental to the baby, right? So there's a lot of people who find out they're pregnant way after they have engaged in different types of behaviors, or, you know, perhaps had it had an alcoholic drink and they're really worried now. Is that okay that that happened? Or they're in less than optimal situations, perhaps living situations or whatever, and they're just then they find out that they're pregnant. For the most part, like I said, babies are fairly resilient. They do very well. And this ambivalence that you may feel about being pregnant isn't necessarily detrimental to the baby, but I think it's a bigger conversation to be having with your support system. And it's a very individual endeavor, right? At the end of the day, it's it's affecting you and mostly you and really getting hooked in, as I have mentioned before, if you're feeling uh some type of way about the pregnancy, being able to talk to somebody and work through what those emotions may be, um, and having a deeper conversation about where it's coming from.

SPEAKER_00 16:03

So, all of that, the importance of talking to somebody, of reaching out, of sharing what's going on. If you think you're supposed to be feeling a different way and you're shameful about the fact that you're not, that reduces the likelihood you're going to. So, if somebody in our lives, how would we know if they're experiencing depression or anxiety during pregnancy if they are reluctant to share it because they're ashamed of it?

SPEAKER_01 16:29

Yeah, that's a good question. I mean, I think it's all about communication. It's all about normalizing conversation. Um, so that's one of the things that I'm a big proponent of is normalizing the conversation surrounding mental health. I think we're doing a better job of that. I think there are individuals in mainstream media who have had more conversations about their mental health, like Serena Williams, right? So she's talked about her postpartum depression. Allison Felix has talked about her postpartum depression. She's an Olympian track star. Um, you have people like Simone Biles, gymnast, who's talked about her anxiety, Naomi Osaka, tennis player, right? So we have individuals, um, especially from diverse um backgrounds, coming out to talk about, hey, this is what's going on for me and my mental health. And it might be an opportunity if we're picking up on any slight differences or nuances with our loved ones to say, you know, did you see, you could bring it up in a different way. Did you see that Serena Williams talked about this? Or what do you think about that conversation? Or did you hear about Naomi Osaka or Simone Biles or Taraji P. Henson is another, is an actress who um has come out and talked about her anxiety. So really taking the time, if you know this person really well, to look for subtleties. Are they sleeping more than usual? Now, that's a hard one because you sleep during pregnancy, right? But more than what you would expect. Um, are they not engaging in things that they used to engage in that would bring them joy or happiness? So picking up on those subtleties, what's going on with them? How are they eating? Are they eating much less than usual? Are they talking less? Are they more withdrawn? Are they isolating? And then perhaps having that be an opportunity to have a little bit of a conversation. Now, you're not necessarily a therapist, but really being able to have that conversation of I noticed that, you know, you're not eating as much, or I noticed that you didn't want to come out with us to do whatever it might be that they usually enjoy. Is there something going on or something that you want to tell me about? But it's not uncommon, especially given kind of the historical taboo surrounding mental health for people to not necessarily want to talk about their mental health, um, especially during pregnancy, but really paying attention and picking up on cues as you as possible.

SPEAKER_00 19:13

Yeah, I appreciate that because I I know the list of symptoms for depression and have been advised to say, you know, I'm noticing these changes in you, but I actually really like your idea of coming in, I won't say like I will say sideways, you know, and saying, hey, there are these people in the news who are talking about it. And what do you think? That's a really um nice way, I think. A little indirect, but a little less threatening too, because you're not going to be as defensive and say, like, well, I'm fine. Right. You know, because you're like, oh, yeah, yeah, I get it.

