We're like pressure cookers. And if you are able to identify your emotion and let it be, it is like releasing the pressure in a pressure cooker. If you don't, over time, the pressure cooker will explode.
Hello and welcome back to another episode of uplift for her. I am your host, Dr Mallorie Cracroft, and we are here today talking about a very important topic. So I'm really glad that we have this special guest with us. We are talking today about postpartum depression, and postpartum depression is something that honestly, I don't think we can speak enough about. We have with us, Lindsay Dean. Lindsay Dean is a licensed clinical social worker, and she works with us here at uplift for her so we are so glad you're here. Thanks for coming, Lindsay.
I'm glad to be here. Thanks for having me.
So Lindsay has been a therapist for how many years?
Seven, seven years.
And then you are also a perinatal mental health specialist, so specialize in all things surrounding pregnancy and also fertility and postpartum. So this is a perfect topic for us to dive into.
Absolutely
Well, first, tell us a little bit about why you were drawn to the perinatal health world.
I think it starts when I was a kid. I always thought I would be a NICU nurse. I loved the babies. Always loved babies. I'm the oldest of five. Oldest sister is my favorite role. And then as I've dived into the mental health realm of things, I've been drawn to all the clients that have perinatal type of problems or concerns and just life experiences. And I love that phase of life.
Yeah, it's so important, and it's so so fun, but also can really be quite difficult if it's not going well.
Absolutely, postpartum depression is so much more common than I think a lot of people recognize. The stats that I looked up are, one in five up to one in five women. I knew it was high, but I was thinking more than 10% of women, which is where some studies put it, but some studies put it as high as one in five women, which is pretty crazy. As an OB/GYN, I can say that we as OB’s don't do enough, and I don't blame my fellow OB’s, because we're not trained to do enough, the insurance model and the schedules are not built at all to do enough. I remember so many instances where a woman comes for her six week postpartum visit, and I have another patient in labor, and I'll get a call that says, we need you right now for delivery, and I'll be like, Oh, this was really hard for you to get out of your house and to get a babysitter, so I don't want to just reschedule and have you come back another time so you're good. And they're like, yeah, and okay, bye. And it's unacceptable, and hopefully I did not miss serve anyone too egregiously. But we can do way better, and we should do way better, because it is so common and it affects such a long period of a woman's life, and that transition into motherhood and her bonding with her baby. So I'm really glad we're talking about it. Let's talk first just about what is postpartum depression, and how would a woman know if she has postpartum depression, versus like that was a hard birth and I'm tired of baby blues,
I think anyone can expect to be weepy, or to be irritable or to be sad during this transition, because it is a transition, and any life transition is going to have challenges. Yeah, there's going to be growing pains, distress. You're trying to figure out who you are, who your partner is, who this baby is, and so there's going to be some level that's going to be expected. I think up to 80% of women will experience baby blues, yeah, but that will usually dissipate. When it doesn't dissipate is when we're probably entering the realm of postpartum depression, and it usually will show up between four to six weeks, weeks post birth. And what that looks like is, you know, low mood. It's hard to take care of myself. It's hard to take care of yourself anyway, because you're into this new baby, but it's even more so. It's drastic. You're not getting enough sleep, you're not taking care of your basic needs. You're more irritable. The littlest things will tip you off, and maybe I hear some of the terms, like postpartum rage, where you're so angry and you don't even recognize yourself, and it's kind of scary. And other things that you might notice are intrusive thoughts, so thoughts that are kind of scary, that don't feel like they're you or feel like they're normal, but they're happening and you can't quite get rid of them, and they're invading your life. Things like that are what you would probably see with postpartum depression. Yeah,
I think that's really great. In my practice, I would see patients, and it was funny, because I would have people say over and over and over, I felt kind of weepy and off for the first two weeks, and then it went away. And that's more what we expect of really, the hormonal changes, the amount of change that your body goes through right when you give birth, in terms of. Things like blood loss or the, sometimes the medications that we give you in childbirth, or the lack of sleep or the pain, or, you know, that's a major, major experience that happens, and oftentimes that by about two weeks, there's a pretty big shift that says, like, oh. And people would say it feels like a veil has lifted, or it feels like a cloud has lifted where I'm just like, back to my normal self. So that should be along the lines of a more typical experience. But as you mentioned, if, if later, those symptoms start turning into more persistent symptoms, and especially more disruptive symptoms, then I think that's where we call it postpartum depression, also keeping in mind that it's a spectrum, right? So there's no moment where it's like, well, you have 80% of the symptoms, but you don't quite qualify, so you don't need help. Like, it doesn't matter. Everyone needs support and everyone needs help. So there's no specific cutoff we're looking for. I would say, if you're struggling, then you've got postpartum depression. And who cares about the label? Like, you can just say, I'm struggling and I'm postpartum. So before we dive too much further into what we do for postpartum depression, can you talk about the stigma that comes up with postpartum depression? Because I think before we can help any women, there has to be some acknowledgement that I need help from their perspective. And why is this such a struggle for some people to ask for help?
Yeah, that's an important place to go. I think there's a lot of things that could be going on, but first and foremost, I think there's a lot of societal expectations, but even self imposed expectations that you know this, this is the greatest thing of your life, and you know it is hard, but you'll get through it. That's normal. And I think some of the other things that can kind of lead into this is you want to have this unconditional love for this child, but you might be experiencing some other things, like some guilt or resentment and some anger, and you don't want to be that mom. You don't want to be the bad mom. And for that reason. It might be easy to Yes, I'm having these thoughts, but we're just going to brush them off. Yeah,
I don't believe it, or I'm going to deny it or right?
