Conversations on Maternal Mental Health
Postpartum Health is a major concern for mothers, fathers, families, and has heavy societal impact. Worldwide, maternal depression is the most common serious health complication of maternity. I speak often about my own experiences with Postpartum Depression and the goal of this podcast is to share the healing principles I learned during my journey to recovery.
So it’s fitting that on May 1st, 2019, World Maternal Mental Health Awareness Day, I got to sit down with Amy-Rose White, one of the leading voices on maternal mental health policies and treatments.
Introducing Amy-Rose White, LCSW
Amy-Rose White, LCSW is a Maternal Mental Health & Couples Counseling Specialist based in Salt lake City. Through her counseling practice she has helped hundreds of couples navigate the enormous stresses related to pregnancy, infertility, miscarriage, loss, birth trauma, the postpartum period, and parenting through early childhood. She has a special interest in the impact of trauma, nutrition, and hormones on physical and emotional health.
In September 2014, she founded Utah’s Maternal Mental Health Collaborative which has joined forces with other maternal health advocacy groups and has become the official state chapter of Postpartum Support International.
Under her leadership, PSIUT has succeeded in passing state legislation to increase awareness, treatment, and funding for postpartum health. They have several project in the works including postpartum educational training materials, postpartum screening, telehealth services for rural areas, and the creation of a massive database of postpartum resources for individuals and providers.
It was a great privilege to have her as a guest on Power Principles the Podcast to share her knowledge and experiences working with Postpartum Depression/Anxiety, and illnesses currently lumped under the term Perinatal Mood Disorders.
Q: What influenced you to become an advocate for maternal mental health?
A: My own experience. I was in my second year of graduate school working as a medical social worker on a labor and delivery floor having no knowledge at all about the realities of postpartum depression and anxiety. A traumatic birth left me with symptoms that I didn’t recognize, neither did the doctors or colleagues I worked with.
“It has been a journey of mine to find the support that I couldn’t and to help providers educate and prepare and help prevent, when they can, maternal emotional health complications. That led me down this path and is why I sit here today.”
Q: Do the terms "Mood Disorder" and "Depression" prevent people from getting real help?
A: The term “postpartum depression” is a complete misnomer. In fact, I had a history of adolescent depression, so I was bracing myself for an experience like that, but when none of my symptoms were similar, I assumed I didn’t have Postpartum Depression. It wasn’t until years later I realized I had Postpartum PTSD, which I didn’t know was a thing. After my second child I thought I was a terrible mom, but I actually did have depression, but it didn’t look like depression I’d had in the past, or anything anyone had informed me about.
The reality is that more and more women experience agitation, irritability, anxiety, and insomnia. The term in the field of clinicians was Perinatal Mood and Anxiety Disorders. Now technically our diagnostic bible calls them Mood, Anxiety, Obsessive Compulsive and Trauma Related Disorders, which of course, nobody says.
The verbiage I think is more accurate is Emotional Health Complications. There are seven common diagnoses that happen to women in percentages much higher than gestational diabetes, preterm birth, and preeclampsia which women are educated about. Yet women are not informed about the variety of different emotional health complications.
These various health complication don’t generally present as a women under the covers crying all day, not functioning, feeling really sad and down. Typically women with these illnesses are taking really good care of their children, they are finding a way to get out of bed. They might have passive thoughts about it might be nice to not wake up so this nightmare could be over, but they don’t feel depressed.
Q: Does calling a disease after an emotional symptom propagate the stigma? What is the physical cause of these emotional symptoms.
A: Historically we have in our medical model an unfortunate separation between emotional and mental wellness and physical health. What we now know from the field of neuro psycho immunology is that every thought and feeling has a physical reaction in the body. One answer is an inflammatory response in the body as well as a dysregulation of the stress response processes in the brain in the HPA (Hypothalamic Pituitary Adrenalacdes) access. So most women presenting with the emotional symptoms we’re talking about today have very clear changes in their stress response physical system that results in the emotional or mental health symptoms.
And the average person doesn’t know that, although it’s becoming more and more understood, and I think it’s largely because we have these very siloed fields of mental health, emotional wellness, and physical health. And then within those parameters we have traditional or allopathic western medicine and “alternative medicine” and the language in the way we talk about these symptoms in all those silos is very different.
Q: How can we change the label so we can change the stigma?
A: Consumers, those of us who care about emotional wellness and are treating it or we are survivors ourselves, we are in charge of that. We as consumers and advocates actually get to determine the labels which hold or don’t hold. I think we are going to see a real shift in that paradigm as a result of women demanding to be screened and treated accurately and given good information. And also that the stigma around emotional health change, because when anyone hears the term mental illness or disorder, I mean, who wants to be disordered? The word “disordered” suggests a permanence. It has the connotation of a character flaw. And that’s what people think of when they hear mental illness is that it’s a weakness, it’s a flaw, you’re not strong or you’re not capable of putting that smile on your face. That’s why the handouts I make always say Emotional Wellness or Emotional Health Complications.
