Pass the Pie… and "Oh, I Had PPD Too"

Hi guys, welcome back to Preview Lions podcast. This is Sarah and we're in our holiday season. And I brought back our favorite reproductive psychiatrist Dr. Claire Smith. She is going to share with us what to do. We're going to be around people we haven't seen a lot, family, friends. We're in a different stage of life now. So why not take advantage of her around people. Claire, welcome. Thank you. Good morning. I was off camera talking to you just about the challenges of motherhood and parenting. But there is so much opportunity for extra challenges and anxiety during the holiday season that we're in just like baseline. We're already kind of like, you know, which way is the wing going to blow us. But here we go with tasks and duties. I think it's like, so if you are struggling and it's the holidays, why does it feel like even harder to say like, Hey, I have post-partum anxiety or I'm feeling depressed. Like, why is that like that? Well, I think the holidays usually exacerbate most things. I mean, as you know, and probably a lot of your listeners know the holidays, you'd think by watching TV that they're the most joyous time. But for a lot of people, they're a source of stress or pain or bad memories or what have you. So I think the holidays can just put a microscope on a lot of things. But I mean, it's hard to discuss because we're embarrassed. You know, we're ashamed, you know, thanks to Instagram, like, soaking up all the newborn cuddles, you know, and I'm not trying to make fun of anybody, but you see that and you're like, you are lying. Yeah. Yes. And and some women just overcompensate or frankly, might just be lying to make themselves feel better. I don't know. And I mean, there are definitely women who do well and don't struggle and are able to take a lot of things in stride. And I don't want them to feel bad about that, you know, or guilty about that or that they can't share that they are enjoying it, you know, not shaming for anybody for not doing poorly. But that's just the minority. So yeah, it's just unusual for someone to never have had a span of time, whether it's immediate post-partum, whether it's the back to work transition, whether it's breastfeeding, usually people can identify with something that's challenging. But you would think from the way people talk and what we see on social media, that that's not the case. So even though people are talking about it more, it still feels really intimidating to bring it up, you know, like one on one, like, no, I am that person that's struggling. There's just so much guilt around it. Yeah. And, you know, if someone say, you know, it's that cousin you haven't seen, but you're really close to, right? And like, you're like, okay, you're sitting there, you're hiding off in your pie together, you know, and you're just like, you want to share, like, I'm not okay. Like, how would you advise like, let's start that with a safe person, right? That might be the first time this person said, Hey, I have scary thoughts sometimes, or like, you know, I wake up and go, What have I done? Yeah, I think that what you said in terms of you already know that person is a, you know, we'll call him a safe person, or you know, the well, they know you well, this isn't a stranger who's like, how you do and, you know, and you're like fine and move on. I really do think that just a little openness goes a long way, you know, vulnerability just kind of opens the door for somebody else to be vulnerable back, but somebody has to take the first step to open that door. So I think that you don't have to, you know, unload completely on someone at once. You know, you can say, you know, being real, and in my case, I found that has shown me really the scope of postpartum struggles that other women I know well, you know, have. I think it feels like people who your friends who haven't had kids yet, they just can't get it. So what's the point? And I think that's maybe true to a degree, but is just because someone can't fully understand doesn't mean they don't want to try to understand and be supportive and helpful. But anyways, that's a little off topic. I just think that, you know, when a lot of people hadn't mentioned this to me before that once I was like, Hey, this is what's happening with me. I was shocked at how much, even though I do it for work, you know, I was shocked at how many people in my personal life. So something really simple, like this has actually been a lot harder on me than I thought it would be, or I'm actually having a bit of a difficult time. And then how somebody responds to that will tell you, Okay, they are opening that door, or they're sharing something, and this can be a more in depth conversation that I go into more detail and really share the extent of what's going on. So I think just starting simple, being honest, and seeing like, Okay, how does that land? And what does that person say? And then you'll know what to do from there, I think. And what would be a great response is someone's like, Okay, I'm on the other side of that. I've been there, I've done that. I've experienced it. I'm noticing my cousin go back to the cousin eating pie is showing these signs. Like, I noticed how she's a little anxious. I noticed that she's not finding joy in the things that I know she usually does. How do you broach that? Like, how would you would say, Hey, Sarah, you know, we're sitting there eating pie, how would you start it with me? Yes, well, I have the benefit of everyone knows what I do for living. So I can fall back on that always and just be really honest with people and they expect it from me. But everyone is not a reproductive psychiatrist, obviously. So again, I think keeping it simple is best. If you've had a kid, I would preface it with saying, like this stage, you don't have to say, Hey, I've noticed you seem depressed. You know, you could do that if that was like the appropriate vibe with that person. But you could say, you know, this stage