And it can be really hard to admit, hey, this is actually going on for me, and that can be a huge barrier to asking somebody. Hey, I don't know if I'm okay, and I don't know if this is normal, and I think I need some help. Yeah, I think that the idea of the stigma is so important. I do think that our culture, and especially man, the Instagram and social media culture of you see these, these postpartum influencers who just show themselves in their, you know, crop top and size zero genes the next day after giving birth, and it can sometimes create this image for us that like, oh, that's how it's supposed to be, because that's what we keep seeing over and over. Meanwhile, there are hordes of women who are struggling and who are not having that life experience, and it just feels like they're experiencing it all in isolation. So we all have this shared experience of whatever the people who are the most forthcoming, and, you know, posting it publicly. But the normal experience is not that, and that can be really difficult for us to recognize consciously. You see it, and so your brain is like that must be normal. But actually the normal is, you know, throwing on your sweats and not having time to brush your hair, so you throw it in a bun and, you know, maybe you get showered at one or, you know, I think that's important to recognize that we have this, this image of what the postpartum experience is supposed to look like. But that image is not accurate. It's not, we're not seeing the, the true image of what the average experience is like for women.
I agree. And I think the other thing is, there's this narrative of it's supposed to, or I'm supposed to, or I should, but really it's a spectrum, yeah, and whatever is happening for you is exactly what is happening for you, and that's good, yeah, saying, Oh, this didn't happen for my sister, or this didn't happen for my cousin, or it didn't look like it was this for them, so it's not this for me. So what's wrong with me? But like, whatever is happening for you, that's your experience. And that's, that's where you start, valid, yeah, that's
where you start. That's right on the tail of that. Will you go into that a little bit about I think that a lot of women are especially first time babies, which postpartum depression is not just first time pregnancy, it can show up later. So you might have 234, babies that are fine and then have postpartum depression the last time. So we'll come back to that. But starting with this idea of women who don't really have any idea about what it's supposed to feel like or look like? How do you help them understand like, what is normal? Because, like, you just said, whatever you're experiencing is normal, but there is sort of an extreme that women want to know about. Like, I don't know if this is normal. Can you speak to that? Like, how should women feel? After they have a baby?
Oh, boy, that's a big question. I I think that you could probably expect a variety of things. I think one of the more anticipated is going well. I think you're gonna be tired for so forecast, yeah, very tired, yeah. And I think that there's going to be a wide range of emotions. You could feel really excited, elated, a lot of joy for this new baby that you just brought in. And you could feel a lot of sadness and weepingness and Oh, but what did I do my life before was so different than it is now I wonder, you know, what if I didn't even come here at some point or, like, when is this ever going to end having kind of thoughts like that, I think can be a little bit expected. Other things you can expect is maybe some confusion about yourself. Like, wait, who am I? Yeah, is this role, yeah? And what is this new role?
Who am I supposed to be as a mom, am I cut out for this and having some questions like that, I think can be pretty typical and pretty normal. What are some thought tips that you can offer women, not even talking about postpartum depression at this point, but just kind of going into that transition and having those moments of like this is not what I expected, whether it's good, whether it's bad, I think you do absolutely see someone women who say, I never knew I could feel this much love for a human like I am so enamored with this baby, and that's a beautiful experience. But there are also women who say, like, this newborn phase is not my favorite, you know, like, I love my baby and I would do anything for my baby, but I don't feel those same Mormon fuzzies that other people talk about. They may not have postpartum depression, they may, may just be going through a transition, right? What are some tips that you can give women who are going through that to kind of help make sense of some of those thoughts?
Yeah, I so I think for anybody, this would be like a generalized tool, something that you can take at any point in your life. But it would the first thing I always say is observe your thoughts. Just notice that they're there and what they're saying, yeah, sometimes, if we don't like the thought, there's this term called metacognitions. It's the thought we have about the thought, yeah, or the feeling, about the feeling. And that will usually push those types of thoughts and feelings away, but we want to see that they're there. They're just information. And so the first thing I say, you're a scientist, just observe. Non judgmentally you say, I'm noticing I'm having the thought that fill in the blank. That's the first step. I love the thing, because for people like me who are kind of controlling,
my brain wants to then solve it like, my brain wants to respond to the thought. And I found it very helpful to have a word or a phrase ready to go so that, as you observe that thought, you say, interesting, interesting, like that. I'll just feed that into my brain of like, you know, I don't feel as warm, fuzzy as I thought I was going to and before my brain can go like, maybe that means I'm a terrible mother, right? You know, you say interesting, okay, interesting and just kind of write it out. What are some other tools? I love that one. What are some other tools that can just help us make sense of the brain activity that's going on during this
phase? So along those lines, it's really hard, but to cut the judgment and so interesting instead of that means XYZ about me. Just notice, this is the thought that I'm having, and kind of taking an evaluation or assessment of how you're feeling. Sometimes, when we even say those thoughts, like there's a lot of tightness that shows up in the chest, we might be shutting down a little bit more, maybe some numbing sensations, like you're dissociating. It's anyway, I would take an assessment of how you are feeling, first and foremost, and let it be there. Honor it. If it's too distressing. Meaning I can't sit in this space, I probably would go step out, change your environment for a second, distract yourself to kind of reground and say, you know, this is me. This is who I am. I'm here. I'm okay, yeah, yeah. I
think from the medical perspective, the brain does some funky stuff when you are going through hormonal shifts and on sleep deprivation, right? The brain does some really kind of unpredictable things sometimes, and I think sometimes those, those shifts, from a brain chemistry perspective, can be racing or chasing thoughts where it's not, not always negative, but it's just thought after thought, after thought, after thought. And I think that sleep deprivation doesn't help that. I think it makes it the sleep deprivation, the hormonal changes, can make it really difficult for us to have a clear brain. And I also think from the sort of physical or medical side of things. I think that the busyness of life, the number of things that we have on our to do list, the number of things we're listening to, you know, we've got podcasts and parenting books and, you know, we're catching up on all of these things. I think that makes it even harder to just make sense of what our brain is doing. And so cutting down on all of those things and giving our. Space, intentional time to say, what do I feel right now and then to just exactly what you said. Observe it. And I know a lot of therapists use the phrase name it to tame it right? Like, yes, give it a name. Give it a name. Like, I feel mad. I feel sad. I don't even know why, but I feel sad. I feel tired, like deep exhaustion, emotional. Tired. I feel, you know, frustrated that I don't have more support. I feel disappointed that people aren't stopping by. I feel annoyed that people are stopping by, you know, like, if we can start bringing those to the surface, it's really powerful. How much the body will respond and say, Oh, thanks. I just needed to get those all out. And it sometimes feels like it's going to come up, like in a volcano, but if we can help it come up, then it still can settle underneath, I think, tell us about any other little tips or tricks to do that, like journaling or something along those lines.