SPEAKER_01 19:43

Yeah. That's good enough. And as you were talking about this um idea of people kind of not wanting to share what's going on with them emotionally. Um, that's directly related to my research. So I utilize a conceptual framework called Superwoman Schema. And Superwoman Schema was developed by Dr. Cheryl Woods Gisgombe, who is my dissertation chair. She's a colleague, she's a mentor. Basically, she says that there are certain socio-historical and cultural perspectives that have happened in this country at the intersection of race and gender that have caused, and this is specifically for black women, but that have caused many black women, certainly not all, to develop five hallmark characteristics. And they are emotional suppression, maintaining a stoic exterior, resistance to being vulnerable, determination to succeed despite limited resources, and wanting to help others, even at the detriment of our own health. And so when we think about those five characteristics there, I think we can also think about it within the perinatal space, which is what I do. I really utilize those five characteristics to kind of guide what my research questions are, and also having a conversation with black perinatal people about how are they emotionally suppressing, right? Right. And usually it it'll come up in different ways when they share their experiences of resistance to being vulnerable because I don't want CPS to be involved, the child protective services to be involved when my baby is born because I had a vulnerable moment and I shared with my healthcare provider something that was going on with me, and they took it too far or took it to a place that it didn't need to be. So I just wanted to mention that conceptual framework as you were talking about um kind of people wanting to um emotionally suppress that is absolutely uh the case.

SPEAKER_00 21:44

Absolutely. Things happen. You don't want the reaction. You want to feel different, but you don't want the reaction. So the second most searched question about depression during pregnancy is how do I know if I'm depressed or just hormonal?

SPEAKER_01 21:58

Mm-hmm. Yeah. So uh it gets back to again, more of are you sleeping because you're tired from pregnancy, or are you sleeping more than what you would even expect due to pregnancy? Are you laying in bed for hours and hours and hours? Are lack of motivation, also thinking about helplessness, hopelessness, like we had mentioned before, also worthlessness, having feelings of wanting to hurt yourself, right? Not wanting to do the things that you normally would want to do. These are all signs of depression, which are very different than just feeling kind of hormonal or kind of up and down a bit. Um, also feeling sad, right? Feeling like um you don't know how you're gonna make it. Um perhaps having a plan on um wanting to hurt yourself or hurt others, those are concerning um symptoms of postpartum depression. Feeling anxious, right? So I as I mentioned, they often come together, depression and anxiety. So are you worrying? Are you excessively worrying? Um, I often say that um many times we're not in the moment. We're off worrying about the future or ruminating about the past. What are you doing? Where are you in in each given moment? So those are some of the differences that you can see between a postpartum depression and just feeling hormonal. Yeah.

SPEAKER_00 23:38

Is there a typical time frame for pregnancy symptoms that, you know, it's a mood swing because of the hormones? And then all of a sudden, like, no, this is something different.

SPEAKER_01 23:48

So I would say earlier on in the pregnancy, you can have a little bit more of mood of mood changes or kind of feeling hormonal, just because there's a lot of changes that are happening hormonally during that time. Second trimester, people usually feel pretty good for the most part. Not everybody, but people would typically feel pretty good. And then third trimester, you can start to feel a little bit more um hormonal or feel like there are some shifts or changes that are happening. Um, so I would say first trimester, third trimester is where you're typically going to see more of these um depressive symptoms potentially come out. But I think also we have to take into consideration psychosocial stressors and pregnancy complications. So what's going on if you're if you're dealing with a pregnancy that is complicated by gestational diabetes or complicated by unfortunately having a child that you know is going to have some type of anomaly or complicated by preocclamia, those types of things, um preoclampsia is high just for simplification purposes, high blood pressure during pregnancy. Okay. It's more severe than that, but just for the purposes of the listeners just thinking about high blood pressure during pregnancy, when you have complications during pregnancy, that can increase your chances of having a depression. If you're having housing instability, transportation issues, interpersonal issues with partner and family members, all of those things can contribute to depression as well. Financial concerns, work concerns. A lot of times people need to take time off potentially for not feeling well during pregnancy, but they don't want to use all of their time, right, that that they may need after the pregnancy. So I've talked to individuals who have felt that that was really difficult to navigate because they're having low back pain. They need to take time off, but they don't have the time to take off, right? So um work conditions can also contribute to depression as well.