was really rough for me. You know, this was really hard on me, where you're at now. So I just wanted to see how you're holding up, like how's it going? You could ask something specific, you can say like if you're texting, for instance, you can say you just wanted to check in and no pressure and text back quickly, but just wanted to see how things are going. Again, depending on your level of comfort with a person, you can specifically ask, are you worried about feeling depressed? Are you anxious about anything in particular, you know, being really specific so that they know, okay, I can be specific back. I don't have to give some vague like, Oh, yeah, it's hard. But, you know, it'll pass. That's usually, I think, where people are like, not sure exactly, like, what is this person really wanting to know? Or are they just doing something they feel like they have to do? And kind of related is, you know, if you're local, offering concrete help, not just let me know if I can help, let me know if you need something. But when is a good time for you next week for me to come by to help with the baby so you can nap dishes or just spend time together or whatever. My friends and I, whenever somebody is pregnant or has had a baby, we just text wellness check, you know, or like mental health check. And obviously, there's a lot of history and years of friendship beyond that. And we are really honest with each other. But even that is like, Hey, I was thinking about you, wanted to check in, like, what's the, like, what are you in the thick of right now? You know, lay it on me, kind of a thing. So there's a lot of different ways you can go about it. No, I love that. And I think people are like, Okay, well, what do I not say, Claire? Like, what is like the blade? Like, you know, I know a lot of it is, I think, I hope for someone who is, you know, I think most comments that are unhelpful come from people who aren't even thinking about it in that way. They're not even aware that something that they're going to say might not be helpful. Do you know what I mean? So I think if you're already a person who's thinking about it, you're pretty unlikely to say something that's overtly problematic. But the biggest things are, I wouldn't go in, like, if you're listening to this, and you're like, I didn't struggle, I can't really identify with it. I don't know specifically what to ask. Then I would not jump in with things like, isn't that newborn phase just the best? Are you just having the best time on maternity leave? You know, things like that, that people who have struggled are, are eye rolling at me like, Oh my God, I would never say that. But, but plenty of people do because that was your experience. Yeah. Or I think sometimes, and even I told this to my residents a lot too, if you're not sure what to say, it can be easy to say something you know you shouldn't say, but it just kind of comes out because you want to try things like, well, at least your baby's healthy. You know, at least you have a baby who's here and healthy. And it's like, okay, well, thanks for reminding me. I'm, you know, people have it a lot worse than me. And that makes you feel like you don't have a right to struggle, be just because everything is going quote unquote, okay. Things like that, I think are best to be avoided. Yeah. And it does, it happens, you know. And I think it's a good transition to, you know, we talked about it's overwhelming. There's a lot, there's travelers expectations. What do you do to safeguard your mental health? And what do you tell like your patients and even like your presence, like this is such a stressful time for everybody. Like, what is some tips like we can go into it just like with anything like we're not going to just run a marathon, we're going to prep for it, right? So we got to get this mindset of like, how do we go into this stressful time? Yes, I agree. I agree with that totally. I think for people with babies, especially, and like a new baby, this is the year to just do what you need to do. I mean, I would personally advocate for doing what you need to do and what suits you most of the time, within reason, but this is definitely the year to like listen to yourself and do what you need to do. If going home is a big help and fills your cup, then yes, it'll be stressful, but just make it work. Traveling sucks. Well, let's not be so definitive. Traveling can suck and it can feel like the end of the world to mess up a baby schedule. Yeah. But it will be fine. And the crying on the plane or missing a nap or fussing or whatever, that is stressful. I don't want to undermine that. It will sort itself out with time though. It will pass, it will get sorted out. So if going home is helpful to you as a person to spend time with family, then that other stuff, it'll go away. It doesn't last forever. I personally get wrapped up in worst case thinking like, but what if it's my grandfather's last Christmas and I didn't go because of this and that selfish, and I sort of can talk myself out of sitting something out. Like for instance, if going home is stressful or you're just not feeling up to it or baby's teething or something, it's just not the time. If you have those kind of anxious thoughts, if that's your flavor of anxiety, then I see you and sometimes it makes me feel better just to suck it up and do it and knowing, okay, I've seen everyone I need to see. I have spent time with my loved ones. I've accomplished that, but I don't think that's really the answer. I think the answer is that it's just one Christmas, it's just one Thanksgiving. It will come again next year. And whether it's your family or your in-laws, like you said, discussing beforehand, what are your concerns? How are things going to look different this year? Setting expectations together, I think that is huge. Yeah, and I've learned in those seasons, and the kids are older, they get so out of routine and our family is such a routine family. We spiral without routine and even there's