So I think for so it's hard to know your emotions, because as a society, I think we are emotionally illiterate. We don't have a wide variety of vocabulary that we can use to describe what we're feeling. We're usually limited to sad, happy, mad, and maybe a couple more in between. So I would say, find an emotions will and learn some words. I love that because it you. The research shows us that if you can accurately identify what you're experiencing, you can tame it. So name it, to tame it accurately, and not to put pressure on of course, but just like,
you don't have to tame it right away, and you don't have to reject that emotion. There's not the judgment there. You're not saying like and keep going, because I want to talk to you about the self shame and the self judgment we get about these emotions, yeah.
So name it, to tame it. Grab a feelings will I can share some resources on some excellent emotion literacy resources, yeah. And then from there, I think it's important to acknowledge, you know the value of being able to feel your emotion. The metaphor I always use is like, we're like pressure cookers. And if you being able to identify your emotion and let it be there is like, releasing the pressure in a pressure cooker. If you don't, yep, over time, the pressure cooker will explode. And sometimes over little things that don't feel like they quite match, or they're not. The word I use is congruent, yeah. And so being able to just acknowledge to yourself, This is what I'm feeling. Feel it you're kind of releasing that pressure as you go, yeah.
And I'll say too, from a functional medicine perspective, that that pressure cooker can explode in your body too, and you end up with gut dysfunction, or you end up with insomnia. You like, it doesn't just it can show up in snappiness and rage, but it can also just show up in the body. And people will say, like, I think I'm coping pretty well, like, I don't have, I'm not feeling any big emotions, and meanwhile, their body is like, Mayday, mayday, mayday. So I think releasing those emotions, I love that, that analogy,
along with that, I think it's important to acknowledge and to normalize that emotions are just information. They're not who you are, and when I feel a certain way, that's not who I am. So I'm I'm mad. I'm not a mad person. Yes, I'm angry. I'm not an angry person. It's, it's just information. And a lot of times, those emotions are just trying to give us something
especially hormonally, right? Because sometimes they're not even rational emotions. They're just being felt. And it's like, what are you feeling? And I think a lot of partners of of pregnant or postpartum women will be like, Why are you crying? Like, I don't know. And just like saying that, like, I feel emotional, I feel sad, I feel, you know, giving those words, I think that's great advice.
Yes, and letting it be there and not having to feel the pressure to fix it. Yes, I know a lot of education I'll give to partners is you didn't do anything wrong. Yeah, emotions are just information. They're there, they're to be expressed, they're to be felt, not to be afraid of and sometimes all you have to say is, I'm mad and I don't know why, yeah,
and let it be there and it's okay. And I think along those lines, the other thought that I had is, you know, taking opportunities to talk to someone, but it kind of has to be the right someone. I think it's, I think it's really tempting if we talk to sometimes a maternal figure or a friend, or, you know, it can be anyone, but we're trying to label these emotions and say, I feel this, and that can make them uncomfortable, and they can then feel like, well, you shouldn't feel sad. You just had a baby. Why don't you focus on the positive? You know, these well intentioned support persons can sometimes do the worst possible things. So I think finding someone to talk to, if you have someone who you can trust, then that's great who's just gonna listen. I think that's where therapy can come in, is just being able to give it worth but I also think it's okay to say I am feeling really jumbled emotions and my thoughts are really jumbled. Would you mind if I just use you as a sounding board? I don't need you to tell me how to. Fix anything, but I do need you to listen. And I need like, an emotional hug, like a verbal hug. And I think if you set someone up that way, it's way easier for it to be a constructive situation, because they're gonna say, like, okay, then it's okay that you feel those things. And I think even as the person who may be struggling, I think it's okay to say I'm okay that I'm feeling these things. So I don't need you to do anything to try to make those feelings go away. I just need to try to get them out of my body and make sense of them.
Yeah, absolutely. I think that's great. And if you don't have somebody in the moment, that's where journaling can be a great tool. And we have so many platforms for journaling that you could just speak into your phone and speak out loud into your phone to record it or write something down, type something out, that can be pretty effective as well.
