Pregnancy: Understanding Postpartum Depression (Part 2)

Are you feeling overwhelmed, angry, or disconnected after childbirth? You are not alone—nearly 20% of new mothers experience postpartum depression, yet many suffer in silence due to a paralyzing sense of shame.

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

In this essential follow-up, host Terry McGuire continues the conversation with Dr. Karen Sheffield-Abdullah. Dr. Sheffield-Abdullah is a PhD, researcher, and nurse-midwife with over 20 years of experience specializing in perinatal mental health. While Part 1 focused on pregnancy, this episode dives deep into the "fourth trimester," exploring why the massive dip in progesterone after the placenta is delivered can trigger everything from the "baby blues" to severe clinical depression.

Dr. Sheffield-Abdullah addresses the "elephant in the room": the terrifying intrusive thoughts many mothers experience but are too afraid to voice for fear of Child Protective Services (CPS). We discuss the critical differences between normal exhaustion and medical red flags, including postpartum rage, anxiety, and the rare but serious condition of postpartum psychosis.

This episode is a roadmap for recovery, highlighting the importance of the two-week postpartum check-up and providing resources like Postpartum Support International (PSI) and the 988 crisis line. Whether you are a new parent or a loved one looking for signs, this video offers the language and hope needed to navigate the challenges of early motherhood.

⏱️ Chapters:

00:00 – [Intro] Postpartum Depression vs. The Blues 

00:54 – How Common is Postpartum Depression? 

07:30 – What is "Normal" for a New Mother? 

09:19 – When Does it Become a Medical Problem? 

12:27 – Who is Most at Risk for PPD? 

21:57 – Is it PPD or Just Sleep Deprivation? 

23:25 – The Truth About Scary Intrusive Thoughts 

24:58 – Addressing the Fear of Child Protective Services 

30:27 – How Long Does Postpartum Depression Last? 

40:05 – Understanding Postpartum Rage and Psychosis 

❓ Questions the Podcast Answers:

1. What is the difference between postpartum blues and postpartum depression? 
2. How common is postpartum depression in new mothers? 
3. Why does my mood change so drastically after giving birth? 
4. Is it normal to cry at commercials after having a baby? 
5. When should a new mother seek medical intervention for her mood? 
6. What are the symptoms of postpartum anxiety and OCD? 
7. Are intrusive thoughts about harming the baby common? 
8. Will I lose my baby to CPS if I admit I have depression? 
9. What is the perinatal psychiatry inpatient unit at UNC? 
10. How can I tell my partner I think I have PPD? 
11. How long does postpartum depression typically last? 
12. Why am I experiencing "postpartum rage" and anger? 
13. What are the signs of postpartum psychosis? 
14. Is it normal to have trouble bonding with a newborn? 
15. Where can I find a postpartum depression helpline? 

#PostpartumDepression #PostpartumAnxiety #MaternalMentalHealth

Transcript

SPEAKER_02 0:00

We have studied postpartum depression. We have not looked at postpartum anxiety nearly enough. And we know that it is actually just as prevalent.

SPEAKER_00 0:08

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

SPEAKER_01 0:14

Does postpartum depression make me a bad mother?

SPEAKER_02 0:17

Absolutely not.

SPEAKER_01 0:21

Welcome to Recoverable. I'm your host, Terry McGuire. Today we continue our discussion with Dr. Karen Sheffield Abdullah about the impact of pregnancy and childbirth on mental health. We're going to focus this episode on postpartum depression or depression after birth. A quick note on language. Dr. Sheffield Abdullah, welcome back. Thank you. Last week we focused on depression during pregnancy. This time we're going to talk about postpartum or after pregnancy and after childbirth. So before we dive into the internet questions, tell me what do we need to know about postpartum depression? How common is it? And how is anybody supposed to know if they have it or if they're just reacting to the change in their life?

SPEAKER_02 1:16

Yeah. So with postpartum depression, we say that it occurs in about one in five pregnancies. So about 20%. You may see some places where it says one in seven, but for the most part, we can think about 20% of birthing people, moms, mothers, women will experience a postpartum depression in their lifetime. So really, what is postpartum depression? It's something that occurs typically after two weeks of pregnancy. The prior to that, we usually see it more as postpartum blues. But if it lasts longer than two weeks, then we're really thinking more of a postpartum depression. And it can go up to one year postpartum. If it goes beyond that, then it's really more just depression. And it can include sadness, hopelessness, helplessness, worthlessness, feelings of wanting to harm yourself, feelings of wanting to harm yourself with a plan, feelings of wanting to hurt others, feeling anxious, worrying, inability to sleep, sleeping more than usual. There's a lot of different characteristics to the way that the body responds to this shift in hormones after pregnancy. So what we know is that there's a really big dip in progesterone once that placenta is delivered. And it's really individualized how one responds to that change or shift in progesterone. For some people, they'll be completely fine. But for some for others who may be more susceptible to postpartum depression or depression in general, it will occur for them. So that's really how we think about postpartum depression. And did you say would usually start about two weeks after birth? Well, yeah. So you can see it at two weeks postpartum for sure. But I was just making the distinction that if it's prior to two weeks, we don't typically diagnose that as a postpartum depression. It's more postpartum blues at that stage. Okay. But I mean it can happen fairly early in the postpartum period.

