“Baby Blues” & Postpartum Depression

Intro: This is Weekly Dose of Wellness, brought to you by MemorialCare Health System. Here's Deborah Howell.

Deborah Howell (Host): Hello, and welcome to the show. I am Deborah Howell, and today we'll be talking about postpartum depression, often referred to as the baby blues. Our guest is Michelle Gentle, a licensed clinical social worker working as the clinical supervisor for the Welcome Baby Program at Miller Children's and Women's Hospital, Long Beach. She's responsible for the clinical aspects of the Welcome Baby Program, including providing supervision, education and training, and staff development. Welcome, Michelle.

Michelle Gentle, LCSW: Thank you so much for having me.

Deborah Howell (Host): Our pleasure. Anywhere from 40 to 80% of new mothers experience the baby blues, but the feelings often go away. About 15% of new mothers develop postpartum depression. So what are the baby blues?

Michelle Gentle, LCSW: That's a great question. So the baby blues is really just a term that we use to categorize mild depression that is interspersed with happier feelings and that occurs for a lot of women, up to 80% of women, after they deliver a baby. So this could be symptoms like fatigue and exhaustion, feelings of sadness, crying, anxiety, mood swings or irritability, feeling overwhelmed or oversensitive, maybe even an inability to sleep and loneliness. They typically go away about two weeks postpartum, and most of the time people don't need any intervention to get rid of the symptoms.

Deborah Howell (Host): So you say two weeks is roughly average.

Michelle Gentle, LCSW: Yes. So the peak is usually around 7 to 10 days. Women can start feeling symptoms within a couple days of delivery and then up to two weeks.

Deborah Howell (Host): Okay. Now, there's a difference between the baby blues and postpartum depression. Maybe you could speak to that.

Michelle Gentle, LCSW: Wonderful. Thank you. Yes. So postpartum depression is a mood disorder that actually impacts, we don't know the exact percentage, but the estimates have been anywhere from 20 to 50% of women who deliver children will experience a postpartum mood disorder. So postpartum depression symptoms are more extreme than postpartum blues. Postpartum blues, again, doesn't need intervention, will typically go away by itself within a couple weeks. Postpartum depression can happen at any time up to two years postpartum. So how would you know your loved one or yourself was experiencing more of a depression? It's really more like a deep sadness, feelings of hopelessness, excessive worry, excessive crying, intense irritability or anger, inability to sleep even though you're exhausted and even when the baby is sleeping and being taken care of. There's a lack of joy and oftentimes feelings of shame, guilt, or inadequacy. The estimates are that it's up to 50% of women, especially in high-risk populations. Just at our hospital, we deliver over 6,000 babies a year. That could be anywhere between 1,200 to 3,000 women a year that are experiencing a postpartum mood disorder after they deliver a baby.

Deborah Howell (Host): That is staggering.

Michelle Gentle, LCSW: Yes.

Deborah Howell (Host): What are the causes of the baby blues and postpartum depression that we know?

Michelle Gentle, LCSW: There's a few different things. So biological factors, we know that after we deliver a baby, our hormone levels significantly drop. So there's going to be naturally just some adjustment because of that. But we also know that there's social and environmental factors. So we have this idea of what motherhood, quote-unquote, should look like after we deliver a baby, and that's reinforced by our media, by social media, and what people decide to share with others on their social media accounts. But then some other factors that can contribute are stress or lack of support for the mother. Women who are in either violent relationships or come from a low socioeconomic status are at higher risk. We know that stress is a contributing factor and sleep deprivation is a contributing factor too. So it's a bunch of different things. But there's definitely things that put women at a higher risk versus women who are maybe at a lower risk.

Deborah Howell (Host): And how is postpartum depression screened and treated?

Michelle Gentle, LCSW: We are getting better. As a society, the stigma of postpartum mood disorders is slowly fading, which is a wonderful thing. And it's things like this that are bringing such important information to the public and taking away the stigma for these moms. So, oftentimes, women will be screened by their physician. We are hoping that in the future every woman will be screened in their physician office, either the OBGYN or family practitioner, whoever she's seeing for her prenatal and postnatal care. There are a few questionnaires. PHQ-9 is a standardized questionnaire, nine questions that can screen a woman for different symptoms that she may be experiencing. So, it's early detection is the key. The women who have better outcomes are detected early, arrange social support or have arranged social support, so either their partner or extended family or even friends. And then plan for practical support, and that could be just arranging child care for their other children or having meals delivered so it frees up their time and they can rest more, especially in the first few weeks. And then ultimately, if they need intervention, support groups are a wonderful way to meet with other moms who might be going through something similar. Therapy can be great also, and then medication management through either your OBGYN or a mental health practitioner like a psychiatrist.