Yeah. Well, you talk to I think sometimes when we're having these feelings, and again, I'm not even talking yet about postpartum depression, per se, but sometimes some of these thoughts and feelings that we have can be a little bit scary. You might feel like if you tell someone, then they're going to freak out, or you might actually feel okay about the feelings that you're having, but you don't want anyone else to know that you're having them. I think sometimes we definitely think of this with with extreme feelings, feelings of wanting to harm yourself or wanting to harm your baby. And I'm, I'll say, from our perspective as doctors, the way we approach it, and then I want you to share kind of how you approach it. But I think there is this thought that if we ask someone you know, do you feel like harming yourself, or have you had thoughts of harming yourself, that that's going to like, set them off, and then they're going to go think about harming themselves. And actually, in medicine, we're very much trained to we ask it every time like I ask that routinely. If there's any sense of any emotionality, then we say, are those thoughts making you nervous, or have you had thoughts of wanting to harm yourself or your baby? And honestly, it never, or very rarely, seems to cause discomfort in the person talking to me. I think if the person is struggling, then they're relieved that someone actually asked them and that there's a safe place to say, Do you know what I am? And it's kind of weird, but I rarely, if ever, have someone who's like, oh, that question made me uncomfortable. You know, I think people either are either like, Oh, no way, or Yeah, I am. And thanks for asking.
Yeah, it's, it's something I screen for every time I talk to anybody, first first encounters and even subsequent ones. It's important to talk about it. And I it can be scary to talk about it. And so a lot of us just kind of beat around the bush or just pretend it's not there. But actually talking about suicidal thoughts and ideations reduces exactly the risk of suicidal thoughts and ideation and I know that it, it can be a depending on whatever your personal beliefs are, your personal experiences are like, No, I know that that's not me. I don't want that. But I am also having those thoughts. It's important to name them and not scary at all, at least in this platform for us to say or for us to hear Yeah, I'm having those thoughts and they scare me, and I don't know what to do about it. Yeah.
What about someone who is supporting someone who's postpartum. Is this something that only a trained professional should do? Or what? What can a support person of someone checking on, not even postpartum depression, but like, if you love someone who's just had a baby, what are some things that they can do to will come back, in general, to what can they do, but in this situation, to to kind of explore our to be that listening ear if there are scary thoughts, even if they're not suicidal thoughts, but just those big emotions that people may feel uncomfortable or scared to share with their loved ones. The
best advice I can give is you be direct. You can ask point blank, are you having thoughts of wanting to harm yourself or others or the baby or however, just asking it directly, without having to mince fancy words, and just to see what kind of ensues from there. I think some people get really scared that if I say yes, that means I have to be hospitalized, or that we have to have some severe interventions. And, you know, there are situations, but for the most part, that's not what's happening. Just being able to say yeah, I am. This is what's going on for me. It usually will unveil some other things that are going on. I'm overwhelmed. I'm feeling I'm
exhausted. I'm
not sleeping. Yeah, that's usually it's the body is designed to keep us safe. And so if it gets to that point, it's usually saying there's so much pressure and we can't find a way out. And so let's unpack the pressure and see what's underneath. I love
that you said it that way. I love that I think, also, from just a support person perspective, I think it's okay to say I think we're pretty good at texting them or stopping by or asking them, like, how are you? And that is, can be a really difficult question to ask if you are. To answer if you're feeling emotionally fatigued, and again, not postpartum depression. I'm just talking about, like I just had a baby, and I don't even know which way is up. And so I think people can just ask, like, how's your mood? I can be your safe person if you need to talk to someone, if you need to just let it out, like, I can be a no judgment zone. So feel free to just speak up if your mood is struggling.
I like the specific questions, because sometimes I think we're trained to say, how are you I'm good. I'm fine. That's automatic, yeah. But if you can say, How is your mood, or did you sleep, yeah, and are you having some anxiety today? Yeah, then that will cut the fluff. Go right to the point,
yeah, to say, How's your pain? Are you in any pain? How's your sleep? How are you eating? How is your mood? How is your you know, how are you bonding to, to be more specific, as we're supporting these women, I think can help take the burden off of even trying to answer the question and trying to think through it, and like, I don't want to go there, but I think the pointed question can be really beneficial. So I love that. Okay, so let's get back then to we're going we have women who are going through this transition. What are some other things that you think about that can support just a healthy mindset in that transition? Other than, you know, we talked about kind of scary thoughts. What are some other ways that we can just support that transition from a mental health perspective,
yeah, I think setting expectations from the get go is important. Tell us more about that. Yeah, having conversations before you get there, and if you're there, then we can definitely have the conversations there as well. But
you're talking about before you even have the baby. Yeah, yeah, before you have the baby.
I mean, it's pretty like you can expect that you're going to be down for recovery for the next three to four weeks. And so what kind of supports do you need in place, and where can you outsource? What kind of help is available to you? Do you have family and friends that that you are comfortable letting into your home and helping you with certain tasks? Other conversations would be talking to your partner and saying, you know, our worlds are going to flip upside down here in a minute. What kind of things can we expect from one another? Our roles are going to change things like that. I also setting yourself up for like basic needs, like set a meal train, ask, usually people are really willing to help out in these types of moments. See who can send some meals over. See if anyone would be willing to help with some dishes or some laundry if you're comfortable. And sometimes I think even on the emotional side of things, like you're gonna have to expect that it's going to be hard that way. And so talk to your partner of like, this is how I like to be approached when I'm moody. Those are conversations I have with my husband all the time. We have code words and like when I use certain code words, and he knows, oh, this is how we show up today.