SPEAKER_01 3:27

When I hear the list of symptoms, and I have depression, so I know what some of those feel like and look like. Are we paying enough attention to postpartum depression if one in five women are experiencing it?

SPEAKER_02 3:39

Well, as somebody who is really interested in perinatal mental health, I'm gonna say no. Right? Agree. So I don't think that we're looking at this enough. I do, though, in full transparency, think that we have studied depression quite a bit and postpartum depression. We have not looked at postpartum anxiety nearly enough. And we know that it is actually just as prevalent as postpartum depression, if not more prevalent than postpartum depression. What I think is that what we know is that within medical schools and nursing schools, there just has not been enough attention paid to the perinatal mental health. So what happens is when you have somebody who has graduated now and is a physician or a nurse or a nurse practitioner, we may not be as well versed in what to expect in the postpartum period or during the perinatal period. And when I say perinatal, I mean during pregnancy and up to one year postpartum. Okay. So I just don't think we're as educated in what to look for, or we're just not as comfortable having conversations with individuals surrounding their stress and psychological distress during pregnancy and the postpartum period. I would love for us to get to a place where we normalize these conversations, where they're not taboo, where it's a question like we ask medical history, medical history, surgical history, family history, and also your mental health history. And we normalize it in that way so that people aren't feeling uncomfortable when they need to talk about it.

SPEAKER_01 5:14

I have so many questions and we'll we're gonna get to them all, but I I just keep thinking about the number of women who are new mothers and they're feeling anxiety, depression, and all of the rest of it because of the changes in hormones in lifestyle and all of it, being dismissed because they've just given birth to a child. And it's like, yeah, that's just even our mothers-in-law and our mothers and our grandmothers saying we all feel like that after we give birth.

SPEAKER_02 5:41

Yeah, yeah. I think that's a really good point. And and and families, especially as we think about older generations, are thinking that's just normal. That's so I had that too. Right. Well, you were depressed, right? You know what I mean? So but they weren't necessarily given that label per se. And so I think it is really it is a lot to be thinking about all of what the postpartum individual is navigating during that immediate postpartum period and figuring out their hormones and and figuring out how their body is responding, and also having to take care of a newborn, and also if they have a partner navigating their relationship with their partner. So there is a lot that's happening all at once that they're trying to figure out, navigate, work through, and it can be a lot. And I think it's really important for us as healthcare providers to have our finger on the pulse of what is really happening with our patients so that we can intervene sooner than later. And so I really advocate for seeing patients at the two-week postpartum visit, not waiting until the six-week postpartum visit. One, because a six-week postpartum visit is known to be underattended. Because typically, if somebody feels good, they're not coming back in for their postpartum visit. I wish they did, but they don't always do that.

SPEAKER_01 7:03

Or if they're not feeling well and they're depressed and they're not coming in because they don't have the energy to do that too.

SPEAKER_02 7:09

That is also a very real possibility, right? So checking in at that two-week postpartum visit is really important to be able to just check in how are things going? How how's if you're breastfeeding, how's breastfeeding going? How are you feeling? How's your mood? How are things going with partner? How are you bonding with baby? All of those types of things are really important conversations to be having because it lets us know how mom is adjusting to this new period.

SPEAKER_01 7:36

Okay, so mom adjusting to new period. Maybe before we dive into postpartum depression and anxiety, we should talk about what's normal. What's normal for a new mother to be experiencing that is different than something that is a medical condition or a problem?

SPEAKER_02 7:52

Yeah, so what's normal is to feel a little weepy or as we say, a little bluesy. I can remember personally after the birth of my first child watching a commercial and crying at the commercial. And I was just like thinking to myself, so why are you crying at that, right? Like I just feeling a little bit more emotional about things, um, feeling tired, feeling maybe a little bit sad. It depends on what your prenatal course was like or what your postpartum delivery was like, right? You're also processing through was there a C-section? Was there a complication? So you might be navigating, kind of thinking through what happened there. So that's not uncommon. You may feel a little bit anxious or worried. It's not uncommon for new moms to feel that way about baby or worried or anxious about yourself. And is this amount of bleeding okay? Is you know, what, what, what am I, the changes that are happening in my body, is that is that okay? But also thinking about baby. One of the things that comes up all the time is is the baby breathing? Because they're such shallow breathers, right? They're they're very shallow breathers, those little ones. So worrying about that, worrying about is the baby peeing or pooping enough? Is the baby getting enough milk? If you're breastfeeding, I can't really quantify how much they're getting. So, like, is that going to be enough? And so it's not uncommon in the postpartum period to feel a little anxious or worried as well.

SPEAKER_01 9:26

So, where's the line? How do you how does a person who's just given birth know, and the people supporting that person, how do you know when it's a problem and a medical condition versus a normal natural reaction to a huge change in your life when you've given birth?

