Real Talk: Community Health Care in Action
A community health initiative brought to you by Frontier Nursing University and Woodford County Chamber of Commerce to improve community health and increase healthcare awareness.
Learn more about Frontier Nursing University at frontier.edu.
Real Talk: Community Health Care in Action
Beyond the Baby Blues
In this episode of Real Talk, Quincy interviews Certified Nurse-Midwife and Frontier Nursing University faculty member, Angie Chisholm (DNP, CNM). Nurse-midwives are integral in the care of mothers and babies during the perinatal and postpartum periods. Their knowledge and model of care can be especially helpful to families who are experiencing perinatal mood disorders and mental health conditions. Angie covers everything you and your support team need to know to be prepared to handle the emotional toll that can occur during and after pregnancy.
Resources:
Kentucky Resources:
KY Moms Maternal Assistance Towards Recovery (MATR)
Online Resources:
Postpartum Support International (PSI)
MothertoBaby Fact Sheets - Pregnancy and Breastfeeding Exposures
Mental Health Provider Locator
Connect with Frontier Nursing University:
Welcome to our second episode. I'm your host, Quincy Feeney with Frontier Nursing University. This podcast is a community health initiative brought to you by Frontier Nursing University and the Woodford County Chamber of Commerce to improve community health and increase healthcare awareness. In today's episode, we are going to talk about perinatal mental health disorders. According to the Maternal Mental Health Leadership Alliance, maternal mental health conditions are the most common complications of pregnancy and birth, affecting over 800,000 families each year in the US. Suicide and overdose are leading causes of death for women in the first year following pregnancy. And most women impacted remain untreated, increasing the risk of long-term impacts. Maternal mental health conditions, as we will learn today, go way beyond postpartum depression. Maternal mental health conditions can occur during pregnancy and up to one year following pregnancy and include depression, anxiety disorders, OCD, PTSD, bipolar illness, psychosis, and substance use disorders. Joining me today is certified nurse midwife and frontier faculty member, Dr. Angie Chisholm. Angie has been a midwife since 2009, originally from Kentucky. Thank you so much for joining me and tell me a little bit about your background and why you wanted to be a midwife.
SPEAKER_01:Well, thanks for asking and thanks for inviting me here to be a part of this important podcast episode. Like I said, I am from Kentucky and growing up, I... I noticed some things that affected families that were dear to me, things like mood disorders and child abuse and other traumas that I wanted to impact in my career. And so when I first went to school, I studied social work and I was on the path to becoming a family mental health therapist. But as I was doing that, I learned about pregnancy and birth and found out about midwifery. And once you feel the call to be a midwife, you really can't deny it. But I noticed that pregnancy seemed to be a sensitive time, that if you could impact the trajectory of that family during pregnancy, you could potentially have a big impact on preventing further traumas down the road. And so that's what inspired me to become a midwife. And I think that's why this topic is so important to me, because I do feel like it sometimes goes unnoticed, undiagnosed, and people are not getting the help that they need. Well, that's a fascinating
SPEAKER_02:background. And I feel like it makes you perfect for this topic. So starting off, perinatal mental health disorders, what are they and who is affected by them?
SPEAKER_01:Well, a lot more people than you would imagine. And there is quite a range of symptoms. And so we'll just Right. and grab one of her kittens like she is going to be like yeah you know so that is the way that women are wired when they have a baby they will become more hyper vigilant temporarily they will feel more anxiety and more worry and that typically lasts like the first two weeks after they have a baby and we generally see that resolve around that time and when you get into into that few weeks after that and people are still feeling that anxious and that worried, then there could be something wrong. So I will just say baby blues is pretty common. A lot of women experience it. It's normal. And when we recognize it as normal, we can maybe not take it so personally. I feel like sometimes, you know, like mother-in-laws or spouses may feel like oh she's attacking me because I didn't fold the blanket right or something like that and they feel really hurt by that overreaction that she might have experienced but it it truly is a normal behavior and something that we expect
SPEAKER_02:right and I think Keyword there, temporary for baby blues, which I think is something I feel like that's something we all hear about is the baby blues. But what is that? And like, what's normal, especially for new moms and the partners? Like, is this, you know, beyond two weeks, is this still baby blues or is this something more? So
SPEAKER_01:typically if it's not resolving after that two week period, because the hormonal shifts involved in being early postpartum are what contribute to baby blues. Um, And if it's not resolving around that time, then there's probably something more going on. And the other thing that I want to just say, some of the misunderstandings that we have about, we call it perinatal mood disorders, because we often think about these things as happening postpartum. as well and so it's not concentrated simply in that postpartum period
SPEAKER_02:right okay so then kind of speaking to that Do you have to have a pre-existing mental health disorder to have a perinatal mental health disorder?