SPEAKER_00 26:04

And all those things are so real and so I think expected, because it is going to have an impact on your finances. It is going to have an impact at it, having a child, I mean not the child itself, you know, on your relationship, on your everything. Those are all really valid concerns. It's like how you internalize them, metabolize them, how what they trigger.

SPEAKER_01 26:26

Right. What they trigger. And I think, yeah, it can happen, but certainly there are highly resourced individuals where these things happen and it doesn't impact them nearly as much. Understood. Right. So wanting to think about the ways that we think about what we call social drivers of health or social determinants of health, these things that I just talked to you about with housing and transportation and um psychosocial stressors that may be coming in can absolutely impact individuals very differently. Yes. And we were talking um earlier about the levels of changes in hormones, but it'll impact each person differently just based on your own chemistry, your own physiology, your own history. So while it might just be, you know, you say, well, it's common, I would expect that people would feel stressed or anxious, or, but it can really be impacted by the life course, what has been your experience across your life, and how um that is impacting you in this moment.

SPEAKER_00 27:37

If someone really hates being pregnant, does that have any impact on their bonding with their baby later?

SPEAKER_01 27:43

Yeah. So bonding, interestingly enough, it's not as uncommon. Difficulties with bonding isn't as uncommon as we might think initially. And it it can it can happen. Um certainly sleep deprivation um can impact bonding your relationship with your partner and how that is going um in the postpartum period can impact bonding. But for the most part, it does work itself out over the days and the weeks of the postpartum period for the for the most part. Um, if you're having real difficulties with bonding, you don't feel like wanting to take care of your baby. If you're able to recognize I need a break, and you're able to put the baby somewhere safe while you take a break, that's less concerning than not knowing that you need to take the break, right? So that's where we get more concerned. Um, do you have a partner where you can say, I need you to take the baby because I need to step away? I'm getting really agitated or irritated, um, or there might be some rage. You really want to make sure that um you are in a position where you're able to connect with partner, family member, mother-in-law, whoever it might be, to be able to take care of the baby and make sure the baby is safe. If that's not happening, then that's more concerning. And we definitely need to get you um connected with a healthcare provider in emergent situations, calling 911. Um, and that's really extreme to need to be able to do that, but wanting to make sure first and foremost that mom is safe and baby is safe.

SPEAKER_00 29:34

Absolutely. So we talked earlier about the safety of antidepressants, at least some during pregnancy. I want to ask about the flip side of that equation. Are there risks for the baby or the mother if the mother's depression is untreated?

SPEAKER_01 29:48

Yes. So if mom is untreated and she is depressed or anxious, there are risks in terms of increased risk of preterm birth and low birth weight for a baby. Yes, absolutely, with untreated depression. So we should treat it's it's it's important to realize. But yeah, we should be treating we should be treating folks. I mean, if people have high blood pressure, we give them an antihypertensive. Right. I I I know we say it and it's very cliche, but if somebody has um issues with their blood sugar for diabetes, then we we treat the diabetes, right? But somehow for mental health, we have to question whether or not it's appropriate to give the appropriate medication, whether it's a SSRI or antidepressant or SNRI or whatever it might be, we absolutely need to be treating it so that we can decrease the chances that they're going to have an adverse pregnancy outcome like preterm birth and low birth weight.

SPEAKER_00 30:46

If someone does choose is prescribed antidepressants during pregnancy, does it mean they will always have to be on them?

SPEAKER_01 30:53

Yeah, that's a great question. So no, it doesn't. Yep. It doesn't mean that they'll always have to be on them. In my opinion, and this is an area that I'm very passionate about, we we're just taking it moment by moment, taking it day by day. We're not thinking too far down the road. We just want to make sure that we're able to get the individual stable. So my first and foremost, as a nurse midwife of 20 years, priority is to treat the symptom and make sure, or symptoms and make sure that they are getting what they need and that they're feeling better. And then we can think down the road, right? But let's, let's, let's get you to feeling better and ideally seeing you two weeks postpartum, not waiting until the six-week postpartum visit.

