Postpartum Mental Health

I am so excited to introduce you all to one of my dearest oldest friends.

She's not old, she's been my friend for a long time. Lacy Rain, Haggerty Tipton. I'm just giving you all of her names in case you want to know her background. She is a certified nurse midwife and she is, Fing brilliant when it comes to maternal health and the process of engaging pregnancy and the midwifery perspective on things, and I wanted her here to share with all of you new parents, just some thoughts on maternal mental health because as we are taking care of infants, what they need from us is lot. They need a lot of our time and our proximity and it takes from our mental energy. And so it's really important that we also think about how to take care of ourselves because we can't take care of our babies if we are not in a place where we are. okay and I don't mean zenned out 'cause nobody's zenned out with a baby.

But I am not an expert in the same way that Lacy is. So I had brought her on to chat with us and have some questions for her and I'm so glad you're here. Thanks for having me. As I feel, oh my gosh, there's other experts out there that could be better at this, but I will do my very best.

I'm very honored. You asked. We all do that to ourselves. It's so interesting. Yeah, I guess we don't, that's, I think that's a female thing. It's like I shouldn't be in the position to be sharing someone else. Someone else probably knows more, so why would it be me? But anyway it's always probably true.

Somebody else probably always does. Your voice matters. And for me, your voice is like so impactful. My first question for you is, when you think about maternal mental health in that early infant stage, so someone has just delivered a baby or maybe they're two or three months into having a child and you're meeting with women and you're checking up on their health, what are some things that you are aware of and looking out for as a midwife when you're meeting with women?

Like what are you thinking when you're meeting with them? The first thing I'm thinking is the longer I've done this and then I've had two children myself, so I I really try to set the stage for people honestly, around the, in the third trimester of pregnancy to help them understand that there's.

So many things, honestly sounds so negative, but working against them with a newborn that I've almost come to believe that some sort of push some amount of postpartum depression or anxieties actually. Baseline or normal? Because you carried a human in your body. You grew them that highly impacted both your physical self, and your mental self because it changes how you live from your day to day.

And then you get them outta your body somehow. Whether that's a c-section or a vaginal birth. It's so hard on your body and requires so much bravery and Just like you have to harness a part of yourself that you don't otherwise need to. And then you have a huge identity shift, and then there's a huge hormone shift with the delivery of the placenta.

And now you have this human being you're supposed to care for and know how to care for them and who you need to nourish somehow. Many people choose to do that with their body. And so now you're like learning how to breastfeed. Oh, and by the way, you're not gonna sleep. . How does anyone get through that unscathed?

 So honestly I come into the postpartum period for in my appointments assuming people are struggling. Yeah. And not struggling. Like this is bad and not I always say this, not this word wrong and you've actually correct me many times, pathologizing it, that it doesn't have to be.

So wrong. It's this is hard. Like you, like I just laid it out on the most simple form, like I just said. These are the facts of what just happened. Who could get through that and be like, I'm fine. No, you're not fine. This is fucking hard. Even if everything is going really well. Yeah. It's just so I think I just come into it with an expectation that people just at the very least need to be heard.

And I think that

I don't oftentimes because I'm a midwife and because the way my practice works, We meet with our patients a lot. We have have relationships with, with them for the most part. And so I don't feel like I have to pry a lot to figure out what's going on for people because I have front-loaded them with so much information in the weeks and months leading up to their birth.

And then after their birth we debrief the birth with them in the hospital. And then we see patients at two weeks postpartum, which most people don't do that. And so we are really frontloading them so that if those feelings start to creep in a way that feels outside of normal, what we all experience.

There's hard and then there's like beyond hard. Like I always think of the difference between " this is hard and I'm managing somehow miraculously I'm managing" or " this is hard and I'm starting to come  apart at the seams like something feels unmanageable to me. I always talk, I really try to do my education with their partner there or their support person, because oftentimes it's a support person that you can see if they show up at that two week or six especially that six week postpartum appointment.

A lot of times first time parents, the partner will always show up, but but if it's a second, third, whatever, fourth baby, and then the partner shows up at the postpartum appointments, they usually don't come to those. They show up. You can tell they're there to be like, Something. Tell her.