SPEAKER_01:No,
SPEAKER_02:no,
SPEAKER_01:no. And I think that is a big misunderstanding that sometimes people feel like that they've never had depression or anxiety before. And maybe they are very happy about being pregnant. And so then their mood changes and they're not sure, you know, what's going on. And I do feel like clinically what I see is that a lot of people who are experiencing anxiety or depression in pregnancy especially don't recognize it until they feel better. Once they start feeling better, then they're like, oh yeah, I think I did go through a depression phase. But there are a lot of things that can contribute outside of that past history. So past medical history of a mood disorder is a common thing that can contribute to developing a mood disorder, but other things like a history of trauma, a recognition, sometimes you don't notice it until you are pregnant, but a recognition that you don't have the support that you need for a healthy pregnancy or healthy early parenting. And so sometimes having a difficult birth or traumatic birth experience can contribute to a mood disorder. So there's a lot of factors that don't have anything to do with your past medical history of those disorders that contribute.
SPEAKER_02:Okay. And okay, so we kind of talked on the baby blues, but what beyond that? What
SPEAKER_01:are the other categories? Yeah. So the other two common things that come up are depression and anxiety. And often people think more about depression, especially during the postpartum period. Mm-hmm. Mm-hmm. Mm-hmm. But are anxiety related sometimes getting fixated on specific things that may or may not be accurate? Mm hmm. you know, I think sometimes people will have like, OCD type of symptoms. And it may come from a good place, like you're wanting to make sure your baby is in a healthy home environment. So you want everybody to wash their hands and be cautious when they're holding the baby and things like that. But it can go to an extreme. And that's where you need to be able to recognize. And I If you are a mom who's been affected or are currently being affected, being able to recognize what's going on is so important. And then if you are a loved one, your role is also important. And I think if I could give you any advice, I would say don't take things personally when somebody is pregnant or postpartum. Like really be compassionate and ask some questions. Find out if there's more going on and what their needs might be. So depression, anxiety, sometimes OCD as a part of the anxiety. And then another category that we see more rarely, but is the thing that I think induces the most fear in people is something called postpartum psychosis. maybe goes to more of an extreme where they're having some paranoid delusions or they're really not able to connect or bond to the baby they're maybe disassociated from what's going on and again that is a more rare like more like 1% of the people who are affected by mood disorders but it can happen and sometimes when I've seen it happen it's really hard for the family members to understand and figure out what's going on. So if you're feeling like. your partner is not really connecting with reality the way that you're seeing it, then it is more urgent to get help right away. And these are the cases where people may need some temporary hospitalization or specific medications to help them recover from that experience.
SPEAKER_02:Right.
SPEAKER_01:So you
SPEAKER_02:mentioned being hospitalized. And I think that's something that's super scary and a reason why people... don't get help, even if it's not, that's rare. But I think even going to their doctor or midwife to say, hey, I think there's a problem happening here. The fear that you are going to be hospitalized or your baby is going to be taken away from you is a real thing out there.