SPEAKER_02 9:41

Yeah, when it becomes all-consuming, right? When you're not able to recognize that, oh, I'm crying at a commercial, but you're crying for 24 hours or longer. You're not able to take care of yourself, you're not able to take care of the baby, you're having feelings of wanting to hurt the baby or hurt yourself. You may be feeling some rage, you may be feeling excessive worry. People can also develop what we call postpartum OCD, right? So we also worry about that as well in terms of anxiety and maternal mental health conditions that can happen in the postpartum period. So worrying about them sleeping more than usual, than what you would expect in the postpartum period. Self-isolating, not wanting to be with family members or loved ones, not wanting to do the things that would normally bring you joy, those are the types of things where we're that's kind of the line where we're saying, okay, we need to be a little bit more concerned here.

SPEAKER_01 10:37

So even within that list, there seem to be different things because if I or or somebody who's just given birth is sleeping a lot, that's gonna has a different risk factor than having thoughts of harming myself or my child. So where's again the line when some intervention needs to happen, where some care needs to happen, it's like, oh, this is important. This is a problem.

SPEAKER_02 10:59

I think when the person who is with the uh birthing person or with the mom, whether it's partner or mother-in-law or mother, when most people have a gut feeling when they notice something is a little bit different with the with how anxious somebody may be about wet diapers or how many wet diapers. Are they counting how many wet diapers? Are they, you know, worried about whether or not um they're getting in enough food or or milk. When the sleep seems to be excessive, not just taking a nap, but not wanting to get out of bed, not wanting to take care of themselves, that's a clue to say that that's concerning. And certainly any um indication of self-harm or harming somebody else, that's a clear um call somebody. We need we need help, right? So if the person, if the person is themselves feeling like they want to hurt themselves and they call 988, which is a suicide crisis hotline, right? But there's also postpartum support international, which is um a great resource and they have a helpline, and they have a helpline both in English and in Spanish and can help connect people to healthcare providers in their respective areas. So they're a national kind of database or repository, if you will, that will will be able to help. So I want people to make sure they know that they are not alone and that we can absolutely help them. Postpartum support international, also known as PSI.

SPEAKER_03 12:34

Okay.

SPEAKER_02 12:34

If you Google them, they will come up with the and they will have the um the phone number for both the the um the English hotline and the Spanish hotline. And then the for suicide uh crisis line, it's 988. Right.

SPEAKER_01 12:49

Are there people more at risk for postpartum depression than others?

SPEAKER_02 12:53

Yeah. So if you have experienced what we call antenatal uh depression, which is depression during pregnancy or pregnancy depression or maternal depress depression, but depression that has happened during pregnancy, you are absolutely at higher risk of developing depression during the postpartum period. Okay. If you've developed, if you have depression at any time during uh life, you can be at increased risk for a postpartum depression. But certainly depression during pregnancy increases your risk of postpartum depression for sure.

SPEAKER_01 13:27

Can you address the prevalence of shame around postpartum depression? Because we're supposed to be so happy we have a newborn. And when we're not feeling happy.

SPEAKER_02 13:38

Yeah, so I think that we've had more national conversations surrounding mental health in this country in recent years. People like Serena Williams talking about her postpartum depression. We have folks like Allison Felix, who's an Olympian track uh runner. She talked about her postpartum depression. We have individuals like Naomi Osaka and Simone Biles who have talked about their anxiety. So we have these kind of high-profile individuals who've talked about depression and anxiety. And I feel like some of that shame and stigma that has traditionally kind of been around mental health concerns is starting to lift ever so slightly. But I really would say that part of the work that I do is I try to come on and do podcasts like this, but also do things like grand rounds around the country to talk with my OBGYN colleagues about the importance of us having conversations with our patients surrounding their stress and psychological distress and normalizing that conversation so that it's not just all on the patient to be able to advocate for themselves, but we as healthcare providers are normalizing that conversation and ideally normalizing it during pregnancy, preconceptually even better, but definitely during pregnancy, so that when we get to the postpartum period, it's just a continuum of the conversation. How are you doing? How's your mood? Is there anything I need to know about you to take the best care of you possible so that you have an optimal outcome? Do you have a history of depression or anxiety? Um, if so, when? How long did it last? Were you medicated for it? So things of that nature, get getting a really good history so that we can have a conversation and hopefully take away some of that shame that is felt in the postpartum period. Because it is true. A lot of times people think that they should be blissfully running through the lilies with their baby and feeling okay. And that's not always the case. And we need to hold space for individuals who don't feel that way.

SPEAKER_01 15:50

And we've talked about social media because, you know, there are going to be the rabbit holes where you start to go down and you think, oh my gosh, you know, I'm I'm gonna have psychosis, and we'll talk about that in a bit, but all the things, and you can get yourself really quite nervous about it, which will not help your anxiety. There's the other side too, whereas you say, running through the lilies and the the they're wearing matching outfits, and the mother looks like she is pre-birth weight and her hair's clean, and you're not. So that is a factor that certainly wasn't uh around when I was having children.