And then, when I start talking about mental health they'll usually, like most of the time people do just say, yeah, this is what's going on. But sometimes they really have to have their partner be like, I. Tell her what's happening, yes. And that's been super helpful. That's been something I think I, I learned from one of my in preceptors and training was that she was like, oftentimes it's the partner that will bring it up to you that they're not Okay.

Yeah. Because again, as mothers we feel so much shame. We have to, we feel like we have to be okay. And I love that you are like inviting the reality that like there's some level of postpartum depression, anxiety, anger that's normal for everybody. And I wanna share vulnerably that for me, like mine did get to a place that felt unmanageable, but it happened later on.

Like it didn't happen right away. Yeah. I was like managing and then when my twins were like eight months old, I all of a sudden was hostile. Like I felt angry about everything. Like I just felt like I was shooting daggers at my husband, at my son, anytime he needed anything that was like, not an emergency.

I was just are you serious right now? Like I just couldn't manage and I felt. I didn't feel like myself. And this is an interesting conversation I have with clients where,  you talked about that transition of I've become a mother, I've become a mother of three now or two or whatever, and now my identity is shifting.

 And I feel different and I don't know how quite, how to find the language to say no, I really didn't feel like myself. Like it wasn't like, oh, my world changed and I'm trying to figure out how to change with it. It was like, I  don't have control over things I normally feel like I can handle in myself.

 What I usually talk to people about in the hospital right after the baby's born, not like the moment after, but when I'm sending them home. 'cause I, as a certified nurse midwife, the type of deliveries I manage are in the hospital. So that's where the context of where I work.

But When I'm sending people home, I talk about postpartum depression, along with other like physical warning signs, like of other complications postpartum. But I give people examples and I say, so in the first two weeks of after having a baby, statistics are that 80% of women experience something called "baby blues", which is like really high highs and really low lows, where your emotions are so volatile .

Like one moment you go from you're looking at your baby and you're just  of joy, of this perfect human being. I couldn't love them more. And then the next minute you're picturing the worst thing ever happening to them. And then you hear something on the news and it just makes you sob and you like can't control it.

Or you stub your toe and you're like ruined for the day. Your partner definitely cannot put a diaper on right. Like you are just like, you're like, oh my God, it's a roller coaster. It's really hard. And it makes you feel like, will I ever feel like myself again? Yes.

So the statistics are 80%. I'm sure that everyone experiences that maybe at least for a couple days. But that should get better by two weeks. And if that's not getting better or getting worse, that's when I want you to reach out to us.  Other things that are really normal but can get to a point where they're no longer normal, are intrusive thoughts and so intrusive thoughts are theorized as being something that helps us protect our babies.

 So thoughts are usually disturbing thoughts and for me, with my first child, I pictured dropping her all the time. And honestly, I picture her dropping her in her head like exploding, like a watermelon. Like it was very violent. And it was horrible and I hated it so much. But you actually gave me this advice at one point.

You said if you can't shoo the thought away, that's when it's a problem. So I could just get myself, be like, oh, that's the thought. Get it to go away. Yeah. And it would come back, but not like right away it would be have to and double context another thing. Yeah. Yeah. And then with my son, I pictured myself standing up with him, raising him over my head and slamming him on the ground.

And I was like, what? Why is this in me? It's very disturbing. And one of, the first things I tell people to do is tell your partner about, tell someone you trust. Your partner. It's not always your partner. Something you trust. 'cause it takes the wind out of the sails of it a bit.

It makes it just like when you say out loud, you're like, oh my God, that's. Obviously I'm never gonna do that. But something in it like dispels the power of it. It's okay, this is something I'm not gonna keep ruminating on. Like I'm getting it out and I'm like, okay.

Just like any secret, right? Like when you like say it out loud, it's kinda oh, it takes some of the power out of it. Yeah. And you're also like, I'm not going to do that. That's not something you want to do, but it's disturbing. It makes you feel bad, it makes you feel shame. Though again, it's actually normal.

