The Truth About Postpartum Depression – Ellen Chance
Hi. Welcome back to another episode of The Mindful Space. Today we have Ellen Chance with us. How are you? Good. Thank you for having me. Of course. Welcome to the Mindful Space. Please. Of course. Excited to have you here. So today we are going to discuss perinatal mental health and maternal burnout, correct? Yes. But before we start talking about that, can you give us a little intro of yourself? Sure. So I’m Ellen Chance. I’m a counselor educator. I have my PhD in counseling, and I’m also the founder of Whole Counseling and Wellness. It’s dedicated to serving women, and more specifically, I have advanced training in serving the perinatal population. So women during pregnancy and in that postpartum phase, we really need that help, too. Yes, absolutely. How did you get into this field and why? Is there a specific reason? Well, it’s been a little bit of a journey. I actually started off as a school counselor and then worked as a K Twelve counseling coordinator when I was earning my PhD. And around that same time, I had my first child, and I had my own lived experiences with postpartum anxiety during that time. So once I earned my PhD, became a counselor educator, working at the university level, and started to feel like this pull to give back based off of my lived experience. And there were subsequent conversations that I had with women in my life, friends, colleagues, about their experiences in that pregnancy and postpartum period, including miscarriage, infertility, loss. And a lot of their stories made me recognize this is an underserved population. There’s not enough awareness, and there’s not enough specialized treatment out there. So I began to pursue pathways of getting involved, including getting involved in organizations that serve this population, volunteering, and then I pursued advanced training in the area. That’s wonderful. Yeah. I feel like a lot of therapists, when they specialize in something, they have, like, a personal story. Exactly. I struggled really badly with my first born, and I remember with my second, I was trying to be proactive that time around. And I’ll never forget I was working or not working. I was at the high risk OB. And I opened up for the first time about my experience, and I said, this time around, I would really like to be proactive, get established with someone who treats perinatal mood disorders and anxiety disorders. And they had no one to refer me to. And this is a high risk OB. I mean, not to not to shame them, but it was like they didn’t have that collaborative network to even point me in a direction. And that kind of lit my fire and was like, okay, well, then I’ll be the person I’ll be that comes to the rescue. So, yeah, that kind of propelled me, and it was definitely a professional pivot. Right. This wasn’t a population I had served previously. I was working with children, adolescents, but obviously so much of what I was doing was transferable. I love it. For those that might not know what is perinatal mental health? What does it constitute? So the perinatal mental health is in regards to women at the time or childbearing individuals at the time of conception, all the way to the first year after delivery. So the first year postpartum, obviously that time is characterized by significant physical changes, emotional physiological changes, and there are unique disorders related to the perinatal population, which we call PMADs. So perinatal mood and anxiety disorders. And what would be the most common perinatal mental health disorder? So the most common, from what we know right, and the people that are coming forward, is postpartum depression. That’s the typical buzword. You always hear people say, I had postpartum. Exactly. And I feel like now it’s definitely more talked about than in previous years. Definitely. And I think that that’s wonderful. It should be something we talk about. It should be something women know about as they approach this huge transition. If you think about a woman’s life and should they become a mother, that’s one of the single handedly biggest transitions they’ll ever go through. And why do you feel that it’s the most common? Just statistics show that the depression is most common. It’s not the only one, though. Postpartum anxiety is right there as far as how common and statistically significant it is. There are other disorders as well, postpartum OCD, postpartum bipolar disorder, and postpartum psychosis, which is much more extreme and could be life threatening. And you could also have a combination of both. Yes, absolutely. A couple of diagnosis together. Absolutely. That’s crazy. But it’s happening every day more and more. So I’m actually not surprised. We also hear more about it than the regular people. But as moms, I feel like just the more people talk, less stigma and then exactly. People feel less afraid to actually talk about the postpartum depression or anxiety or whatever it is. Absolutely. Now, what is the difference between maternal mental health or maternal and perinatal? So you will often see them used interchangeably, but the way that I like to conceptualize it is maternal mental health is forever once you become a mother. Right. There’s unique challenges that you face as a mother. The physiological changes, the emotional changes, and also just the grief process of becoming a mother. You’re completely changing a piece of your identity forever. And with that comes a lot of challenges. So my maternal mental health is