SPEAKER_02 16:22

Yeah, and I I I I have seen on social media a little bit of pushback there where we we talk about kind of this kind of like rebounding right after you have the baby where you you're bouncing back to your pre-pregnancy weight and you're working out and you're looking amazing. And that's not true for most people, um, for most individuals. And so I have seen some social media where they're like, come on, guys, let's really have a real conversation about what a natural body looks like after giving birth. And for many, you still look pregnant, right? And so it it takes a while for that uh postpartum belly to um go back to its pre-pregnancy size. And so not wanting to rush that, but really taking the time and also hopefully people can shift their algorithms so that they're seeing more of things like that, right? Where we're shifting into normalizing what a real postpartum body looks like versus what some of the celebrities um can do. And I'm and I'm not saying that that's healthy either.

SPEAKER_01 17:25

If someone suspects that they themselves might have postpartum depression or that someone they care about does, what should they do?

SPEAKER_02 17:32

They should ideally talk to their healthcare provider. So talking to their OBGYN or their nurse-midwife and saying things like something doesn't feel right, or I feel off, I'm not feeling like myself, I'm having difficulty coping, I'm not motivated, I'm not wanting to take care of the baby, whatever that might be for them. So just describing what it is, and same for the loved one. It could be that at a visit, they bring that up. I wouldn't really recommend surprising the individual with a conversation that they don't know is about to happen with the healthcare provider. Like make sure that the person who you're worried about knows that you're going to have the conversation, right? You know what I mean? That you're going to mention it. So having that conversation prior to talking to the healthcare provider just for trust reasons there, but really wanting to make sure that you're just describing what's what's here, what's here in this moment. You're navigating what's worrying you. And with some of the individuals that I've had the opportunity to do research with over time, I've asked them things like, have you had conversations with your healthcare provider surrounding your stress and your psychological distress? And it's been a resounding no, right? And I really think that it's important that we normalize that conversation from the healthcare provider standpoint so that we can help the individual and hold space for them and say, I hear you, I see you, you're valued, here's the resources that I have. Let's see what we can do to get you connected as soon as possible. Now, there are times where I think the conundrum can be that we have an individual who is pregnant or postpartum, and OB says, Oh, you need to go to psych, right? And then psych says, Oh, you're pregnant or postpartum, you need to go to OB. So they're kind of being pushed back and forth between the two healthcare providers and not necessarily getting the care that they need in a timely fashion. And so that's one of the areas that I think we can really do a lot of work on. And that's why I emphasize so much about making sure that we're having conversations at the two-week appointment visit, which is not standardized. Like that, I'm I'm talking to my fellow healthcare providers and saying, let's do this, right? Let's talk to folks at two weeks postpartum. And then also pediatricians. A lot of individuals are being screened at their the pediatrician appointments because they're bringing the baby in so soon, before six weeks, that the pediatrician is able to ask questions like, How are your moods? How are things going, or distributing or administering the Edinburgh postnatal depression scale or the EPDS? That is the standard, standardized scale that is recommended by ACOG for us to be screening women with. ACOG being? ACOG being the American College of Obstetricians and Gynecologists.

SPEAKER_01 20:34

So if someone is listening, watching, and being shuffled, if they're like, yeah, that's happening to me right now. You know, they said I needed to see a therapist, they said I needed to see my doctor. What do you recommend they do?

SPEAKER_02 20:44

My recommendation is that they see their therapists.

SPEAKER_01 20:46

Okay.

SPEAKER_02 20:47

And preferably somebody who is very, very well versed in perinatal mental health. And there are all different types of ways to get that information. One is through postpartum support international, PSI. You can also uh look at NAMI, which is the National Alliance on Mental Illness. That's another organization that can be helpful. But um, I would say only because OB's midwives to some extent aren't as well versed in perinatal mental health because we're we don't get that education during our the our training, that going to the therapist is would be my first point of contact if possible, if you're getting bounced back and forth. Now, there are plenty of OBGYNs and and midwives who feel comfortable prescribing. Right. But if you're getting bounced back and forth and you feel like your OB does not feel comfortable with that, then go ahead with the mental health care provider.

SPEAKER_01 21:46

I'm going to shift to the internet searches now. And the number one most searched question by new mothers is how do I know if I have postpartum depression or if I feel the way I do because I am hormonal and sleep deprived?

SPEAKER_02 21:57

Yeah. So hor hormonal hormonal. Hormonal changes, um, absolutely that progesterone drops and you can feel different in terms of mood changes, right? So the the the mood shifts and also sleep deprivation is real. Yes. Uh babies, you know, they don't they don't sleep a whole lot, right? So they do, just not exactly when you want them to, let's just put it that way. So um the sleep deprivation is also very real. What I would say is that the hormonal changes and the sleep deprivation can lead to and contribute to the postpartum depression. So what we're wanting to do for somebody who's like, how do I know if I'm depressed? If you're having thoughts of hopelessness, helplessness, worthlessness, um, feelings of wanting to hurting your hurt yourself, crying for 24 hours or longer, not able to take care of yourself, not able to take care of the baby, um, sleeping longer than what you would consider is normal sleep for a postpartum period. Not wanting to eat, self-isolating, um, feeling worried, feeling anxious. Things of that nature are really concerning. And that's when you want to reach out to a healthcare provider and say, something's not right here.