SPEAKER_02 31:43

Okay.

SPEAKER_01 31:43

I feel pretty strongly about that, especially as it relates to um uh mental health. I think we diminish how important it is to check in with individuals, especially with all the hormonal changes that are happening. Six weeks is too late, and we know that the six-week postpartum visit is notoriously not attended. Because if they feel good, they're not coming back. It's usually only if they don't feel well that they come back for the six-week visit. So, two weeks, check in. How are you doing? How are you feeling? How is your mood? How are you doing with the baby? How are you bonding? If you're breastfeeding, how's that going? Do you have support at home? Like all of the things that we need to know to make sure that you're doing okay. And if you're not, what is the appropriate step? Getting you on some type of medication. And then also, I emphasize not really thinking about how long you're gonna be on it. If it's six months, if it's a year, if it's two years, it's it's whatever is needed. And then first and foremost, thinking about the fact that if we start you on something and then you're at a really good place and you're thinking you want to stop, we're not stopping cold turkey. Right. We're gonna do a nice taper to where your body is able to adjust and we can uh see how things are going. And it might be that we decrease the medication and you're like, ooh, I'm not sure how I'm feeling about getting off it. I might need a little bit more time at this dose, right? And and then adjusting. So it's really about shared, what we call shared decision making and having a conversation with checking in with one another on a periodic basis. It might be monthly, it might be every two weeks, depending on if you're with a therapist, I might not need to see you as frequently. So, because the therapist is taking care of things and I'm just doing more of medication management. So it depends. You're the mother of four. I am.

SPEAKER_00 33:43

Did you feel during your pregnancy that your mental health was even a factor that other people considered or were you checked in on?

SPEAKER_01 33:52

That's a really good question. So you're right. So thank you for mentioning that. Yes, I'm a mother of four. So I have a 28-year-old, a 25-year-old, a 23-year-old, and a 14-year-old bonus daughter through my second marriage. I would say that I was treated the way most people probably in that time period were treated. I was given a piece of paper that was a screening called an Edinburgh uh postnatal depression screener uh for depression, and I circled what I felt on those things, and then I don't recall anybody talking to me about it. Yeah, me neither. So I would say that I probably didn't score high enough to be for them to worry about me. So they just they were kudos to them for giving me the screener and scoring it. But what we know is that for screeners, we really it's a jumping off point to have a conversation. So I'm supposed to bring the sheet in with me, right, to talk to you and say, so I see that you answered this way.

SPEAKER_00 34:56

Right.

SPEAKER_01 34:56

Tell me a little bit more about that. Right. So it's it's an opportunity for a conversation. I think those conversations aren't happening and we're missing depression and anxiety. And I actually think it's higher than what our statistics state. And don't get me started on lots of other things, but I also think that culturally there are nuances with different cultures and how they identify with anxiety and depression. And I don't think that the existing screeners pick up on that at all. So I think we're missing it for people of color, unfortunately. So, but no, I don't think that um I got optimal care um when it came to my mental health. I think I was taken good care of um for the most part for my pregnancy. Right. But as it pertains to my mental health and my stress, probably not.

SPEAKER_00 35:50

Probably not.

unknown 35:52

Yeah.

SPEAKER_00 35:52

I would have to agree. I don't think it was even on the table. And I was a lot earlier than you were. So okay. This we talked a little bit about being in bed, but this is a term that's all over social media bedrotting. Is bedrotting a sign of antenatal depression or depression during pregnancy?