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I feel so excited that you said grief, because sometimes when things, when we have the baby, we don't expect grief is going to be a part.
And it may not be something that seems worthy of grief, right? Like, heaven forbid you have a loss or have something happen to your baby. I think people would understand grief, but even things like, I really didn't want a C section, and I needed a C section that's going to take mourning. For a lot of people. That's going to take some grief for a lot of people, and so even tiny things we can experience grief about.
Yeah, exactly I like. The mindset I like to encourage is, you know, let's have your plan. Also have flexibility and open mindedness, like be prepared that when some something might not go your way, or the way that you had thought it might be, and that's okay. We can adjust. And giving yourself that mind space to have the flexibility and breathing room, I think, can relieve a lot of pressure, because sometimes we're so bound on. This is how, this is what needs to happen, but giving yourself space to say maybe it doesn't have to be this way. There are other options can give some relief. And I think the other important piece there is having open communication with those who are around you, and having the consensus together, like we get to change minds, and we get to be flexible, and we get to talk about it. So I think the flexibility is really important along that going back to emotions, allowing space for your emotions, grief is really a valuable one to take into consideration. We think grief only comes in times of, you know, big loss, but I like to say grief happens anytime there is a loss, and that could be a loss of expectation, a loss of hope or control. Control things that I had hoped for but didn't happen the way that I wanted to, even things that you didn't have, that you lost the opportunity to have, is totally appropriate for grief. I love that. I
think it's so important, and we'll transition here. One of the reasons I think it's so important is, I think it can be a setup for postpartum depression. What are the other things that you see in this postpartum transition? What I'd love for women and their support people who are listening to this, what I would love for people to take from this is, what are the things that we can have in place to hopefully never get to postpartum depression? And one of those is, I think we've talked about a couple of them having clear thoughts like naming and taming, getting your emotions out, giving them space to breathe, and just accepting that we have thoughts and emotions that we may not know where they come from or, or they may feel unwarranted, but not shaming or or guilty ourselves because of those, I think, watching our expectations and being willing to shift if our expectations are not met, and going through some of that grief and allowing ourselves to say, like, that's not what I wanted, and that's okay, just to leave it there and say, I didn't want that, and leave it there. You know, what are some other things that you see in this regular postpartum transition that can be really helpful to hopefully prevent postpartum depression going along with
what was already been said. Like the phrase I like to use is give yourself permission, permission to let it go or to change or to be sad or fill in the blank. I think other things that we could do during those postpartum depression, I social support is really important, yeah, I think modernity has kind of shifted some of those things for us, that some of those social supports that were there before aren't so built in now, and there's a lot of isolation, and I think isolation is breeding grounds for postpartum depression, yeah, where you feel alone, feel by yourself. You can't ask for help because other people are so busy. And maybe some more expectations is I should be able to do this by myself.
Yeah, so and so did so and so was able to do that by themselves. Why am I struggling? Probably because I'm a bad mom, or I'm weak
or right? Yeah. And I think we need to normalize like this part of your life is not something you do by yourself. Yeah. We need people around us, yeah. And we need we need help. And so I think the social support is really important at this piece, also
from a medical perspective. Because I think one thing I want people to recognize is that mental health in general, but postpartum depression, it's rarely one thing. It's rarely a thought pattern alone, and it's rarely lack of sleep alone. It's usually a stacking up of factors that hits critical mass and the brain says, like, I'm done. I got nothing left. Like it starts to either misperceive the world through through chemistry, through neurotransmitters and inflammation, or it starts to just shut down and not perceive the world. And those can be really scary things. So I want to point out a couple medical and sort of lifestyle changes that people can be really mindful of. And you mentioned one of those, which is social connectedness versus isolation. I think that a lot of times, especially if we have a very difficult birth, then we just don't feel like leaving the house, like my bum hurts, like I don't want to go out and do something, and I don't want people in my house because I don't like the way my house looks, or like I didn't get ready, and I don't want people to see me that way. But if I go out, then I have to get ready, and I'm too tired to get ready. We've got something's got to give there. I think I have a lot of patients that in the past who I would talk to, and they would use the phrase, like living in a cave like it. You know, oftentimes the blinds are drawn because your sleep schedules off, so you're sleeping in as late as you can, which I fully support. But then the blinds are drawn, and then you kind of get around some point to to taking care of yourself, because you've been feeding the baby every two to three hours, and then changing the diaper, and then falling asleep, and then you wake up and do it all again. And it's hard. It's really hard, but this is where we have to not neglect our our framework of our health, that architecture of our health, which I would say, is daylight, sunlight. So especially during the winter, at least opening the blinds, which seems so little and so silly, but it actually makes a huge change in in trying to attempt normalcy, you know, to say, like, okay, it's morning. I'm going to open the blinds. That, like, that's the only thing I'm going to do today, but I'm going to open the blinds. I think the next step up from that would be, can you step outside your house, like, can you just go out onto your porch? You don't have to exercise, you don't have to go for a walk. Like, can you literally open your door and step outside and stay there for five