more sugar and it's like there's sensory overload. So for us, it's like really like we've had to learn trial and error, but it is like I need to get up before my kids. I need to like walk, I need to run, I need to work out, I need to have a few minutes for me and my devotional time, and then I can be mom. I need to have some caffeine, but it's like it is hard when you're someone else's house, you're like, okay, I haven't got to do that because I don't want to go wake up my in-laws, you know, but it is kind of going like, wait, is this situational or is this something I can control? What can we control versus not? But a lot of times we can't control anything and I think that's half the issue. Right, it is. It definitely is. I feel you on the schedule and I know a lot of people are schedule oriented. Some people aren't, but most people are and that's one of, I think the biggest lessons I've learned over this first 18 months of parenthood is that it's sometimes yes, getting off schedule is not fun. You know, it's not that it's, oh, it's always ends up being fine. No, no, no, no, no. I mean sometimes it's difficult, but it does not stay that way. So it just depends on what your priorities are and if going home or traveling is something that you really want to do, then know that what comes is going to come and it will pass. Yeah, no, I love that. So let's say we're diving into now, we're around these people, right? Let's take advantage of it. So let's say she's trying to get pregnant and she hears the pa-cousin conversation and she was like, oh, wait, what? You know, you had this spot and you felt this and right where she's spiraling a little bit and then maybe she hears what her grandma tried to be like, oh, I had this and you know, your uncle has this mental health. And so how could she go into this of going, okay, I've heard about risk factors, right? I know I need to know my family's mental health history. I need to know just like, you know, if heart disease runs in the family, if bipolar runs in the family, right? And I do need to know kind of situational things. So how should she take this information and a positive way, don't spiral, but kind of like take it as powerful tool to educate herself? Yeah, I think A, especially if you're pregnant and people are giving you their own prior experiences and their horror stories, you know, sometimes it's just about nodding and smiling and excusing yourself to get another plate of food, you know, at the first possible chance. It's, gosh, I'm so sorry that happened to you, you know, I mean, and that's that. And in terms of if you're trying to get pregnant or you are pregnant and you've, somebody else says, oh, I had, you know, I find that older generations may not think that postpartum depression was like was a thing when they had kids, but in hindsight, maybe now they better understand it or things like that. But I would suggest reminding yourself that with things like postpartum depression or anything really in pregnancy, the causes are multifactorial. So yes, a lot that's out of your control, hormone changes out of your control, your genetics out of your control, you know, external factors may or may not be in your control, sleep may or may not be in your control, like other things that your family members, whoever that might be had going on in their lives, their relationships, their whatever that could have contributed. So like you said, knowing your family history is important and the responsible thing to do. But all it means is that it may live somewhere in your genes. And a lot of things live in our genes that never come to fruition. So I would try easier said than done, but try to funnel it into empowerment and education. Like you said, checking in with yourself, being proactive, knowing your resources, what you would do if you felt your mood beginning to shift or your anxiety becoming less manageable. Tell your OB about your family history and just ask him or her, what do we have available? Do we have anything available? What should I call you? What should I do? How is it typically addressed in this practice so that you have a plan that you could implement as soon as possible, if need be. And also, I want to empower people to ask for even like a two week mood check or something sooner than that six week postpartum visit. People do it for mood check for blood pressure checks. It's not a rarity in the OB field. It's just not something that's offered to every single person. But please ask for it. If you want to be sure you are checking in with a medical provider because you are concerned about your mood because of your family history or your personal history, request that two week mood check. That's perfectly appropriate. No, I love that. And you're right. It's not talked about. It's not asked about. And like, it feels like, wait, I have to ask for someone to check on me? Yeah, you do. And that's just kind of the state of our society, unfortunately. And I think if she is worried about risk factors and she's like, okay, Claire, what is a step I can do now if my OB is like, hey, that's not really my field. Where could she go? Because, you know, reproductive psychiatrists like you, they're not in every state. So what's kind of your advice to those women if they have someone like you versus if they don't? I know it's tough. As your listeners know, I would always recommend postpartum support international PSI. They will be the preeminent resource that anybody can access. If you have anyone in your state, they should be searchable on that website. They also have themselves like phone lines to call in. They have online groups like some they have some sort of support available for anybody in any state with any insurance, no insurance. So that would by far and away be the best resource. I'm hoping as we go along more and more and more that increasing amounts of OBs are comfortable with at least like a Zoloft Alexa pro something like that. And if not, you can always try primary care