And so people, when I tell people about this, they look at me like I'm crazy and I'm like, I know. I know. And maybe you won't feel have any of those thoughts.  But you probably will. It probably won't be to the extent that maybe I had them, but even as. I said, and then hypervigilance. Yeah, just constantly checking to make sure your baby is strapped in their seat, right?

That they're breathing,  not wanting to leave them with anyone but you, including your partner to some extent. All of that is normal. When it's a problem is when it's keeping you from being able to engage with that baby and engage with the people that you love and do the necessary things to take care of yourself too.

Like I think, if. Baby is sleeping and you're not sleeping because you're watching them to make sure they're breathing well. You're not taking care of yourself.  Then it's going to exacerbate what's happening mental health wise it's gonna get worse.

So I think people look at me like I'm crazy and I would say intrusive thoughts and rage are the two people things that bring people back to our office the most often. It's not usually I'm so depressed I can't get out of bed and I can't care for my child. That does happen, but it's usually those things have preceded it, which are both in under the umbrella of anxiety that if you are ruminating about 

your intrusive thoughts if you are hypervigilant about the safety of your baby, and if you are having a lot of rage, then those are all things those mediated by anxiety and so feeling that level of intense anxiety for so long. The natural consequence of that over time is depression.

But usually once people get depressed, they've been really anxious for a really long time and it doesn't look like what we think of as anxiety. And so rage is a really interesting one because I would say that's the most common, and that is the one that actually I think, brings people into our office the most often because it's people like you who Are not really an angry person that you're like, where is this coming from?

We all have anger in us. Yes. But where you're like, I hate everyone and everything, no one can do anything. And I am so angry and I'm mean, and I felt mean. Yeah. And that is again, that's another thing reason we warn the partners. We're like A, some level of this is normal.

Yeah. Some level of them being like, pretty critical of you right now is normal because they, it's overwhelming. They birthed this human, they grew them in their body. They feel the ultimate responsibility for them. And so even though this is a shared process, ultimately that birthing person is going to feel  I need to protect his baby.

And so sometimes that's going to come out as you not being able to do things right.  I know as I'm like, eh, you probably aren't. They probably do have an instinct that you don't have, and you do need to honor that to some extent. And also they don't we have instincts and also we don't know what we're doing.

So it's it's both things, I try to warn partners that you need to have a little bit of thick skin, but if it gets to the point where you don't recognize your partner anymore, they don't recognize themselves more often than not, that's anxiety.

That's not just them being a bitch. Totally. Totally. And so for me that was harder 'cause that's how mine manifested mostly as well. But I already am  kind of an angry person and so for me I was just like, oh, I'm just like more angry now and instead of recognizing it for what it was.

And so there's some people doing great things like you on the internet that are really getting that information, out that and just point out there that mom rage  is real and it can get really bad. And it's physiological, right? This is not my heart. This is like my brain chemistry, my nervous system.

I'm overstimulated, I'm constantly being touched. There's constant noise, there's constant need. When you said I'm just an angry person, of course as your friend, I wanna intervene with that just slightly, because I'm like, you mean you've had a lot of trauma and have also had to carry a lot of anxiety in your story, in your life,

So it wasn't a new experience for you in terms of a physiological state, you were like, oh, I know this defensive place because you've lived that in your story. But I would argue you're not an angry person. I appreciate that. I have my own drama, but my trauma didn't tend to lead towards being physically unsafe.

So I don't have that same response. I do think that I felt almost physically unsafe. Like I was breastfeeding twins. Someone was constantly touching my body. I couldn't get a thought out without being interrupted. I really don't know how much I was eating at that point 'cause I don't remember  sitting down and cooking myself nourishing food like I was eating cheeseits off the floor.

I do think there is such a natural physiological rage response that is trying to protect us. I think some of us feel shame of oh, I was being a bitch or I was being mean 'cause that is how I felt. But I, when I look back, I'm like, no, I was desperate. Like my body was like, you are not okay.

It was sending signals to  everyone around me I'm not okay. I'm on edge. I don't feel safe. And for me, I made the choice to go on antidepressants and it was like mind boggling to me. How? How tremendously that helped me.  Do you have the ability to explain to us what happens when we go on antidepressants in that state and why that helps?