covering the lifespan of a mother. Really? And the other one, you said it was at conception. Conception up to a year. Yes, which I never thought that it was up to a year. I thought it was till you have the baby and then you cut it off. Right? No. Yeah, I wasn’t a year. And organizations like Postpartum Support International, they do a ton for this population. It’s remarkable they even see it up to the first two years after having a baby, and they offer services for women and families. Yeah, let’s not talk about services and maternity leave. Yeah. I mean, that’s a big part of the problem. Exactly. That’s a whole other episode. Yeah. There we go. Invite me back. Exactly. Now, what are some of the concerns about perinatal mental health? What are therapists or people most concerned about when it comes to that subject? It can become extreme, especially if it goes untreated. I mean, it can lead to extreme feelings of isolation. It can lead to self harm, suicidality. It could lead to the woman harming their own baby. So there are some pretty significant concerns. We’re hearing more and more about postpartum psychosis, which is characterized by hallucinations and delusions. So we’re learning more about postpartum psychosis, which can be characterized by hallucinations, delusions. There’s higher rates of suicidality associated with that as well, and harm to self and the baby. So it’s definitely something we have to respond to immediately. Exactly. How can we respond to it? I don’t want to say fix, but how can we start working on the perinatal mental health? Well, I think you use the word stigma, and I think that that is kind of the first point that we really need to address with this population. There’s a lot of shame and guilt surrounding these experiences. Right. Fear of coming forward. Right. If I admit what I’m going through, if I admit what I’m thinking or what I’m feeling, then people are going to think I’m crazy. People are going to think I’m a bad mother. People might take my baby from me, right? What did I do? She’s like, oh, no, don’t go there. Okay, so repeat that last sentence. There’s fear associated with opening up about the experience. Right. Are people going to think I’m crazy? Are people going to think I’m not a fit mother? Right? Are they going to take my baby from me? There’s all of those legitimate fears, and then there’s internalized shame about I should be enjoying this. Everyone says how wonderful this is, right? I’m laughing because it’s like the typical answer is, it’s so hard and it’s stressful and you’re not going to sleep, but it’s very rewarding. Enjoy every moment. Yeah, and it is, but exactly. For somebody who’s not enjoying any part of it, I can only imagine how shameful you must feel. You already have. Do you breastfeed? Do you not breastfeed? And then on top of that, it’s like, how are you not happy that you have a baby? And it just leads to this outcome of people not taking care of their own mental health. Exactly. So I think that’s the first point, I think, as a community, really, wrapping around new mothers is important, informing their social support and their circles of what to look out for. And then certainly this should be universally screened. Right. We’re starting to see that more now, but often women are screened at six weeks postpartum, and then that’s the last they see a doctor for a while. When is the latest or up to what point could you be diagnosed with postpartum depression? Anytime in that period. The first year? Yes. Okay. Or during pregnancy. Is there anything more common than other? It’s just very randomly. About 50% will develop in pregnancy. Okay. So there are signs I shared with you. Like, this is a lived experience for me. There were so many signs for me during pregnancy that I was anxious, and it only continued to progress and get deeper and more pervasive and more dark. It was like this carousel I couldn’t get off. It was just going in circles. You, as a trained therapist, were you able to recognize these things even in the beginning, or were you kind of lost? No, I knew what was happening to me, but here’s the kicker, is I never got help. Right. Because those feelings of shame that I’m talking about, I felt those so strongly, like, I should be doing better than this. I should be feeling better than this. I should know how to overcome this. Which is so against our training as mental health professionals. It’s not rational, but that’s where my headspace was. Yeah, well, people tell me all the time, well, you’re a therapist. I’m sure you handle things well. I’m like, I’m also human. Right. We can’t treat ourselves. Exactly. I’m like, do you see a surgeon doing surgery on themselves? No. Right. Same concept. I need my own therapist. Right, but it’s true. Like, the ego gets to us, right. We can handle it. At what point? So you never got the help. You kind of went through it, and then you decided you were going to get help for other people. Yeah, well, it was my second pregnancy where I did try to find help for myself and was kind of left with no resources, really, no direction to go. And my son was a 2020 baby. Luckily, my second pregnancy was completely different. I didn’t have any symptoms of anxiety, which is funny, because he was born in a pandemic, you would think, right, maybe it would be more present then. But long story short, it just really made me recognize that this is a need and something that I felt really passionate about, something I felt like I could really help with. Yeah, I mean, it was personal