too. They are an excellent resource. Depression anxiety should be well within their wheelhouse. And the vast majority are comfortable with this. So all states have primary care doctors. And so if you're not established with one, then I would get established with one. But that would be my recommendation. Something, you know, if you want to see someone in person locally, an actual provider, not an online resource, but PSI is by far the best resource. And I'll leave that in the notes. And I think a common question along this is, okay, so I had postpartum depression before I had anxiety for Claire. I'm pregnant again. And I know I experienced this with some of my friends and family. Just when I was pregnant again, they tiptoed around it. Is she going to get again? Did I tiptoe around myself if I was going to get it again? Yeah, kind of, you know, to be honest, what do you say to patients? It's like, huh, I can't go back to where I was there. Or now I realize how bad I was, like, are they going to get it again? What can they do? Like, how do you have that conversation with friends and family? As far as are they going to get it again? It's hard to find an exact percentage. It's probably somewhere in the 30ish percentage range, maybe a little low or maybe a little high or somewhere in there. So that might be reassuring to some people that it's probably not as high as people might think. But I think piggybacking on what we just talked about, okay, it's not just that you have family history of it. And so you want to be aware of what you would do. It's more so like, okay, what do I do? So you want to know the answers to these questions I already talked about and do something with that information, not just have it. That would be my best recommendation. So I do find that women, we see a lot of women who had post-perm depression in the past or maybe it wasn't treated, but they're pretty sure it is, know now that they are no more about it and informed. And then they get established with us during pregnancy. Some have had continued mood symptoms or anxiety. Some are doing okay and they're simply just wanting to be established because like you said, it was so difficult the first time and they do not want to go through that again. I find that those people tend to do it pretty well. It's much, much, much less than 30% who have a recurrent. So the proactivity and being established with someone and knowing what it was like and that kind of a thing is can be very helpful. So another thing I want to that I think is partially reassuring hopefully and partially action-oriented is what were the circumstances around your last pregnancy and your last delivery? Is any of that modifiable? Meaning like can any of it be addressed? Is any of it already addressed? So it could be your relationship at the time, what your overnight feeding plans were or how that went. The medical status of your pregnancy, were you high risk? Are you high risk now? Where were you living? What was your social situation? What was your exercise routine? I mean some factors are able to be changed and some simply aren't. You know there's no amount of yoga that can prevent everyone's post-war depression. So there's anything that can be changed that's within your control? Change it. That was contributing things like stress, overwhelm, financial security, planning ahead, the plan for those first few weeks postpartum that's so critical. Other than that it's just being aware of what it is. How does it feel? How does it feel for you when you look back? When do you think it started and like what was the point at which maybe didn't realize at the time that things started to shift? You know that's a big advantage. So recognizing it and not waiting to get it addressed. Yeah hindsight is 2020 right and you've already been there done that. That's what I said I said you know I think that is the gift of the second time around is you've been there know that and you can recognize it. Well what is one thing that if you would want listeners to kind of know about their mental health from just like you as you know just clear not even for the reproductive psychiatry cat that you know you would tell one of your friends or you're gonna tell your daughter one day about mental health that they can take it to heart during the season and even as we go into the new year. You know I have a lot of thoughts on this. I think the first thing to address is that you know since we're talking a lot about interacting with others and sharing with others and being open and vulnerable that ultimately how people respond to you is not really within your control. I mean it's not within your control not even not really. You can deliver this information in a sincere relatable vulnerable way and someone is fully able to maintain a position that's not terribly understanding or validating and that can feel so crummy when that happens or if it happens and I don't want that to deter people from sharing and seeking help and asking for help. I discuss it a lot with patients who in a different scenario maybe you're having issues with a close friend or a family member often it's a parent or a sibling or an in-law and the patient is doing everything you know quote unquote right in trying to have a dialogue and you know about something that is bothering them hurtful to them affecting them comments that this person is making or you know whatever it might be and sometimes the needle doesn't really move like they've done it they've done the right thing and and nothing really happens without other person's behavior and so when that happens you have to then shift the focus internally so the options at that point are never see this person again cut them out of your life which you're not most people are not going to do that to their mom and don't want to do that to their mom that's not what they're after is no contact it's just that this thing that they keep doing you know whether it's commenting on their parenting or body image or when I was