minutes? It's, it's actually pretty massive, and it's so easy and yet so hard to do. So full support for people who'd feel like they can't, but, but if you can, that can be really beneficial. I think the basics of hydration, you know, like, when you're when your body's not well fed and hydrated, then it doesn't work as well. And right on the heels of that, are nutrients. And this just a plug out there to anyone who's bringing a new mama meal. I know you want to bring comfort food, and I fully support that. But please, just bring the woman some vegetables. She may not want them, and you can ask her, but, but really, I get so impassioned about this because I see it so much. The body is in an immense state of healing and repletion, and we do not value that nearly enough. How does the body start to heal its tissues? It has to have amino acids and nutrients and magnesium and zinc. And if you've been having morning sickness for nine months or 10 months, and then you have this baby, and then someone's bringing you a pasta bake, bless their hearts. Bless the hearts of everyone who ever makes someone a pasta bake. But bring them some some beans and some peas and some carrots. And even if you just bring them cut up and say, Here's your comfort food, here's your carrot sticks for when you're snacky, here's your like, I just think we undervalue the need for nutrition in an effort to like comfort. And we we've got to balance it like you've got to feed yourself so you can heal yourself. And that's, that's probably and then sleep like, if you're not sleeping, it's, it's, if you're not sleeping and your mood is doing okay, then watch it closely, if you're not sleeping and your mood is starting to struggle, then you've got to sleep, whether that means you trade off with your partner, whether that means you have a support system come in. This can be really difficult, because not everyone has a support system, and it can feel really terrible to say, like, Well, what do you want me to do? And I totally know that, and that's where we, as your doctor, can sometimes access social systems and social social supports. But there are doulas that you can pay to come stay with the baby overnight, and they'll bring you the baby. You feed the baby, they put the baby to bed. Sometimes, if with severe changes in mood and sleep, we do talk about changes to breastfeeding and just saying, like you've got to heal your brain, like your brain is not okay right now, it's not thriving on the amount of sleep that you're getting. So the sleep, if the mood is starting to struggle, is is kind of a complicated con. Conversation, but it's a non negotiable. So that's sort of the physical side of support. Anything you wanted to comment on any of that, I
think the thing I want to add is how important it all, it all is, and how it works together. Yeah, you can't take one without the other. We're kind of in this balance of physical, mental, emotional, and that's, I think it can feel overwhelming. Of
I have just gonna say
the same thing, yeah, yep. And be every I have to do all these things, all these expectations and just to be okay. And that can be overwhelming, yes, and so I think at this time, back to the expectation conversation is whatever doesn't need to happen, drop it exactly. And like, taking care of mom is taking care of baby. These are non negotiables a lot of the time, yeah,
and also to rely on the support system. Like, your job is to sit there and heal and take care of the baby. Those are your jobs. And we can talk about, and we won't have time today, but we can talk about another visit, about society construct, and how it really gets in the way of that. Yes, it's not okay, but really that should be your main focus. Is you should heal, and you should take care of your baby. And that becomes complicated when you have other children, and if your mood is doing okay, then then I'm good, like I won't, I'll be fine as long as your mood is doing okay, then you do. You do what you've got to do if your mood is struggling. We have to hit these basics, and we have to make sure that you have what you need to get better, because it's just such an important time to feel better, and I hate seeing that wasted time of you know, like, this was your time with your baby, and this was your time healing. And you're not, you're not okay. So relying my point with all of that is relying on that social structure where you can, and if someone says, like, hey, what can I do for you? Instead of saying, Oh, nothing, we're good. Like, could you make me a veggie platter, please? Could you bring me a smoothie? Could you, you know, make me some lactation cookies. Can you? Can you? Can you do something for me? Welcome that and invite that in. Give people the opportunity to fill in some of these gaps. Like, could you come open my blinds? Like, it doesn't have to be it. We should get past the idea of, like, Oh, they're gonna think I'm ridiculous. Or they they're gonna think, I'm silly. If you're not okay, you've got to ask for help. You've got to start making these things happen. And it can feel overwhelming, and that's, that's where you and I come in as practitioners, is to say, like, and then we help you. We get you better.
Yeah, I was going out in there is, oh, man, so many thoughts that were running through my head. But one of the things that I do as a therapist is help take the overwhelm away. I do a needs assessment, and I can help prioritize. This is important. We could drop some other stuff, so taking away that mental burden of like, I don't even know where to start. I don't even know how to figure this out, right? Yeah, that's huge, and everyone's going to be a little bit different, and everyone's situations are very different, and so it's going to look different family to family of what needs need to be prioritized versus not. But it can be overwhelming to say, okay, so this is what needs to happen. I can drop XYZ. So that's something that I can help with as a therapist, but also any sort of family member can help there. And
just a plug for you know, our model that we have here at uplift for her is is an integrative approach, so that the therapist is saying, What are you eating these days? How much are you sleeping these days? Have you gotten out for a walk? You know, I think that's really important, that whoever is on your team to support you is understanding that this is one big picture. This isn't going to be just thought work. We have to make sure that that all of those needs are being met. Yeah,
and that's one of the first priorities. If someone comes and sits with me for postpartum depression, it's, I'm not going to dive into your trauma. I'm going to dive into Eat, sleep, breathe, move your body. Yeah, what's happening here? Where? Where are things strong and where do things need some more support?