 As a midwife, I believe so much in the power of a very natural process of pregnancy and childbirth fertility. I want to honor the normalcy of all of it and not again, pathologize everything.

And yet sometimes it feels like we're so set up.  Like, again that's part of why I talked about that in the beginning of you put all these, just all the facts of how child rearing goes. Like how could anyone not struggle with their mental wellness?

And then you throw into it that you are usually by yourself. That's what I was just gonna say, like I think the tradition of midwifery too is a bunch of women coming together  supporting other women.  This circle of inherited wisdom and support being passed down and offered and we don't have that anymore.

I was in Covid, but I was like by myself in my house with my three children and my husband and that was it, right? Yeah. Oh, like you said, I don't know if I was any nourishing meals, like of course you weren't. My husband would come home from work and be like, Have you eaten? And I'm like, I think I got a piece of toast.

Because you think you have lost time, you have a newborn, but you don't, you have no time. And so it's no, somebody should be bringing you nourishing meals.  We do like the meal trains and stuff like that, but really right now it feels like a setup, like again, that's why no one can get outta this unscathed.

But really we are supposed to be in community doing this that's a really sad thing that we've lost that.

I agree. And that people shouldn't be like handing their baby over to people. Yes, that's sure that did happen. But more it was people caring for the whole, you just, even just like an older woman, you're feeding your child in an older woman's next to you and she's oh that's, they're not latched, here's how you latch.

Or I shouldn't hurt when they latch. You're like, oh, what? I know. I think there's so many little pieces of wisdom that when you're dealing with it by yourself, you have a colicky baby at home and they've been crying for three hours and your brain is are they dying?

Am I failing? Are they? What? What's the thing? And it's not working . There would just be, someone else in the village that's oh, my baby was like that too. You go take a walk. I'm gonna hold your crying baby for 10 minutes while you get your brain back. Come back we're not supposed to be in this alone.

So I agree with you. So you were saying all of that in response to my question about antidepressants. 

I always start the conversation with people about addressing their mental health struggles. At any time in pregnancy, but of course in the postpartum period especially. Here's the things we can do to support our mental health and, nourishing meals, getting at least four hours of sleep at a time.

That's usually when I ask a partner to get involved and we have a very thorough conversation about feeding before and after that and earplugs and gonna the other side of the house, and like how four hours is like this magical number that, four hours are not enough sleep, of course, but if you get four hours of uninterrupted sleep, people are like, oh my God, I feel so much better.

Trying to get out and move their bodies, think supplements that support our energy and mental health. 'cause fatigue is a big part of making us feel unwell. We're naturally fatigued after having a child. And we talk about meditation, we talk about mindfulness. I talk about all those things.

And I also go. I know that right now that all feels insurmountable. Yes. You're just trying to survive and they're like, yeah, alive. Totally. Totally. And people when I validate that people start falling, they're like, I just like, I can't, I know all that stuff. I know I need that. Usually I do.

Pretty much say we have to get you four hours of sleep at night. Like we have to, if their babies aren't sleeping that much, which most aren't at that point. I really recruit family members to help with that and really try to tell 'em like, four hours of not pumping or nursing will be okay.

So I have to usually help them through that process, but then I always recommend counseling along with medication. The data is very clear that those two things together is ideal. And then I again say, but I also know that the idea of adding another appointment into your life is probably again, insurmountable.

And unfortunately, access to counseling is very challenging right now.  But usually when I bring up medications, one, two things happen. People either go. Okay, great. You could tell it like a relief that somebody said that this might be what you need.

And then the other response is, no, I don't, do medications. And it's hard because I've been there. You understand both of those reactions? Yeah, I do. Yes, totally. So I think that without getting too much into the details of the mechanism of action, but it depends again, on the patient and on the drug.

But the patient that we generally recommend, the antidepressant class that we most commonly use is called an SS R I, which is a selective serotonin re-uptake inhibitor. It just increases our available serotonin. Serotonin being, one of the love positive hormones in our brain.