SPEAKER_01:Yeah, I totally agree. And I see that in practice, often, people are afraid of being judged. And I think one of the things that motivates moms quite often, is the feeling that they are going to be a good mom, right. And so when they are dealing with some things that they, they can't really help, you know, that they're having this response, but somehow in their mind, they're feeling like this means I'm not going to be a good mom or I'm not capable of being a good mom and we really have to work on and that's why I'm so glad that we're here talking about this today but we need to work on decreasing that stigma and letting people know that it's not uncommon you know to have some mental health changes related to pregnancy and why wouldn't it be I mean it's one of the biggest transitions both for you know moms and dads really it's a big transition to go from not having children to having children. You are grieving the time in your life, the way it's always been, when you could take a nap whenever you want and you can do kind of what you want. Now you're kind of relying on needing to parent and the child's needs is gonna come first. So that's a big transition. And then I think socially, we used to have a lot more support for parents. We used to have grandparents parents and extended families I know even in my generation I had so many cousins and aunts and uncles and I don't think my mom ever had to pay for child care but it's a totally different reality now for most people and we have parents trying to do it all literally they're trying to work full-time careers and be good parents and then take care of a household prepare healthy food and You know, there's so many things that go into it. And it's no wonder, you know, that people aren't, you know, having a difficult time. But we need to sort of normalize getting help and recognizing that the support systems are not ideal in this country. And give people resources where we can and I think the first step really is just addressing that stigma and letting people know it's okay to ask for help both you know in your family and in your friend groups but also from your health care provider and health care providers need to also be doing a better job at screening people sometimes they may just look at somebody and they have you know maybe they are in good money or they look put together when they come to the appointment and they may not recognize that that person is suffering you know from mood changes so we need to be consistently screening everybody for mood disorders so that we can give them timely help yeah and I think a
SPEAKER_02:key thing that you said is that there could be something wrong but it doesn't mean that they're a bad parent because I think that is the biggest fear is that you're a bad mom you're a bad dad or a whatever and that's not necessarily the case and so getting the good help or getting the help shows that you are Yeah, because you're taking care of yourself so you can
SPEAKER_01:take care of your child. when we need help and get that help.
SPEAKER_02:Okay, so what does that screening and getting a diagnosis, what does that look like?
SPEAKER_01:Yeah, so most clinics, OBGYN or midwife clinics do, and sometimes even pediatric clinics now, are screening people for mood disorders postpartum. I think we could do a better job of screening people in pregnancy. And I have a background as well in working with people with substance use disorder. And I think we also really need to be screening folks at the very beginning who have substance use disorder, or sometimes even people with pre-existing mental health problems, if we're not addressing that in early pregnancy, it may impact their engagement with prenatal care and ultimately their outcomes with the birth and potentially even, you know, long-term parenting. Right. Okay.
SPEAKER_02:And I think one thing you had just said, so the screening early on and like my pediatrician, they did screen me But I remember we didn't really do much. It was like, okay, good. Thank you for filling this out. And then that was it. One thing that I think is beautiful about seeing a midwife is that you have a two-week appointment. And I think that is critical. And that's not the case everywhere or with every office. And I think that was huge for me is that I got to see someone at two weeks and then again at six weeks. Yeah. Do you want to talk on that?
SPEAKER_01:Yeah, I would love to. So ideally, we would be seeing people much more frequently postpartum. Like I said, it's a big transition period. And I do think Kentucky has made some big efforts to improve postpartum care. We did pass an initiative to get postpartum care covered for the first year postpartum. So if somebody is dealing with like a substance use disorder or a mental health disorder we can um as their like obstetric provider midwife or um ob physician could continue seeing them for follow-up again we've already established a relationship with them and it's not to say that they don't need other care and in an ideal world within these ob or midwife clinics we would have access to social work and other resources whether that's um Like for substance use in a clinic that I worked at, we had a specialized program that had a social worker and a provider that could prescribe medication and also peer support. So we could create really innovative models to keep people healthy and to keep them parenting with their kids. But it's not happening enough. It's happening some. And I think what you described as, you know, being screened, but not really the follow up that you needed. And that's kind of a risk and why some of the providers aren't doing the screening is because they don't know what to do afterwards. If somebody does identify, you know, that they have a problem, we need to have streamlined referral routes available. Yeah, yeah,
SPEAKER_02:that That's I think super important. Cause I do, I think back to that, my pediatrician appointments and I was like, well, what are you going to do with this? Like you guys can't do anything for me. But so I think, well, do you want to talk about treatment options? Yeah. Let's talk about treatment options. And then I think one of the most important, this episode, I feel like when you, you look at it on paper, it's kind of, you think it's for moms or moms to be or new, whatever. But really it's for the support people like that. I think is the biggest takeaway is that the support around the moms and the families is what's going to help the most. Um, but let's talk about the treatment options available to moms.