SPEAKER_01 36:08

Yeah, so good question. And I think with bedrotting, um staying in bed and just hanging out there uh for long periods of time, it's gonna go back to the same things that I've been saying before, which is it's concerning if it's accompanied with feelings of helplessness, hopelessness, worthlessness, not wanting to do anything that brought you joy, isolation, feelings of wanting to harm yourself, feelings of wanting to harm yourself with a plan, wanting to hurt somebody else? Those types of things are more concerning than hanging out in bed for long periods of time. I mean, we can have a conversation whether or not that's a really good idea to do, right? You know what I mean? But who among us has not perhaps spent more time in bed scrolling, you know, looking at their phone, looking at whatever TikToks or watching Netflix or whatever it might be, and you just lose track of time. That's very different than a shift into a postpartum depression. So really wanting to hit home, the the sadness that can be there and also that anxiety that can also be there that we need to be looking for for antenatal depression.

SPEAKER_00 37:33

So for someone who may be listening or watching and has maybe even from bed, what are some tiny manageable steps that you know can help to shift someone and break the cycle without overwhelming them?

SPEAKER_01 37:48

One of the things that I would say is trying to there's there's this term of um getting out and touching grass. Now, of course, it's I'm in Wisconsin and it's really cold. So uh don't know about touching grass, but like getting out, um, shifting perspective, going for a walk, even getting on the phone, talking to a friend. I've got to talk about meditation because of mindfulness. Um doing a sitting meditation, doing a body scan, which you can do in bed, which can lead to calm or peace, or just a sense of getting back to this present moment and getting out of kind of losing sense of time with this bedrotting, right? So meditation, going for walks, these are little things that you can do. Um, listening to music, listening to podcasts, um, things of that nature that um can bring you little semblances of joy, right? It might even be um like I I listen to one particular podcast that I know is going to make me laugh. Right. So it's just something that allows me to kind of elevate my mood and just kind of takes my mind off of maybe some things that I might be stressed about. So um thinking about those types of things that you can do.

SPEAKER_00 39:14

Yeah. You brought up a body scan that you can do in bed. Can you give us a quick uh summary of how that process works?

SPEAKER_01 39:22

Uh yeah. So the body scan is one of my favorite mindfulness practices to engage with. And it's really about falling awake, not falling asleep. And so being aware of what is here in this moment and checking in. I often will tell um when I'm leading a body scan, I often ask people to envision uh a small flashlight that's shining on the different areas of the body as I talk them through it. And you're just thinking about what sensation may be present, what's calling your attention. You're quieting the mind so that you can notice what's here in this moment. In the foot, in the knee, in the hip, in the back, right, in the neck, in the brow, in your cheeks. Right. So I'm talking you through each body part. Body scan can take anywhere from 20 to 45 minutes. Wow. Depends on your level of comfort with a longer body scan versus a shorter body scan. But it's a beautiful way to really bring you to the present moment of what's you're feeling in your body. Now that doesn't work for everybody because some people don't like to feel what's in their body. And so we want to be trauma responsive and trauma sensitive to what works for people. And if they find that they're in a body scan and they're being activated in any way, stop the body scan. That's not serving you. So let's not do that, right? But if it's an if it's appropriate and it feels safe for you to do that and engage in that, it's a beautiful way to kind of bring yourself back to this present moment in a way that takes you out from the bed rotting.

SPEAKER_00 41:12

If a pregnant person is struggling, do you recommend that they bring someone with them to the doctor so that that other person can both monitor that symptoms are being disclosed and addressed?

SPEAKER_01 41:24

Yeah. My my initial thought is only if that person is going to be helpful for them. Right. And so um thinking about who is that, who is that person for you and the level of trust that needs to be there for you to be able to divulge whatever may be there for you in your mental health in front of this person. Um, but absolutely I'm thinking about partners, I'm thinking about um in-laws, I'm thinking about parents or grandparents that might be able to come just so that they can, like you said, just have an understanding of what's going on for you and also be able to monitor um if there are shifts or changes once you get home that they they can pick up, pick up on and be able to be helpful with.