Deborah Howell (Host): Are there groups now where when a woman is so busy and maybe has multiple children, including the infant, are there things like go-to-meeting or places where they can do it online?

Michelle Gentle, LCSW: Yes. So I'm going to give, and actually I can give them right now, there's a few different sites that a woman can go to. And we're actually really lucky here in Long Beach and at Long Beach Memorial or for Memorial Health System is that we have a few things in place here. There's a weekly group. It's not online. It is in person, but there's a weekly group run here by a licensed clinical social worker called Nurturing the New You. It's a free support group for new moms. That's held every Tuesday, I believe from 10 to 12 in Miller Children's Pavilion. And I'll give you my contact information if anybody would like to contact me to get more information about that. But then there's also a lot of online resources through maternalmentalhealthnow.org. and Postpartum Support International. So maternalmentalhealthnow.org is basically the LA chapter for Postpartum Support International. The phone number for Postpartum Support International for the listeners is 800-944-4773. But yes, there are online forums and there's actually even home visitation programs that do everything virtually. There's one through USC right now that has support for new moms virtually. They even provide an iPad to do it through. So there's a lot of different options.

Deborah Howell (Host): Fantastic. I'm so glad to hear that. So there's no reason to go it alone. Are there other postpartum mood disorders that we should know about?

Michelle Gentle, LCSW: Yes. So the most talked about is postpartum depression. We're finding that a lot of women are experiencing high rates of postpartum anxiety. Sometimes depression actually manifests as anxiety, but there are different postpartum mood disorders that are classified a little bit different. So some women actually experience postpartum panic attacks. A panic attack feels like a heart attack. So some women feel pressure in their chest. They have difficulty breathing. They have palpitations, dizziness, numbness, and tingling sometimes in their extremities. Sometimes they're even woken up out of their sleep with a panic attack, and that is like a postpartum anxiety disorder. There's also postpartum obsessive compulsive disorder, which oftentimes women mistake for something called postpartum psychosis. Postpartum psychosis is typically what we see when we see that a woman has hurt her children and then we see it on the news. The news will say it's postpartum depression. That's most likely not accurate. It's most likely a postpartum psychosis at that point. So there's similar symptoms to postpartum obsessive compulsive disorder and postpartum psychosis, such as intrusive thoughts where maybe the mom has thoughts of harming her child. But with postpartum obsessive compulsive disorder, these thoughts are very scary to the mom. So she might have these intrusive thoughts, including images of hurting her children. She often will do things, compulsions to alleviate that anxiety. So, for example, if she has these vivid images of the baby being stabbed by the knives in the house, she will go to great lengths to get rid of that threat. So she'll throw away all of her knives or she won't let anybody else touch or hold the baby because she's afraid something's going to happen. So she knows that her thoughts are scary. That's more of an anxiety disorder, the postpartum obsessive compulsive disorder. Women who truly have a postpartum psychosis will, well, first of all, it's very, very rare. They estimate it's only about 1% to 2% of all births. But it's, we call it egosyntonic. It's not scary to the woman. Her bizarre thoughts make sense to her at that time. So she may harm her child believing that she's actually helping her child. So that again is very rare, but what we see a lot now is now that we're talking and educating women about these different disorders is that these women who have maybe had the obsessive compulsive disorder with a previous pregnancy didn't say anything because they were so afraid of being labeled crazy and so afraid of that people might fear that they were going to harm their child. So the more education we can get out about these different disorders, hopefully the barriers will come down for these women and the stigma will be removed and that these women can get the mental health and support that they need.

Deborah Howell (Host): Absolutely, Michelle. I have a final question for you. Where can listeners go to get more information about the Welcome Baby program?

Michelle Gentle, LCSW: Great. So Welcome Baby serves LA County. We're a home visitation program for parents with new children or even prenatally sometimes. So go to firstfightla.org and you can search for the Welcome Baby program in your area. If you would like to call our office here at Miller Children's Women's Hospital Long Beach, we're at 562-933-2410. And I just want to make sure that every woman out there, if they are experiencing a postpartum mood disorder, know that you're not alone. It's not your fault. And with the right treatment support, you will feel better. Thank you so much for having me.

Deborah Howell (Host): You are just a gem. We appreciate so much you taking this time. You do such important work, Michelle. Thank you for being on the program.

Michelle Gentle, LCSW: Thank you. Thank you so much.

Deborah Howell (Host): For more info or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. I'm Deborah Howell. Thanks for listening and have yourself a wonderful day.