SPEAKER_01 23:16

I smiled while you said that, not because I think any of that sounds fun or or nice, and I live with depression, so I know how not pleasant it is, but because you keep saying the list and it's so nice to keep hearing it. Because it's just like wherever someone tunes in in this episode, you're gonna get the list from you. And I appreciate that you keep saying it because it's important for us to know and be aware of for ourselves and for the people in our lives. So thank you. Yeah. New mothers I've talked to about postpartum depression frequently talk about scary or intrusive thoughts. Yeah. Talk to me about that, please.

SPEAKER_02 23:47

So intrusive thoughts are more common than you might think. Individuals, it's not uncommon to have intrusive thoughts come in. It's just whether or not you actually have the majority of people who have no desire to act on the intrusive thought. If you have the desire to act on the intrusive thought of maybe perhaps wanting to hurt your baby, or I won't give too many examples of the intrusive thoughts. Um dropping baby seems to be a big thing. Right. Dropping baby, maybe dropping baby in the tub, uh, perhaps things like that. You want to talk to somebody if if you're having that intrusive thought and thinking that it actually might really happen. A lot of times people have intrusive thoughts and they realize that they're not gonna do it. Right. They're just like, Right. I don't know why I'm thinking that, right? They're just like that. Where's that coming from? Yeah, where is that coming from? Why am I why is that happening? But they know that they're not going to act on it. If you're having an intrusive thought and also thinking, I might act on this, that's when you want to have a conversation with a healthcare provider immediately. Whether that's a 911 or reaching out to a healthcare provider in your area or again, postpartum support international, getting on that hotline and getting the name of a provider in your area.

SPEAKER_01 25:08

So let's address the elephant in the room there. There are a lot of new mothers who would be very afraid to tell someone that they are having those thoughts because they're afraid child protective services will take their baby away.

SPEAKER_02 25:20

Having your baby taken away is not necessarily as easy as people might think it is. Um and so, you know, obviously it's on a case-by-case basis and really understanding all of the psychosocial stressors and things that might be going on in that uh family. But more times than not, people can receive mental health care and not lose their baby. Good. Especially if you have family members and partners that can be there to help take care of the baby. Now, if you're by yourself and you don't have anybody else that can help you with the baby, then the baby might have to go into some type of protective services while you're getting taken care of. Just because you're working through a maternal mental health condition does not mean that you would have your baby taken away, even if you're having intrusive thoughts. There are intensive outpatient therapy organizations that people can attend and they keep their babies or they take their babies with them, right? Um, and then there is the perinatal psychiatry inpatient unit, which is at UNC. It's a five-bed unit for people who are acutely ill. So they're either suicidal or actively psychotic. And so there are individuals that are there. Now, on that unit, typically you don't have your baby with you on that unit because they really prioritize sleep for the new mom. So um, but even in those cases, they still keep their baby when they when they are better. So you said UNC. Yep. UNC, University of North Carolina at Chapel Hill. And there are others as well? There it's only that one in the country. Okay. But people fly from all over the country to come to that unit.

SPEAKER_01 27:07

So that fear though has to stop women from saying this is happening.

SPEAKER_02 27:12

Yeah, no, it does. And I I I have heard that many times where people will say things like, Well, I've been hesitant to say anything to my health care provider or to the nurse or, you know, the the nurse practitioner, the OB, because I in a vulnerable moment, I don't want things to be taken out of context and then have child protective services at my delivery or come take care, come take my baby from me. So that is a very real fear. I think there are times when that may happen, does happen, because I've heard that it has happened, but not necessarily that their baby was taken away, just that a social worker and child protective services shows up to have a conversation, but not that their baby was necessarily taken away from them. But even still, that's that's unacceptable to not be told that, well, as a result of what you share, there's a little bit of concern here. We're just gonna connect in social work just in case you need them. Like, you know what I mean? There's a way to have a conversation, there's a way for there to be shared decision making, for us to not blindside people, for them to be able to be aware of this is just precautionary.

SPEAKER_01 28:23

We want to protect you and the baby. Exactly. Yeah. So if we think a new mother in our life might have a postpartum depression, what's the way to approach them that won't lead to them just saying, hey, I'm fine.