Yeah, absolutely. I think that's I think that's so important. So let's shift now and tell us a little bit about how therapy Well, actually, let's shift back to just postpartum depression now. So a woman has gone through this first four to six weeks and thought she was maybe okay, but now things are starting to feel like some intrusive thoughts, feeling down most of the time, just not having as much as many up days or up moments, just really starting to feel, I call it a pit, starting to feel like you're kind of stuck in a pit. What if a woman goes to a therapist? What can she expect from that and and how helpful can that be? Like, how does therapy actually help? Because I think there is this, this thought that, like, Well, I'm just going to go talk to someone, and then I'm going to feel worse because I just talked about all the things that I'm sad
about. Yeah, it can be kind of a daunting thing to think about. I have to go talk to somebody now and bring this all up. I don't want to talk about it. It hurts. So when somebody comes to me. For concerns with postpartum depression. I'm going to hear first and foremost, what got them to schedule the appointment in the first place. And then I'm going to talk about, you know, the needs. Let's I'll jump straight there, like, tell me what's going on, what's happening in your day to day, and fill all of that out. I'll probably give some assessments. We have a couple. There's many questionnaires, or Yeah, questionnaires to fill out before you come which I hope people are getting screened throughout their pregnancy anyway. But anyway, back to therapy. So I'll, I'll fill out a needs assessment. See where things are strong, where things are not so strong, and see where we can kind of put some things into place to help support, and then, depending on what comes up there, we may dive into some some tools. It's called CBT, cognitive behavioral therapy, where we'll work a lot with what's going on in your mind. What kind of thoughts are you having? I'll ask about, quote, unquote, scary thoughts or intrusive thoughts, and say, Are you having some thoughts that you know, maybe I would like to cause harm to myself, or what if? What if I threw my baby across the room? Or what if XYZ happened? Just alarming to them? We'll screen some of those just to see how that's going. Sometimes, even just being able to air it out is enough.
The thing I want to emphasize there is, you know, from the physician side, we sometimes feel very helpless when it comes to postpartum depression. Since I've started practicing integrative and functional medicine, I feel way less helpless. I feel so empowered to say, like, let's fix the body side of this. What can we do to help those hormones? What can we do to help the body have the resilience that it needs so the brain isn't running amok? Because sometimes this is is it's at its root. Oftentimes it's just physical. But what we want to connect here between, you know, you've got a doctor and a therapist talking together. What we want to connect is that sometimes the body, the changes that happen in the body, create these thoughts, or take thoughts that maybe you had a predisposition to and turns up the volume on them, and we can think like, well, I need to find a functional medicine doctor so I can fix my body. And obviously I'm a fan of that. But at the same time, that doesn't automatically retrain those thoughts to go away. And in the meantime, while we're helping to work on the body. You've got to know what to do with those thoughts. You've got to know how to respond to it. And it really becomes kind of a conversation in your head of like, okay, I'm having this thought that I don't care for, I don't like that thought. It's not leading me to a good direction. So therapy can help to bring awareness to those thoughts and then give you
tools. Yeah, I was going to mention that one earlier. Thank you for bringing it back up. But sometimes it's hard to know what our thoughts are. Yeah, it's if somebody there asks you point blank, are you having intrusive thoughts or expectations? Like, nope, yeah, right. But there are happening kind of on that low level, subconscious level, and that's something a therapist can help. Like, we're skilled in being able to and trained to be able to help identify, yeah, what's underneath, and be able to bring those to light and to the surface, because we can't really do anything about it if it's laying in your in your low conscious once we kind of bring it up and bring awareness, then we can start doing Something called cognitive restructuring and challenging negative thoughts and giving your brain a new way to think. Yeah, some of that information, yeah.
I want to touch on. So if someone's looking they're struggling with postpartum depression, they really want a great support team so they know they should consider seeing a therapist. I want to touch on, what are the things a great perinatal therapist should really bring up. And I think one of the things is that needs assessment and really looking at the body before just saying, like, what's going on in your brain? Like, it would be a misstep for them, and not everyone's trained to do that, but to find someone, hopefully, who pays some attention to to emphasizing like, how can we get you sleeping? How can I help you with your thoughts and expectations and relationships and and support systems. How can I help you get those physical needs? I think that's really important in a therapist. I also think that someone who is going to really understand, we haven't spoken about this in detail, but to really at some point come back to the the birth experience. I think so many people don't get a chance to I mean, you have this birth experience and someone says, oh, how was it? And you're like, it was beautiful. I have this baby, and that's kind of it. And you're like, when, as an OB, I will often have patients tell me about their birth experience, and it's crazy, you know, like, it feels like a really big thing for them, and they really need the opportunity to unravel that complete birth story and to even help dissect it a little bit and say, yeah, why did I feel that way? Like, why do I feel this heaviness with regards to my birth because I love my baby and I'm so happy she's here, but why do I still feel this jumbled and. Emotions. So I think having a perinatal specialist who can help really navigate that birth story and finding clarity, and I want you to comment on that in a second. And then also, as an OB, one of the things that I hear the most is I'll say, like, Well, did you try therapy? And they say, Yeah, I tried it, but they didn't really tell me what to do. Like, I know they're not supposed to fix it for me, but like, they were just a really good listener. And so I kept going and I kept talking, but then that was kind of it, and this is something you and I have spoken about, which is why you're working here, is because it's so important to me that when people are seeing a therapist, the therapist should be a really great listener, that's right, but the therapist should also at some point say, what are we gonna do? Like, what are the tools that you need to have this be different, and there should also be some sort of end game about, like, this isn't therapy for 510, 20 years, right? This is like, how do we get you better in the most efficient and effective way possible? So will you comment on the birth story, and then also on that idea of not just a good listener. So
yes, perinatal therapy is a little bit different than maybe some traditional ones, because we have a very like acute event that just happened. Yeah, that brings up. It could bring up a variety of things. So first and foremost, we talked about it, but doing the needs assessment see what's happening real time that we can maybe put in some interventions to alleviate. Yeah, let's work with your thoughts, give some good skills and tools to help reframe some of those things that are not getting in the way, and then from there, we can, I do it, what we call a biopsychosocial so taking an accounting of everything that's going on that makes you who you are, and that could be like, what brought you to want to be a mom in the first place? What was your fertility journey like? Maybe it was an unintended pregnancy. Unintended. Were there previous miscarriages? Were there on complications like starting even into the conception? Part of so important to recognize all of that going through pregnancy, labor, delivery, even postpartum, like there's so many things that could happen there. And so those are things that I'm looking for and assessing to see how did you experience it, and what was going on in your mind in some of those events, because some of those might hang around with you in the present moment and don't leave Yeah. And even past that, what sometimes comes up for people is when they have a baby, their own childhood trauma comes up and say, I love this thing so much. Why didn't my parents love me the same? Yeah? And so it's complicated. It's so complicated, yeah? And so that's something that therapists are trained to kind of look out for, is the intersections between all of these different experiences that might be going on and how they might be impacting you. And then also, it's a delicate dance, because I don't like pulling up things that aren't relevant for you, right? But also, there are some things that in the past that are now informing, informing are more present that we probably need to address, and so those are things that I'm looking out for, and of keeping I'm transparent. That's one of my values as a therapist, is I keep you involved in the process with me. So this is what I'm thinking. This is what I'm seeing. Here are some plans that I'm bringing to mind. How does that sound for you? Does this resonate? Does this work? It's very collaborative process therapy. And also, what's our action plan? Because it can feel very hopeless. Of I just bore my soul out to you, and these are all my pains. Yeah, what are we going to do with it?