And, there's theories as to why people in post-partum period may not have as much circulating serotonin. I don't think we know. I know that we don't know, and there's a lot of things that are happening that are impacting that. And some people, I think, maybe have always had lower circulating serotonin and if I just had other ways of coping.

And then I think for some people it does not happen until the postpartum period and for many of those people that it happens in the postpartum period. It does resolve after a period of time, depending on the person. But, so I usually go into the mechanism a little bit and just say, this just increases your availability of your brain to be access that hormone that makes us feel good.

And just like things like sleep helps us feel good and exercise and nourishing food and good relationships. All these things that you don't have access to right now. I do think it's a really simplistic way of thinking about it, but I don't think there's a better way than to think about it as simplistic as if I told you had really high blood pressure and needed a medication for it, you would take it.

Yeah. Mostly there's just not that same thing. And it'd be like, there's always other things you can do to support you, your blood pressure, but the high blood pressure leads to stroke and heart disease, and you're gonna be like, okay, I'm gonna do it. And the same is true for mental health and it's, it is really too bad how much it's been stigmatized and I do understand why, because as a midwife most of us are generally questioning of things. And so we don't just jump onto things out of the gate. We tend to evaluate. You're curious about very discerning and we don't usually follow just algorithms.

This is what you do when the, we treat very individually. And generally what I tell people is medication. This is obvious, but I'm gonna say it anyways, is not gonna take away the fact that you're not sleeping, that you have had a huge identity shift, you feel isolated you feel ill-equipped to do something that you are required to do, which is care for your child.

It's can't change any of that. But what it can do is keep you from spiraling out when you think about those things. And so I generally tell people especially like if somebody comes to me and they're describing postpartum rage or really bad intrusive thoughts that they can't get to go away.

I go, it will not take those things away, but it will give you that pause that you need before you react to it. So you know how, you're getting really worked up and angry and you know that if you just took a deep breath and walked away for just even like four, five seconds. You might be able to go, okay, I'm really annoyed about that, but I'm not gonna react or I'm gonna react this way.

But most of us, especially when you're dealing with fight and rage, you don't, you just react. Yeah. 'cause you are in that fight. You're in fight or flight, that's what's happening. And so it gives you that pause and so for me, when I started antidepressants, I've tried, I did two different ones.

I did them both after my children were born and both took around a year before I did it, a year of suffering.  And I'm an expert and here I am  denying my own truth until I didn't. And I just really felt wow. I felt, so much more aware of how my brain was actually processing things.

And it gave me more time before I reacted and said or did something I regretted. And so people, 'cause one of people's fears is that it'll make them not feel anything. It's definitely a risk. But if it's being managed well. And if you have a practitioner who really knows what your personality is they're gonna start for certain ones that are better for certain personality types.

And for me the one I was on the second time round really just helped me calm that reaction. And so again, I still had rage, I wasn't stuffing it, but I was able to have that breath where I was like, okay, that was annoying, but I don't need to react. Manageable versus unmanageable. That was like the differential. Did I still have twins and another child in a pandemic? All of that was still there. Yes, I felt like I had some more self-control. It didn't feel like my nervous system was like pin prick reaction.

 It was like, oh, you just spillt milk. Ooh, uhoh. And I'm like containing my reaction inside and my internal voice is inside instead of what was happening before, which is like my inside voice would go outside and I'd be like, oh and then my kids were like, I'm like, oh no. And then I'm feeling terrible 'cause I just scared my kids and I don't wanna, my kids and all they did was spiral.

Spiral. And I feel like I'm a bad mom. And then I'm like, maybe I'm not a bad mom. Maybe my partner's not doing everything they should do to help me. And now I'm like mad at my partner and my partner's and then I spiral again versus this is hard, but I know it's a stage and I have that sense of the past and the future.

I have a sense that right now is not everything. I'm putting it. Whereas I think that when you're in those states, it feels like there is only this suffering. There was only this feeling of feeling trapped and stuck, and now I don't I know that yes, this is hard, but it will pass. Okay. Let's get one last thought from you.