SPEAKER_02 28:38

So one of the things that I think about in working with new moms is how is your mood? How are you how are you feeling? Or I've noticed that you've been sleeping a little bit more than I would expect after having had the baby. Uh what's what's going on there? Or you haven't wanted to come out with us to be with the rest of the family in the living room or whatever you've been isolating back here in in the bedroom. Is there something going on there? How how how are things how are you feeling? Right. So I I I I think it's approaching it with just compassion and holding space and and saying, it's okay. I'm here. You're not alone. Um, so that's the way that I would think about approaching it. Another way is um when I was talking a little bit about the prominent people in mainstream media who have voiced their own struggles with mental health, maybe approaching it in that way and saying something like, you know, what I had saw recently was that Serena Williams actually had postpartum depression. What do you think about that? Or um, or I saw that Allison Felix talked about her postpartum depression after her delivery. And I'm I'm wondering what what are your thoughts about that? And this is what they were saying, some of their symptoms were, or you know what I mean? And maybe being able to strike up a conversation in that way would be helpful.

SPEAKER_01 30:14

I think even saying one in five women can experience this lets you know it's not just me.

SPEAKER_02 30:19

Right. It's yeah.

SPEAKER_01 30:20

It's like, hey, there's this really common thing that might be happening, and I just want to check in with you and see if you have any of these.

SPEAKER_02 30:26

Yeah. And when you hear one in five, it really makes it more real. And especially thinking about the that prevalence, right? One in five, I think it sounds more prevalent than if you even say the 20%. Right. When you say one in five, it's just like, oh, right. Yeah.

SPEAKER_01 30:42

Looking around the waiting room in the OB's office, you're gonna probably have four other people there. Right, right. Exactly. Uh, the second most searched question about postpartum depression on the internet is how long does postpartum depression usually last?

SPEAKER_02 30:55

I think it's variable. I think it's whether or not an individual is medicated. Are they seeing a therapist? Uh how is that working for them? Do they have support at home? What are their other psychosocial stressors? Work, finances, transportation, housing, right? So I think there is so it's multifaceted. Gen genetics, um, however, we typically see that it can go up to a year, right? And potentially longer. It depends. Do you have other children, right? Are you able to just focus on yourself or are you having to focus on all of the competing demands that are in your life, right? So um, I don't know that there's a hard and fast about how long postpartum depression lasts, but my my initial thought are about one to two years. But that's just me, just based anecdotally on what I've seen within my own practice and um what I have read.

SPEAKER_01 32:01

That sounds so long. And when you're in the acute stage, the thought that it might last that long, that would be really bad news to hear. I'm assuming that if you are properly treated, medicated, seeing a therapist, those kinds of things, that you might still qualify or or have it that long, but it's not at that level anymore.

SPEAKER_02 32:21

Exactly. The idea is that you might still have the diagnosis, but that you're feeling much better. There you go. Yeah, right, exactly. So getting them connected in with um medication and with a therapist for sure, you're feeling much better. We're getting you the the idea is that we're getting people to a place where they really are fully functional in their daily lives and able to take care of baby, able to take care of things at home, perhaps able to work, um, able to take care of yourself. Exactly. So yeah, that that is that is the goal. That is the goal. So that's a really great point that while it might last for you might be medicated for a year or longer, you you might be medicated, but you feel much better. So good.

SPEAKER_01 33:10

I'm like a year. Do I wouldn't wish that I'm my worst enemy? Yeah. Another common question that new mothers ask is does postpartum depression make me a bad mother?

SPEAKER_02 33:18

Absolutely not. It's just life happening, right? Like it's it's just part of what can happen for somebody in the postpartum period, but certainly does not make an individual a bad mother in any way, shape, or form. So I would want to definitely debunk that myth if that's out there, that somehow postpartum depression is making an individual a bad mother. Yeah, I think that's that's steeped in the shame and some of the stigma that traditionally had been out there surrounding maternal mental health years ago. But nowadays, I'm hoping people are not um feeling that way.

SPEAKER_01 33:59

Uh, because it absolutely not. I can imagine feeling like a bad mother if I am not experiencing warmth and caring feelings toward my infant and thinking something's really wrong with me. And in fact, if you have depression, something is wrong and needs treatment. But it's not that you as a human being are bad at this. Is that a differentiation worth making?

SPEAKER_02 34:22

So I'm I'm just thinking, yeah, with postpartum depression, there's a shift in hormones, and that shift in hormones has caused you to develop certain symptoms. And you're a person who's coping with the symptoms of depression or a person coping with the symptoms of anxiety. But I don't know that I think something's wrong with you. I I think that it's just a part of life that is happening. You know what I mean? Like again, wanting to take a little bit of that stigma off of something being wrong. But for sure, as we think about bonding, it's gonna take time. And even for individuals who aren't depressed, they may have a a difficult time bonding with baby. I I think people assume that you're immediately going to bond with this with this baby, and that doesn't always happen that way for people. Um, but there again, no judgment, no shame, no stigma there. Just taking the time, taking it day by day. And it is not uncommon for people to have difficulties with with bonding initially, but it usually more more times than not, the bonding happens just fine.

SPEAKER_01 35:32

And when we see babies, you know, out in the wild before we have our own, they don't tend to be newborns, you know, and they're they're cooing and they're you know, they're holding their heads up and stuff. It can be kind of alien to hold a brand new baby and think it's a it's a different experience. It it may not be what you expect because of everything you see is different.