Q: What impact do thoughts, feelings, and the environment have on emotional health?
A: The field of Cognitive Behavioral Therapy argues that thoughts create feelings and feelings create physiological responses in the body. It’s difficult to know which came first with someone.
In this world we have an enormous toxic burden around pollutants, pesticides, plastics, electromagnetic frequencies. Our endocrine systems, I don’t think evolutionarily have caught up. And pregnancy is an inflammatory state, it’s an immunosuppressive state. So during postpartum, if you have a high toxic load or you have a bunch of viruses in your body, such as Herpes 1 or Epstein Barr Virus, or viruses and different genes allow our bodies to metabolize toxins at different rates. I think we are going to see that a lot of the physiology around mental health has to do with our bodies grappling with our environment. And if you have a woman who has a hormone sensitive brain, which many of us do, the enormous changes of pregnancy and postpartum tip that over.
Q: What's your advice for expecting mothers?
1. Keep Moms Number One Priority
The top level answer is to continue the same level of care after delivery that a mother experiences during pregnancy. During pregnancy women are considered special, people open doors for us, give us their seats, want us to eat the best food, ask how we are doing. Then after delivery it becomes all about the baby and the mother is sort of neglected. Keep the mother numero uno. You can’t pour from an empty vessel. The example I use with clients is that cars have to be fueled up and get regular maintenance and oil changes. We don’t neglect changing a car’s oil for ten years, then get angry at the vehicle for breaking down going up a hill.
In American culture, the mother has tremendous pressure to be perfect, look perfect, to love every minute, do it well, figure out the educational needs and dietary needs and allergies of each child. And if she gets it wrong, she’s a failure, which leads to women neglecting their nutrition, their sleep.
2. Prioritize Sleep
You have to fight for sleep. During pregnancy, plan for how you can get a 4 to 6 hour stretch of sleep as soon as possible after the baby is born. Most people look like I’m nuts when I say that, but for preventative purposes, sleep is the most important thing you can do. It’s difficult for women to take naps or ask someone else to feed the baby because we feel like people are watching and judging us and expecting us to do it all.
3. Food and Water
Drink a ton of water. We have an acronym snowball and the s stands for sleep and the n stands for nutrition. Keep your nutrition just as it was during your pregnancy.
4. Ask For & Accept Help
Get rid of the thought, “If I don’t do this, no one will.” A lot of women over-function. We think, I’m tough. I’m strong. I’m going to bounce back quickly. I’m going to get this done and it will make me feel accomplished. There are a lot of losses of control when we have children. Sometimes overdoing it is one way we compensate and feel like I got something done. We long for that sense of accomplishment, but over-doing doesn’t fill up the tank. This running on empty will burn-out your physiological components and your brain will complain. You will start to see break-through, bleed-through symptoms. Which is why sleep is the most important thing. We don’t know if a woman truly needs medication, if she needs a certain nutrient if she’s not sleeping. Sleep is always the first place to start because sleep can resolve a vast majority of symptoms or at least make them manageable.
Q: What is the solution for better and more frequent health checkups for new moms?
The policy team at PSI-Utah includes representatives from the American Academy of Pediatrics. One thing we’re working hard on, and this comes from the AAP, are recommendations that at well-baby checks moms also are routinely screened for depression & anxiety and then referred to a qualified therapist or support group, and also given information about nutrition and sleep. I think the pediatrician’s office is the place because most moms do take their children to well-baby checks for at least the first year and often beyond. Whereas a woman might get a six-week obstetrician checkup, then no one sees her again, so the pediatricians are really the only medical eyes on mom.
The benefits of moms being screened by pediatricians beyond that traditional six-week OB postpartum visit are numerous. For one, the well-baby checkups are already on mom’s calendar; it’s not an extra appointment she has to schedule. Also, often symptoms haven’t presented or regulated by six weeks. The first six weeks are pretty rocky anyway, so it’s hard for mom or doctor to know by six weeks what is “normal” postpartum recovery and what are “abnormal” symptoms signaling a more serious postpartum illness. Pregnancy and becoming a mother is such a personal transition anyway, that oftentimes women don’t recognize for three, six, ten, eighteen months that they aren’t themselves. I advise women to pay attention to not feeling “right.” Listen to the intuition that says, “I don’t feel like myself. This is not me.” Instead of defaulting to believing it’s a character weakness, know that there is likely more going on physiologically that can be treated and can get better.
In nearly all cases, although women are at highest risk for emotional health concerns during their reproductive, child-bearing years, women also tend to respond to appropriate treatment far faster than at any other time of their lifespan. When you get the right combination of treatment—talk therapy, sleep, nutrition, social support, medication—women are much better within weeks, not even months. I expect women to have a turn around within a session or two of coming to me. In the vast majority of cases it is totally treatable, completely recoverable. Sometimes I see women who have experienced mild life-long depression or anxiety who, with treatment, feel better than before they had children.
People in general, we settle for not feeling well, and we don’t have to. And we aren’t making the world better for our daughters by not speaking up and expecting better treatment.