Yeah, good luck. Yeah, yeah, exactly.
And so I think it's, it's important balance of, you know, being vulnerable, but also, what am I going to do with it and working with your therapist to be able to find that delicate dance? And I think it's also important that you know you feel like you connect with your therapist. That's so important. If you don't feel like you connect, it's not a good fit. Yeah, and that's something you want to sooner rather than later? Yeah,
check out,
see how you feel. That's what's really important when you're looking for a perinatal specialist and or even a therapist. But then even find somebody who specialized in this realm, because there are so many intricacies, and it requires a little bit more training,
I think, too empowering patients or women to change therapists, you know, like, it's okay to say, like, I'm not finding this helpful, but don't, don't throw it all out. Don't give up the idea of getting support. Because I see people years later who are like, Yeah, I went to therapy for a little while, and it didn't really help, so I didn't go. And then here they are, two Three years later, are still struggling. And so if it's not helping, then number one, speak up and say to the therapist, you know, like, I didn't find our last session very helpful. Could you maybe give me more tools at the end of this session? Because as practitioners in general, we're trying our best to read the room. We're trying to read our patient, and sometimes we get it wrong. You know, you think that, like, Oh, they're not ready for that, or I think that they don't. Want that. And so you you, you're trying to give them what they need, but also read what they're ready for. And sometimes we're just off a little bit. And so I think, as a practitioner, most of us, if not, then you should find someone else anyway. But I think most of us are pretty open to, oh yeah, I can totally do that differently, like I've got buckets of tools I can give you. I just didn't know if that's quite where you were, but, yeah, let's talk about specific things you can can do. And if that doesn't work, and you're still just going and talking and not feeling like it's productive, by all means, get a different therapist. You know, kidding,
and I want to put out there, like, as a therapist, that is something that I keep in mind. And if an invite that, if someone's like, I didn't like, what happened? Yeah, please tell me I would rather know Yeah, and see if we can make any changes. We just assume everything's fine, yeah, yeah. And if it turns out that I'm not your fit, I will help you find a new one. I love that it's so it's more important to me that the client feels the connection and feel like it's helpful, yeah, to the point I will help refer out if I'm not that fit, yeah,
well, gosh, we could keep talking all day. We'll have you back on because I think there's some other little nuances that I really want to dig into that can make it really difficult and that are fixable like are so there are ways that we can help women through this. More than anything, I hope women hear that that postpartum depression is treatable and it's fixable and it shouldn't last for years. It can, but we can do things to get it better, and there's no reason why you can't get your life back and start feeling more like yourself. There's no reason I really believe that and and I'm I just want that birth experience and then the postpartum and that transition to that new baby to be really wonderful. And that doesn't mean it has to look like anyone else's experience, but it can be a really wonderful, though complicated experience for you. It I just have so much I have such a strong belief about that, and sometimes we do use antidepressants, but there are about 15 other things that we can do to support a woman that don't involve antidepressants. And it's not one or the other, it's what's best for that person. So I think a lot of people don't seek help because they're like, Well, I don't want an antidepressant. Like, well, I mean, we'll talk about that, but also like, let's see what else we can do. And full disclosure, like, going to an OB GYN, a lot of women will not have the support that they need. They'll say, like, I don't feel like things are quite right. And the OB, GYN, will say, Great, here's your Zoloft prescription or your Prozac prescription. And they'll say, like, I don't want to take that. So I guess, I guess I'm stuck and like, find a perinatal health specialist, find even just on your own, focus on those basics. Focus on those nutrients and and sleep and movement and light, and it'll get better. So thank you for coming on. This has been such an important episode, and we will be back next week for another episode at uplift for her. If you are listening to this, reminder that you can watch it on YouTube, if you are on Youtube, then like subscribe. If this has been helpful for you, please leave us a review that's really helpful for us to get the word out we are trying so hard to educate women and provide them with resources so they can really feel their best and have a really great, healthy life. So please share with a friend, leave us a review, and we'll see you next time. Thanks for listening, and come back next time for another episode, and remember this information is for education only and not intended to be medical advice. The.