SPEAKER_02 35:52

Yeah, it is a different experience. And and newborns, for all of their fragility, they are pretty hardy.

SPEAKER_03 35:59

Yeah, yeah, yeah.

SPEAKER_02 36:00

You don't think but I'm somebody who loves newborns. So I as somebody who has three children, um I absolutely loved the newborn stage. Okay. So um, like nothing better. I I've never seen a newborn that I haven't wanted to hold. And I was a postpartum nurse, and everybody always wanted to put me in the nursery because I loved the newborns. I absolutely loved that. And then I will say that older was a little bit harder for me to bond with. Do you see what I'm saying? So it's it's it's it's can be variable, I think, for folks and when they when they bond. Some people are like, oh, I like them when they're really super sturdy, when they're a year or two years old, or I really like when they can start to coo, like you said, coup and and roll over and crawl and get into things. But I would encourage people to be gentle with themselves as it uh as it relates to bonding and give it time. And if you're finding that you're really not able to bond with baby to get some type of um help, but that that to be gentle with yourself in how long that takes, because it can take a little bit, especially for the newborns.

SPEAKER_01 37:16

Another top search question is how do I tell my partner or family that I have postpartum depression, or I think I might.

SPEAKER_02 37:22

Yeah, well, I think it all depends on the relationship you have with your partner or your family. So um if you're in a really healthy relationship with partner and family, I again don't think that you need to complicate the conversation. You can just say, you know what? I don't feel good. Something doesn't feel right for me. I I can't necessarily put my finger on it, but I'm feeling really sad, or I'm feeling unmotivated, or I'm feeling super tired, or I don't feel like I want to take care of the baby, or, you know, whatever that might be, and and having that conversation. Same with loved one, whether it's mother-in-law or mother, father-in-law, father, cousin, auntie, whoever that might be, that trusted person that you feel like you can go to them with your, you know, innermost thoughts and say, something really doesn't feel right here, and I think I need some help. And I think that's perfectly okay to say.

SPEAKER_01 38:18

And as a nurse and midwife, you've had a lot of those conversations, and you say sometimes you notice and say, You just don't look right. That's uh any life circumstance can cause us to not feel right.

SPEAKER_02 38:31

Right. And and to and to say to the person, so tell me a little bit about what's been going on. You know, how how how are things been going in your day? How are you doing with baby? This is me as midwife saying to a patient or a client, what's going on with your partner? How are you sleeping? How are you eating? Are you drinking enough? Um, drinking enough water? How's breastfeeding going if the person is breastfeeding or chest feeding? I think there are a lot of different ways that we can compassionately be navigating these conversations so that they don't feel so stigmatized or uneasy, but we can navigate it with ease and gentleness and compassion.

SPEAKER_01 39:17

Do the symptoms of postpartum depression go away on their own, or are they likely to worsen if they're not addressed?

SPEAKER_02 39:25

So I would say that there are people who will say, I probably had postpartum depression, right? And and they've now moved on from it. So yes, it is possible for these symptoms to go away on their own. I would say that it's unnecessary suffering because there are so many things that we can do to help. Yes, they can go away with time, but wouldn't it be nice to be able to have somebody to talk to, like a mental health care provider? That can be a licensed clinical social worker, that can be a psych mental health nurse practitioner, that can be a psychologist, a psychiatrist. So we have lots of different options for mental health care providers to be able to talk to. And then also thinking about medication with that. I'm not saying you have to be on medication, but we know that therapy works well, we know that medication works well, and we know that therapy and medication work even better together.

SPEAKER_01 40:19

New mothers are also frequently searching why am I so angry with my partner? Or why am I so angry with my baby?

SPEAKER_02 40:27

Yeah, hormones, right? So more hormonal changes there. And it is not uncommon to feel irritable, agitated, angry, rage on occasion, postpartum rage. The thing that we need to pay the most attention to is are you able to remove yourself from the baby for sure, so that baby is not getting hurt. If you notice that you're wanting to hurt your baby or hurt your partner, now that's another conversation to for us to have with your health care provider or with your mental health care provider. So um either the OBGYN midwife or a therapist. But it's not uncommon just because most likely related to sleep deprivation, but also due to the hormonal shifts that that happen, you can feel irritable. That irritability can lead to that agitation, which can lead to that anger, right, which can then lead to the to the rage. And so um recently I had talked with somebody who had had real postpartum rage and had thoughts of wanting to hurt her baby and actually shoved her baby away. And she knew at that point. She she walked to the um to her partner who happened to be sleeping in another room with their little one, another little one, because so she had more than one baby, and she said, I, I, I need help, I gotta go. And and they she was hooked in with somebody by the next day. So really wanting to make sure this is serious. When we're when we're talking about anger and rage, um, we're really worried about whether or not baby can be hurt.

SPEAKER_01 42:11

So if we're talking about one in five new mothers can experience postpartum depression, what percentage of those people are going to or are likely to experience rage or psychosis? Because I want to inform, but I don't want to scare somebody watching.