at this point. Like, I want help. I can’t find it. Go do the help. Right now, in that transition of giving birth and becoming a mother, what are some of the major effects that it can have on a woman? Sleep deprivation is the number one. Right. It’s an immediate shock to your system. You are so sleep deprived. And that’s when a lot of the onset of symptoms or the intensifying of symptoms occurs. So when I work with a client, that’s the first question I ask them. How much sleep are you getting? That’s the first piece of work I do with my clients because if that isn’t taken care of, you’re not going to see any progress with your symptoms. Sleep deprivation has very serious consequences on the brain. Do you mind explaining what are the symptoms or signs of postpartum depression? Absolutely. Some common signs might be just frequent crying, inability to control your emotions, withdrawal, not taking care of basic needs. Right. Hygiene similar to common signs of depressive symptoms in anybody, but it is definitely characterized by a lot of emotionality and definitely the withdrawal. Right. Feeling very down. It’s important to capture that. This is different than the baby blues. Right. Have you ever heard, oh, she had the baby blues? Right. So what would be the difference? So baby blues typically happen to every woman that’s had a baby and it’s in that first two week period, it’s characterized by the hormonal changes, and then after the two week period, it should subside. Okay. If it’s persisting beyond that, that is a sign that it is postpartum depression and you should be talking to a doctor and getting help. Okay, so two week mark. Yeah. And how long could the postpartum depression last? Depends. If it goes without treatment, it could persist past the first year. If it goes untreated absolutely. Does it become depression after the one year or still postpartum depression? Well, is it postpartum onset? Got it. How do you manage a client that comes in and says, well, I’m not sleeping a lot because the baby’s not sleeping a lot? What’s a solution that you provide for them? So we try to engage their support system. Right. We try to get them to a place where they feel comfortable and empowered to ask for help. A lot of times there’s fear about letting someone else help with the baby. That can lead to even more sleep deprivation because they’re not seeking any support. So definitely engaging the support system. I know it sounds cliche right. And it’s a little bit triggering. Right. Sleep. When the baby sleeps, it can feel a little minimizing. But at the end of the day, if I’m prioritizing doing the dishes in the sink and completely neglecting my sleep, I need to figure out what’s more important, what’s more of a need right now. And so that word need is something that I address with my clients all the time. We all have foundational needs in this period. They’re giving so much that a lot of their very basic foundational needs are going completely unmet. So we begin to explore that together. Yeah. And then that’s when your support system can also jump in and do the dishes or pass by and help you clean the apartment. That’s right. Or hopefully you have that. Exactly. And that’s not always the case. And that presents a challenge and that’s a major risk factor. Exactly. For those that are not able to get support system, single parents and other things that work. They can get maternal burnout. Absolutely. Let’s talk about that. Yeah. That’s another common concern that we’re seeing in working with women and mothers in particular. You’ve heard of burnout in an employment occupational setting, correct. Well, now research is showing that mothers are experiencing the same chronic symptoms of burnout, which is physical exhaustion. Mental exhaustion. Emotional exhaustion. And that occurs because you are in this go go mode, right. You’re in this chronic stress giving yes. And you’re trying to meet these demands that ultimately leave you at the bottom of your list. Right. Again, your needs are going unmet for quite some time, and then you begin to burn out. You physically, emotionally get into that phase of exhaustion. What are some of the most recognizable symptoms? So you’ve probably heard terms like mom guilt, right? Mom rage. So you might see somebody who’s really irritable, right. A short fuse. You might see someone who’s constantly feeling guilty, like they’re not enough. Right. They’re not giving enough, they’re not a good enough mother. Physical exhaustion, lack of motivation, just kind of cutting off from their social circles. Like, not even engaging in social support anymore. Disconnection from their children and their partners is a big one. Right. Feeling very disconnected. It might even be, like, fantasizing about not being a parent anymore. Wait, that’s not normal to the extreme. Like, wait, I picture myself, Hawaii, childless all the time. What do you mean? No, but I get it. I get the difference to the extreme where you’re considering it or completely disconnected from the real life of actually having it. Right. You want to think of that word like chronic. Like, this is becoming exhausting. Exactly. What can we do? Is there anything we can do to prevent maternal burnout? Well, I know you touched on it a little bit before, but really looking at systemic change I think is going to be so important. I know it’s something that our country has been we’ve been up against in our country. We’ve been lacking. So certainly there’s some systemic issues here. Parental