I was just gonna say that we use the term dysregulated a lot with children. And for me, when I was like learning about that idea, I was like, oh my God, that's just been me my whole life. That's describe children, but it's Oh, I've just had a really hard time.

No one's ever given me tools to regulate and so no one co-regulate with you, right?  There was no co-regulation, so your little nervous system was dealing with all these big, scary things on your own, and so you had to go into that activated state of dysregulation to protect yourself.

 I think that's what's happening for a lot of people in the postpartum period. And I think that for for those of us who were co-regulate and had tools, many of those aren't accessible once you have a child. So for me, the way I do regulate myself is exercise.

Running and biking and being outside. And I was like, but I can't do that. I can't do that right now. And I really want my patients to honor that too as well. I'm always weighing those risks and balances with them, I say I know you're normally someone who runs a lot or whatever, does x a lot like, and that's really not what your body needs right now, it needs healing, and rest and recovery.

But I also wanna honor that that's what your brain needs. And so then I have some pretty nuanced conversations with people not in that setting of here, okay, let's talk about a way that we can honor your need to be outside in nature or be able to, maybe not run yet, but at least access that movement of your body in that endorphin release and that space.

And while also trying to as best  we can to let your body rest. But sometimes we're gonna sacrifice some of the healing that needs to happen to our physical body for our brain. And only you can make that decision, and so I don't ever, like when people say 

you should always do this or should never do that. I'm like, listen, there's a perfect, don't let perfect be the enemy of good. And so there's a perfect way to let your body recover postpartum. But for some of us it's I think maybe I'm gonna put a little bit of risk on my pelvic floor to be able to go out and just go on that walk next to the river for even 20 minutes and I feel a semblance of myself.

It's like that touchstone that some of us need. But with that said, those coping mechanisms that we've had for when we're dysregulated just aren't always accessible. I wish so badly that every single woman on earth could have a midwife support like you, like I'm getting emotional about it, but like the way that you like go to bat for people and the way that you see women and see the complexity of what they're going through. I adore you and I know every single person who's watching this is gonna be like, where does she practice? Can I have my next baby with her please? I think that midwifery is really misunderstood in a lot of ways in that I think that people think midwives are just all about like babies and birth and women and yeah, I'm into all those things, but really most of us are in it because we do feel, Women have not been honored in the process of pregnancy.

Having a voice, having true informed care, really knowing what their options are and what the actual risks, rewards, all that. That being honored as so paternalistic. Yeah. It's just like we know better. Here's what you do and oh my gosh, we actually do have so much deep knowledge in this and, and also we have intuition and we're so individual and the medical system for reasons.

Has to standardize things. I get that. I don't think that's wrong. It's a huge system, but I also am like there is room for individual very individualized care. And midwives honestly do it the best and not all midwives but for the most part, most of us are in it because we are advocates for you for the birthing person.

And that can mean what you want for your birth could be vastly different than the next person or what I want. And as long as you, I feel that your decisions are based off information that's unbiased. I'm  gonna support you. You're amazing. Yeah. I do think that midwifery is really special.

I'm very lucky. Thank you for sharing with us and being here. Thank you for loving me. Yeah. You know what? Just to be inspired by Lacy, even more inspired by Lacy, she's currently on a road trip with her family for a year because she figured out how to save enough money and be frugal and put everything into a certain box so that her family could just go and spend a year on the road.

So that's why she's in a super cool hippie van situation, whatever. It's just my office. I, yeah, we're only a couple weeks into it. We'll see. It's honestly, I'm going super well, but it's like we're at the very beginning stages of this, but yeah, it's been, I like really miss my work actually.

I would, of course, I, but I don't feel like I need to go back right now. I'm not like, oh, I need to go back. I just actually feel like I do live and breathe this even, I'm taking, I've been on two month break so far from it and I'm Listening to podcasts about midwifery. I'm like looking at the courses I can take.

A lot of people thought, oh, this will be really, you'll probably take a complete break and check out. And I'm like, I actually do. No, if I'm the attachment nerd, you are for sure the midwifery nerd for sure. Yeah, you are. And I love that about you, and I love everything you bring to it, so thank you.

‍