SPEAKER_02 42:26

My understanding is that that psychosis is more like a one to two percent. Okay. That's a much lower percent for psychosis. Um, I'm not an expert on psychosis, but I will say that psychosis is a reason to be hospitalized. So um that's not something that we're typically managing outpatient. So that that UNC PPIU perinatal psychiatry inpatient unit, um, that's the time where you would be on on a unit and getting care to make sure that we can manage with your psychos manage your psychosis. Uh postpartum rage isn't as common, but with psychosis, it's really you can kind of be out of touch with reality um and and what's happening around you, as well as really having the intent to hurt baby. Um, and also self-harm uh can be involved there too. And so a postpartum psychosis is something that we, as I said, is taken very seriously and is something that is typically managed in-house or inpatient type situation.

SPEAKER_01 43:38

That's an emergency room 911 kind of situation. Absolutely. That sounds so scary too.

SPEAKER_02 43:44

It is. It is scary. It's it's scary, I think, both for for mom and scary for a partner or family members to know what's happening to my loved one and are they gonna get better, and what do we do here and how How do we get the best care taken for them, taking uh taken of them? So um I have seen it and I take it very seriously. So and with treatment, is mom usually okay and able to remain? With treatment, mom can be okay. Okay. Um and inpatient treatment will typically shift to outpatient treatment. Okay. Yep. So they're not typically just inpatient and then home and fine. Okay. No, this is a much longer-term type of uh management of care.

SPEAKER_01 44:30

Another internet question. If a new mother has not bonded with her baby and doesn't have loving, caring feelings that she expected to have, does it mean she will never have them?

SPEAKER_02 44:39

No. I I think that these are things that can develop um over time. So we were talking a little bit about bonding and how long um it can take. And I was just saying just be patient with yourself and and be gentle with yourself and that transitionary period. It's a lot that you're navigating. But if if it takes a new mom longer, it doesn't mean that there's any issues with long-term bonding.

SPEAKER_01 45:09

As we wrap up the second half and our entire conversation here, what would you what message would you like to leave somebody watching this? And then I guess we're talking to two different audiences, both a new mother who is like, what's going on? What what am I experiencing? And is this normal and all that? And somebody who's thinking, I think she might have postpartum depression. Like a loved one or a family member? Right, exactly.

SPEAKER_02 45:35

So first of all, what I want folks to know that there are resources um that are available and that they're not alone. Um and that this is not forever. That there are very skilled practitioners that can um provide excellent care to get the loved your loved one um what they need. For the person who is wondering, do I have postpartum depression or what's going on with me? I'm gonna say, let's normalize the conversation. And it's okay to talk to your health care provider. And I know I will speak for myself as a healthcare provider. I want to know what's going on so that I can take the best care of you as possible and get you connected in. I may not have the resources readily available, but I will get them. Um, so typically, let's say I'm I'm in a day where I have a bunch of patients back to back, and then I have this patient that comes in that needs resources. What I might do, depending on the severity of what's going on with that individual, is say, I'll call you tonight with the resources. So I'll get through the rest of my day, take the time to find out exactly what it is that they need, and then call them with the phone numbers and all that's needed that same day to make sure that they're connected and hooked in. And so I would say more providers than not, the providers that I know want to know this and want to be able to have those types of conversations with their um with their clients, with their patients. So it's okay to come in to us and say, I don't know exactly what's going on, but something is not right. And I really need the help.

SPEAKER_01 47:17

That's the language I think is so important because we don't know how to describe it because we haven't experienced it before or don't remember it or whatever. And to just say, like, I don't know what it is, right? But it is not right.

SPEAKER_02 47:28

Right. And not everybody has the language to say or feels comfortable wanting to put the label, yeah, I'm depressed. Right. Or I'm anxious. Right. But you might say, I'm I have headaches, I'm irritable, I'm agitated, I'm not sleeping, right? That's gonna clue me in to ask some additional questions, right? I'm I'm feeling really sad, I'm feeling low. But you might not say depressed. But don't worry about having all the right words. Just say what it is that that is there, and then we will figure it out as a healthcare provider. That's what we've been trained and educated to do. And then for the for the loved one, having the conversation, navigating the conversation with gentleness and with ease and with compassion again, and saying, So I'm a little worried about you. Or I've been thinking, what's what's been going on? You seem a little different. Or what have you been thinking about recently? You know, just asking them what what's on your mind? Like I'm just curious. Because I think there's something going on, but I don't know what it is. So that's even a way to be able to have a conversation there. Um so those are the two things that I would that I would want to leave people with is there's resources, we can manage this, let's normalize the conversations. But I believe that there's hope and that we can do this and do this well.

SPEAKER_01 49:04

Perfect way to end.

SPEAKER_03 49:04

Yeah.

SPEAKER_01 49:05

Dr. Karen, I'm so grateful for your compassion and all your experience and the fact that you shared it with us today.

SPEAKER_02 49:11

Thank you so much for having me. It's been a pleasure, Terry. Wonderful.

SPEAKER_01 49:16

And we will be back next week with a deep dive into another topic.