SPEAKER_01:Yeah. Um, there are really good treatments and I think there's also a lot of myths and misunderstandings around treatments. So what I can tell you, um, that whenever I'm identifying somebody with a mood disorder, whether it's during pregnancy or postpartum, the The first thing that I like to do is to screen them for other medical conditions that could cause mental health changes. So two common ones that show up in pregnancy are thyroid disorders and iron deficiency. And if we are going to have a successful treatment plan, we want to rule those two things out first. And then from there, I usually talk with patients about what what their feelings are around interventions. Would they prefer like exploring therapy options and going the route of like a therapist or would they like medication or would they like both? What the research tells us is that both is often the most evidence-based and successful, you know, treatment that we have available right now. They're also are some innovative like new treatments coming out but I won't go into a lot of detail because I do think that's something that you should explore you know with your provider but sometimes people have strong feelings like I don't want to go to a therapist or I've had you know my insurance doesn't cover a therapist or it's too difficult to find somebody that I match with there's all those things and then also on the other end you'll see people who don't feel comfortable you know taking medication while they're pregnant or while they're breastfeeding and what I will say about that and this is one of the links that we'll give you in the show notes is there is a great resource called mother to baby that specifically looks at medications and how they interact with breastfeeding or pregnancy and many medications are safe to take and what we do know is that untreated depression or anxiety is not safe right so we when you're looking at the risk versus the benefit that's what we need to think about it's not like taking medication or not taking medication it's like treating depression or anxiety versus not treating it right you have to think that through a little bit and it can be confusing and I think particularly with anxiety because sometimes what I see is that the anxiety presents, like if you're talking about medication, then they can get really fixated on, you know, the potential harm of the medication and that might be part of their anxiety, but they don't even realize
SPEAKER_02:it. Yeah. Yeah. And they're not seeing the benefits that, you know, outweigh everything else. And I like that you talk about looking at the whole picture before just jumping into a medicine and slapping it over, you know, a disorder, but looking at everything that's happening with the patient and then deciding the treatment plan. And that's part of the midwifery model is shared decision-making and the provider is telling you what the evidence is, and then helping you make a decision.
SPEAKER_01:Yeah. And I also think there is, you know, room to really look at your lifestyle. Things like exercise and nutrition and certain targeted supplements can also help with mood. But it can be very overwhelming. I mean, I think, especially with depression, in this case, the motivation to really make big changes or, you like reaching out and finding resources, when you feel this overwhelming depression, it can be very difficult. So I think really just having those conversations with a care provider who can help understand what's what's important to you and help you move from the place that you're in now to a healthier place. Yeah.
SPEAKER_02:Okay, so finding support in your community and at home. Where let's start within the community, where can you find it first? And how can community members Yeah,
SPEAKER_01:that's a great question. Like I was saying earlier, you know, our communities don't look like they used to look. So we sometimes have to find communities. our own communities as new parents. Sometimes there are like Facebook groups and it depending, like if you go to church, sometimes you can find mentors or people to support you in your church community. Um, sometimes if you have, um, work friends or other people, um, who've had kids before that you can connect with. Um, but definitely, um, the thing that I see within family dynamics sometimes is that when somebody is struggling with mood, um, it can be hard for like, um, saying earlier for families not to take it personally. And we really just have to move away from that and look at like when somebody is exhibiting some of these symptoms, how can we be helpful? And sometimes the things that we think will be helpful won't be helpful to that person. You know, a really common thing is that um family friends or in-laws may want to come over and take the baby for a few hours but if somebody's having a lot of anxiety about the baby then taking the baby is not going to solve the problem and maybe that is what they need but it's not going to work and so um maybe what would be helpful is if you came over and did their dishes or did their laundry or um brought them meals for the week um So sometimes support looks different than the way you think. And so maybe asking what would be helpful versus just assuming that you know what's best and and people, you know, family and support people, especially people with more lived experience, do have solutions and know how to help. But sometimes. you can interfere with your ability to give the help if you're just making those assumptions that you know better.