a parent or whatever it might be so what you have to what then what you decide to do thereafter if you're not going to cut them out of your life is internal then it's no longer really a dialogue with them you're not setting boundaries with them anymore if they're not going to respect and honor them you have to set expectations and boundaries for yourself on okay then this is what I will and won't talk about this is what I environment I will or won't be involved in and at a certain point it's just the reality of that person and and that relationship and that's not to say that's not sad and I think the other thing is somebody whether it's a spouse or a friend or a parent or a co-worker they may not get it it's particularly having a baby newborn struggles whatever it might be post-prime depression they may not get it in the way that we want them to and that's frustrating but it's okay you know not fully understand he is not the same as not caring to understand which I sort of mentioned earlier like for example I was thinking of how I could relate this to myself since this is what I do and now I have a kid so I feel like I can understand and empathize but I've never lived with chronic pain for instance so I don't think I can really understand that experience but I'm certainly receptive and empathetic to the best of my ability to what that might mean for someone so you can still be open and honest but the point doesn't have to be they get it it can be like you're saying what type of support do I need what do I want from this person how can they be helpful and I want to be careful here because I don't mean that spouses in particular are helpless creatures and the burden's always on mom to say this is what I need and this is what you need to do you know I'm not talking about sharing diaper duty or like cleaning bottles that's not what I mean I mean if mental health isn't a familiar concept for them it's okay to give a direction give some direction and be a little bit more concrete if they're willing to be there and be supportive and understand but they just don't understand understand yeah I experienced that perfectly when I was being a nurse for many years and a lot of our veterans experienced PTSD and I was compassionate towards it I didn't fully grasp how it impacted your life until I had a traumatic birth and I experienced PTSD but I could have never have fully got it before I experienced it so I think that was a big eye-opener for me and it was interesting that I treated and this supported so many patients and then I had to have slipped experience and go wow but I think it helped me look at people and be like you don't have ill intentions sometimes it's that capacity they just it's not there or the knowledge is just like it's a lived knowledge a live truly I got you I understand you versus I love you I care for you I want to support you I just this is an amount in left field right yeah exactly and not to end on a not a negative note but at the end of the day some people this is not who we're talking about here but there are a small amount of people who don't really care and understand and that has nothing to do with you doesn't reflect on you or like invalidate what you're experiencing and I try my best sometimes it just feels bad and that feels bad but I try my best to feel sorry for those people because can you imagine what it would be like to be their partner or to be walking around in that person's brain and in a world where you don't have the capacity to hear someone's else's struggle and hear them support them like that's sad that's a sad life for me and that doesn't reflect on me no I love that and I think there's so much control and power and just like inner strength and lived experience and like being vulnerable again and I will tell you I've never not been vulnerable with the right person right situation of course I've been memorable some people like oh gosh I'll never speak that way to you again okay cool no right but I generally usually find that opens like a really good path for us to like bond or some of my closest new friends in this situation of life or in it's just me being like hey yeah this is why I started Previa I had post-mortem impression all right yeah I had anxiety yep I had a dramatic birth there like oh you're safe space so I think that's so much value in this season we're going to survive the holidays and we will come to the new year and be like oh but you know what I think this year we're going to now especially from this conversation in your insight Claire is to say use these opportunities to connect use these opportunities to educate yourself others or set those healthy boundaries and show your children what healthy boundaries is or the importance of routine and respect so Claire you always are dropping so many wonderful truth bombs on us and we appreciate and we love it even now more that you are in the depths of motherhood with us so we will bring you back and we will talk more especially toddler years can't wait for us to go through those thank you all right listeners cheers to you guys hang in there me Claire's in the holiday season with you we're out there you know trying to run to target plus get get down to nap plus try to remember what's tomorrow so hang in there we'll see you guys next week maternal mental health is as important as physical health the previous alliance podcast was created for and by moms dealing with postpartum depression and all its variables like anxiety anger and even apathy hosted by ceo founder sarah parkers and licensed clinical social worker whitney gay each episode focused on specific issues relevant to pregnancy and postpartum join us and hear how other moms have overcome mental health challenges as well as access tips and suggestions on dealing with your own challenges as moms you can also browse our podcast library and listen to previous episodes at any time please know you're not alone on this journey 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