SPEAKER_00 42:13

Continuing on the theme of the doctor's appointments, how do you tell your this is one of the search questions, so it's in first person, how do I tell my OBGYN or primary care physician that I'm depressed?

SPEAKER_01 42:24

I I really think that we can advocate for ourselves in meaningful ways and say, you know, something feels off for me. I don't really know how to explain it, but something, I don't feel like myself. Something feels different. And it's been since whenever it is, right? So it might be first trimester since we're talking about antenatal depression. It might be first trimester, second trimester, third trimester. And you can even say, I have no history of depression, or yes, I have a history of depression or anxiety. And then just say how you feel. I feel sad. I feel like I don't want to do things. I feel like really unmotivated. I feel nothing. I feel nothing. I feel numb, right? Just say what it is. And a really good healthcare provider will respond to that. Right. So I'm hoping that listeners and viewers are not feeling like they would not be able to share that with their healthcare provider. As a nurse midwife, I really want to say that from a healthcare provider standpoint, I want my patients to be able to come to me and have that conversation. And oftentimes I will say to somebody, because I really believe that it's important to be culturally humble. I don't know that I can ever be culturally competent in another person's culture, but I can be humble enough to say, what do I need to know about you in order to be able to take the best care of you so that you can have the best outcome?

SPEAKER_00 43:57

That would also be a good question for. Us to ask, you know, our partners and the people in our lives, what do I need to know about what you're going through to be able to support you? I'd love that.

SPEAKER_01 44:08

Absolutely. And so I think in in having conversations with the healthcare providers, just say it. I mean, we hear a lot. Over the 20 years of being a nurse midwife, there's not much that I can be surprised by, right? So, and we're trained to be able to do this, right? Educated to be able to provide support. Some of us have been educated a little bit more than others. And I will say mental health is definitely one area that is lacking in medical education and nursing education. I think we need to have more of that, especially surrounding perinatal. So during pregnancy and during postpartum. So this is really important that we're having this conversation. But definitely healthcare providers have to do their due diligence in order to be able to provide care for this population given the prevalence of anxiety and depression.

SPEAKER_00 45:06

In the beginning of our conversation, you mentioned that if you have a history of depression, you're more likely to have antipartum or depression during pregnancy. And if you have depression during pregnancy, you're more likely to have postpartum depression. With that last part of the equation, are there things that we can do in, say, our second or third trimester that will in some way lessen or mitigate, even maybe avoid depression postpartum?

SPEAKER_01 45:30

Yeah, that's that that's a really interesting question because it's multifaceted, right? So there's so many different factors that contribute to your risk for postpartum depression. Some of it is just biology, right? Some of it is just our genetic makeup, um, and some of it is psychosocial stressors. Um of it is uh the nature of the environment that we're in. And so taking that into consideration, what I would say is having a great support group, if you need a support group, like a mom support group of some sort, uh some sort that you can do during the pregnancy period, um, talking to folks. There's also um centering pregnancy. I don't know if you've heard of that before, but centering pregnancy is group prenatal care.

SPEAKER_02 46:25

Okay.

SPEAKER_01 46:25

Um, where um pregnant individuals all around the same time of pregnancy come together and they do their prenatal visits together.

SPEAKER_00 46:37

Wow.

SPEAKER_01 46:37

So we're listening to fetal heart tones, we're measuring bellies, we're doing a blood pressure, we may be checking urine, like doing that, but we're also having a conversation. So everybody is hearing the same thing at the same time. So that one, it's helpful for me as a provider to be able to talk to 10 to 15 people at the same time about what to expect at 15 weeks pregnant. But what is also important is that they're hearing from their peers. Oh, I had that. This is what I did.

SPEAKER_03 47:06

Right.

SPEAKER_01 47:06

So it's really a really nice way to um have some support. So as we're thinking about ways to maybe decrease your chances of a postpartum depression, getting into psychosocial support, getting into involved with uh things like I talked about, like mindfulness, um, also um getting in talk therapy, potentially, um potentially getting on medication during the pregnancy so that we can decrease the chances that you would have a severe postpartum depression, um, because there's different levels to uh to the severity of the depression. Um so though those are some things that you could try um prior to the having the baby that would set you up for success, if you will.