SPEAKER_02:Right. And not taking it personally and not playing the victim, I think, because then it makes the person who is struggling not want to ask for help whenever they're even ready to ask. And I just jot down some notes because I had a baby, so he's 18 months old now. And within my my community, I found this is kind of weird, but like my lactation specialist, I mean, I was going to go to her because she became part of like, that was kind of therapy for that was therapeutic for me. And that was really helpful. Um, my physical therapist, like just those different places that I found community and help. And, um, just kind of not where you would expect it, but that's where I felt the most comfortable and the most, I would say accepted. But then I also found there are so many like free new mom circles and new mom groups. And so I think that's really helpful, especially for having infants. I think once you kind of get past that three month mark, it kind of fizzles out because as a society we don't, We kind of view that's postpartum, but really it's up to a year. And so I think kind of looking where you least expect it and just kind of trying to find where you can find it. And I think for those people, just where I found it, they led with compassion and they listened and didn't offer unsolicited advice, but also... knew when to say something and when to offer gentle help
SPEAKER_01:to me. I'm glad you brought up the unsolicited advice thing because I do think that that is a source of stress for new parents. And it's a source of conflict sometimes. What I usually advise people to do, unsolicited, is to really listen with your heart around the advice that you're getting. And If there are things that you feel because you get to establish what your family is going to look like, and the kind of family that you want to have, and it might look different than the childhood that you had growing up, or what other people in your community feel like is normal. So I think if you get advice, you know, listen to what feels good to you and feels right to you. And it's okay to pursue those things. But if you're getting advice that's causing you more anxiety and more stress or doesn't feel like it resonates with you then you don't have any obligation to take that vice or to try it or anything but I do think most people have good instincts and they just need to be supported in following those and we're all different so we're all going to do it a little different so there's not necessarily right or wrong you know paths but there's going to be the path that's right for your family and And it gets a little confusing when everybody's telling you to do something different. Right, right. Or Facebook's telling you to say and then you have
SPEAKER_02:the internet and it's telling you a million things too. Yeah. it's hard for them because they feed off of your energy and, and they're going through a huge life change as well. So how can they be supportive? Um, what can they look out for? And yeah,
SPEAKER_01:Well, I do think that partners are really instrumental in diagnosing, you know, mood disorders. And so I do think keeping an eye out, like, is my partner losing interest in things that they used to really care about? Are they feeling like down and depressed a lot of the time? Or, you know, on the anxiety spectrum? Are they lashing out at me? Are they seeming unreasonable? Yeah. Am I not wanting to come home from work because of this? So they are really key at helping identify when there's a problem. And I also feel like partners feel a lot of pressure to fix everything quite often and recognizing that. Right. Right. feeding and I was waking up to feed the baby anyway but my baby was pooping every time and just that little gesture of him picking up the baby taking the baby and changing baby's diaper and bringing baby back you know that was a very simple thing that he did that made all the difference for me yeah not always possible you know depending on people's work schedules and so forth but there may be little things that you could do to give your partner more rest and also I think knowing what your partner normally does for self-care like in pregnancy or before pregnancy and reminding them of that like maybe it's they need a pedicure once a month or maybe it's you know that they need um some time alone like to go for a walk or to take a long bath or something like that but suggesting those things that they usually do for self-care or maybe giving them the space to make those things happen and the okay you know to do that because a lot of times our needs will go on the back burner you know when we have a new baby and over time that builds up you know and um that's a key thing i think partners can do yeah and and i think
SPEAKER_02:um to my husband um taking time for himself too yeah the support person for them to also but i think still addressing what's at home. And if, if, you know, call the mom's friend to come over so you can go and do whatever you need to do, um, to have that time away too is super important. And I know one thing that I was really lucky, um, to have that isn't necessarily normal here in the U S is my husband had four weeks off with me and that was incredible. And I still remember the day that he had to go back to the office because I was like, Oh no. Okay, anything else that you think we, we missed? I mean, there's so much
SPEAKER_01:that we could talk about. Yeah, well, thank you so much for joining me
SPEAKER_02:and for your sharing your expertise. Yeah, thank you for having me. I know that this can be a heavy topic, but it's important we talk about it to help our families. We hope that this was informative for new moms and moms to be as well for the people who support us. So grandparents, spouses, supervisors, neighbors, friends, and so on. Prioritizing your health and the health of those around us creates a happier and healthier over time. We'll see you next time.