leave. Right. Postnatal care, as I said, women see a doctor after six weeks, and then they don’t see a doctor again. Right. Also, just the demands of motherhood. So it’s like these cultural expectations of the mother and then how that plays into that load that the mom is taking on that is just completely unreasonable, and it compromises their well being. Once they’ve reached a point where maybe they do have paternal burnout, what are their options? So definitely beginning to meet their needs. Right? Like, if you look at it from, like, I haven’t been meeting my needs for an extended duration, we want to look at it holistically of like, how can you start taking better care of yourself? And it has to go beyond just occasional self care. Right. You have to be willing to give to yourself what you’re constantly giving to others. It’s that whole can’t pour from an empty cup. But it’s words to live by. Right. You are constantly pouring into others. As a mother, especially a working mother, you’re everything to everyone. Right. And that’s just unrealistic, and it’s taxing. And so setting some boundaries is really important. I don’t know if that’s something you’ve learned boundaries with yourself. Yeah. For me, I had no issue on having other people help me. I was also young, so I think that I was just like, want to help? Sure, jump in. I also wasn’t able to breastfeed, so that helped too. It’s like, I’m sleeping. Here’s the bottle. Here you go. But I always wanted to take care of myself first, because I noticed when I didn’t, then I wasn’t able to take care of anyone. Right. So I always kept good for you. My friends, around, or if I wanted to do something or beach day, just bring them along. I see a lot of people having almost, like, two different lives, and I definitely avoided that. I still do it. I still have my own time, my time with my son, and then I have my time with my profession. But it’s hard because I have friends that don’t really know how to do that or even have time with their partners. Yes. You have to be able to wear many different hats and for them to be exchangeable, not just, I’m a mom and that’s it, or I’m a professional and that’s it, or I’m a woman and that’s it. And it’s hard. Not everybody can manage well. And I think a lot of people try to take on all those hats. Yes. And that, too, can become overwhelming because they want to be perfect in every role that they’re fulfilling. And it’s like if you were to write down all of your roles that on a daily basis you’re fulfilling and the expectations you place on yourself in those roles, what’s the emotional toll of that? What’s the physical toll? A lot. Yeah. That’s why I said interchangeably. Yeah. Right. And then that’s it. I’m not working. I’m doing this. And then you do, this is my fun hat. I’m out with the girls, you’re with your grandmother, and then you go back. It’s like, all right, I’m a mom full time. Let’s do homework, bring out the worksheets. It’s worked so far. I can’t say it’s perfect, but it’s definitely draining. I notice that when I do try to do multiple at the same time, I’m just, like, exhausted, I need a break. And then it’s spa day. Yeah, there you go. Mom, help me. What can we do, or what can family and friends do to help those mothers in need? I think kind of helping with that load we’re talking about. And some of it’s invisible. Right. Have you heard of the invisible load of motherhood? It’s like all of the things that people don’t even see. Explain further for those who don’t know. So if you think about all of the decisions you have to make as a mother in a day, all of the thoughts, all of the tasks you have to run through mentally. Right. Did I make the doctor’s appointment? When is the dentist appointment okay? Did I pack the lunch? Right. Mentally, you’re going through a list. A list constantly. You’re making decisions constantly. And that’s invisible to others. Right. And that in itself can be very overwhelming. Right. We go on vacation, the mother might find themselves taking on the entire load of preparing the family for the vacation. Right. And so you ask what spouses, partners, family can do. How can I lighten your load? Let me do that back for you. How can I lighten your load? Or what do you need right now? Because you’re constantly giving to others. It’s a simple question right. That sometimes we forget to ask. Very important. Yeah. Some people might get shocked, like, wait, what? What do you mean, what do I need? Oh, okay. I guess go change the kids. I’ll do the bag. Are you okay? What’s going on here, exactly? Well, I loved the whole conversation. I really hope that we can bring some awareness and eventually break all the stigma. What would be your last message for somebody that might be going through postpartum depression or maternal burnout or anything related to that? I think the overall message I would hope to convey is that you’re not alone. There’s support systems out there. There’s support groups out there. There’s trained professionals out there, and one in five women experience some form of a Pmad. So it’s important to recognize that this is common and it’s treatable. So you will get better. I mean, that’s the encouraging part there. You will get better. Yeah. That there’s hope. There’s light at the end of the tunnel. Yeah. You’re not alone, and you will get better. Great. I love this. Well, thank you all for watching. Will see you next week. Please, if you like what we talked about, don’t be afraid to leave us a comment. And don’t forget to subscribe. Bye.