SPEAKER_00 47:55

That connection and that interaction sounds so important because if you could say, like, I am really, you know, also you might have your support where you say, I need a break and somebody else in that group. How would someone find a group like that?

SPEAKER_01 48:06

The centering pregnancy they would find through their OBGYN practice or their midwifery practice. It is something that is done more with midwives. Um we tend to be a bit more holistic in in the way that we approach care, less medicalized. Um and then as far as like mommy and me type uh groups, Facebook is full of them.

SPEAKER_02 48:29

Okay.

SPEAKER_01 48:30

So, you know, going on social media and and and looking for those types of uh support groups exists for sure. Yeah.

SPEAKER_00 48:38

So there have to be mothers to be watching or listening to this who are saying, I told somebody how I was feeling. And all I was, all I heard was, everybody feels that way. Everybody who's pregnant feels that way. And it's dismissed.

SPEAKER_01 48:54

Well, what what I usually will say is go find somebody else. Yeah. Go talk to somebody else. And as somebody who is um uh in full transparency navigated anxiety my entire life, um there are really good mental health care providers and not so great mental health care providers. And there are those that have like their bag of tricks, and once that's exhausted, they don't know what else to tell you, right? Or what else to do. Um, and I have had to be a fierce advocate for myself to say, well, that's not working for me, and I'm on to the next person. And it can that be exhausting? Absolutely. Is it fair that the onus is on the patient? No, not at all. But I will say that if you feel like you are not being heard, seen, or valued, you absolutely need to go on and move on to the next provider. There are good providers out there who will absolutely um take your concerns very seriously and not dismiss you. And if you're being dismissed, it's time to move on.

SPEAKER_00 50:00

I'm gonna ask a question that may be controversial to ask. Is there a difference between a male, someone who has already given birth themselves, I won't make it about gender, and someone who hasn't, in terms of understanding the complexities of pregnancy and anxiety and depression?

SPEAKER_01 50:16

Yeah, so that's an interesting question. I think you can argue it both ways. I think you could say, yes, obviously, somebody like me who's had three children and parenting four, um, my ability to be able to empathize and perhaps identify with some of what is going on with my patients is there. It's it's higher because I've I've had lived experience, right? However, I don't think I have to have the experience of being a diabetic to take care of a diabetic.

SPEAKER_00 50:53

Understood.

SPEAKER_01 50:54

I don't have to have had hypertension to take care of somebody with hypertension or empathize with what their symptoms may be on a particular medication or something like that. So I'm hesitant to say that for sure, you know, if you've had a baby before, you can empathize more than somebody who hasn't. I think there are plenty of people who have empathy and are able to provide stellar perinatal care who have never had children in the same way that I can provide care for individuals who have, you know, conditions that I've never had, right? So yeah, that's how I would answer that question. Although, do I think that perhaps I I bring in um a level of understanding to the conversation with my patients who are pregnant? Yeah, I do. Yeah, but you do.

SPEAKER_00 51:48

So and I had a male OB just to for on the record, and I thought he was, as you say, stellar and um, you know, helped me with all the aspects of it.

SPEAKER_01 51:56

So I've had a mixture of all of them. So I've had a male OB, I've had a female um nurse midwife, and then my third baby, as I um had told you before we um started the podcast, my third baby was an unplanned home birth because third babies are really fast. And she came out in my bed. And so there you go. Um, but uh, I would say that there were pros and cons to each of the pregnancies and the pregnancy experiences.

SPEAKER_00 52:25

Thank you for your time. Yeah. We'll wrap up this episode here, and we will be back next week to continue this discussion, and the focus will be on postpartum depression and all of the things that a person can experience after giving birth.