Speaker 1: 0:10

Hey guys, welcome back to Preview Alliance podcast and this podcast episode I'm super excited about and it is talking about, so I'm going to go ahead and, just in case you've got little ears, this is baby blues, postpartum depressioniety and Maternal Mental Health. So if kids are listening, this is one of those episodes. Let's just put the AirPods in or wait to a different time. But our guest today she's a very, very respected name in the field of maternal mental health and now she's diving in some other really great things for us menopause women like myself which she'll share with us. But Dr Delphine is with us. Welcome, dr Delphine, and we're so happy to have you.

Speaker 2: 0:49

Thank you so much, Sarah. It's great to be here. Very kind introduction.

Speaker 1: 0:54

Well, can you start off? I know a lot about you and your research, but can you tell our listeners a little bit about you from just a research perspective, career perspective as a mom?

Speaker 2: 1:05

For sure, happy to.

Speaker 2: 1:07

So I have been a women's mental health psychiatrist for over 20 years and I started basically working in the days when people were ashamed and there was stigma around postpartum depression.

Speaker 2: 1:25

And I've been working steadily as a psychiatrist, seeing patients, doing advocacy work, doing some research, doing leadership, teaching medical and other allied health care providers all about women's mental health through many, many years and I've been really proud of some of the work that I've been able to do in terms of helping individuals, helping their families and treating people on the individual and family level and also hopefully making a difference by trying to educate people, adding a little bit to the body of research, and it's been my pleasure to work in all those different fields of women's health, women's mental health, throughout many, many years.

Speaker 2: 2:09

So I've done research in areas related to women's mental health and using technology, looking at some text, messaging to use basic technology that we use in our everyday lives to try to introduce that into care for people who are at home, postpartum, isolated, not sure what to do, not sure where to turn, and then also creating a platform for people to get help and some resources, and then I've sort of morphed into developing a women's mental health care service platform and education platform for health care providers called betterbriacom, and I worked for many years in an academic hospital in Toronto, canada, and then, a couple years ago, along with one of my close colleagues, also women's mental health psychiatrist, we launched Bria and people can find us at betterbriacom to see the kind of work that we do to really support people across different life stages so people trying to conceive pregnant, postpartum, early parenting and then, as you mentioned, perimenopause and menopause, because I think while when I started 20 years ago, you know we were talking about postpartum, and now we've all aged and we want to talk about what's happening to our brains, our bodies, our hormones as we go through another life stage, transition and are sort of exiting the reproductive years and try to understand what the impact of our fluctuating hormones is at this end of the reproductive stage.

Speaker 2: 3:47

So I see it as all very cohesive, very united and really with my mission to get us talking, get people the services they need and also to educate healthcare providers about the link between hormones and mental health and how they can help one person at a time, one family at a time, couples and really speak out about these very, very important issues.

Speaker 1: 4:12

I love that, I love that and it's all such needed. And again, truly, your research was some of the first research that I really dove into back about postpartum depression, like you said. So thank you for setting groundwork for generations to come. But I want to talk about your book. So, if listeners don't know this, you wrote a book when Baby Brings the Blues and I read through this book recently and I kept saying I even told you this by email I wish I would have read this when I was pregnant and I did not, and I wish some healthcare providers would still read this to this day.

Speaker 1: 4:45

But what I wanted to start off asking you is, you know which? It was interesting too, because your daughter, who was three at the time, asked you you know why are you writing this, mom? And you said to help me mothers feel better, and that really resonated with me. And you know you're saying that the majority of women are suffering in silent and the research says that. We know that personally. Who's lived that? Why do you think that still is true? You know later, and what common themes of like. Why do we, as moms, suffer silently? Why don't we get help?

Speaker 2: 5:20

Well, it's a very complicated question and I'm glad you asked. First of all, thanks for mentioning my book. That daughter is now a sophomore in college and I'm hoping that the next generation of upcoming moms do not suffer in silence. Is that? I do think we have come a long way. I do think people talk about it a lot more than they did when I wrote the book, when I started over 20 years ago, and I think you know now so much so that people say I have postpartum. It's part of our lingo, it's part of what we do talk about. So I do think we've made some headway in terms of people feeling comfortable, coming forward saying they are struggling.

Speaker 2: 6:07

That is not universally true across different ethnic groups, across different religious groups, across certain populations or segments of our society in North America in general, unfortunately. And why do I think it's still suffering? Because I think a few things. One is we have all these ideas in our culture that being a mom is this beautiful, wonderful, just purely happy experience and that when someone has a baby, that's all they should feel and if they feel anything different or anything less, shame on them, they're a bad mom, they shouldn't have become a mom. Those myths of the perfect, idyllic mother and motherhood are very, very pervasive, and I think that leads people to say, oh, I don't have only positive, 100% good feelings. Now what's wrong with me? I must be some kind of real monster if I am having these thoughts, if I'm having these feelings, so because of that, people retreat, they go silent and they don't speak up when they're struggling.

Speaker 2: 7:13

I think that's number one. I think number two is there are very strong stigmas in many segments of our societies against mental health and that we know across the board, people struggling with mental health issues at any stage often really suffer in silence. I do think that's changing, as I think the motherhood myth is changing, but I still do think we have a long way to go to de-stigmatize people talking about their experiences of mental health, especially when they are going through it. People often come out a lot of celebrities, for example come out and say I struggled in the past tense, I did this in the past tense and now I'm through it. But it's rare that you hear someone while they're going through it and I get that, of course, when you're going through it, the last thing you want to do for some people, and maybe it's a generational thing.

Speaker 2: 8:02

Maybe our generation is less likely to post every moment of their experience on TikTok or on Instagram, but I still think it's hard for people, as they're going through it, to be fully honest about what's happening. And then I think people, none of us lives in a vacuum. We live in societies and cultures and maybe religious groups or ethnic groups that think you know what, suck it up. This is hard to be a new mom, you know, don't complain about this. You have a baby, when so many people don't have a baby.

Speaker 2: 8:32

So people get that pressure from the people around them, their families or communities or religious groups or other communities to say don't speak out about this, like shame on you for this. So that's another reason that people say, yeah, I should just keep it to myself. And then there are other people who feel like I'm really worried. If I do speak out and I tell anyone, they're going to call child services on me. That's a big myth that I think a lot of healthcare providers need to understand really the intricacies of postpartum mental health issues and what is a concerning symptom when child services do need to be involved and when they don't, which is much, much more common.

Speaker 2: 9:15

So I think, for all those reasons in someone's personal life, society, and then I think people often go to see a healthcare provider. They have the best intention, they want to get help, they want to speak up. They finally gotten their courage up to talk to their healthcare provider and the healthcare provider says, oh, you're fine, don't worry about it, or nothing helps anyway, like you can't take medication If you're nursing or breastfeeding. This is normal to feel this way. So then people are silenced by their healthcare provider and they think, oh, okay, I just need to keep on white knuckling it through this if there's really no treatment available and maybe there is treatment available in the form of therapy, but then it's really hard to find a therapist. In many parts of the US and in Canada therapy is expensive, therapists aren't very accessible to a lot of people or there aren't enough trained health care providers to really meet the needs. So I think, for all of those different reasons, people end up suffering, struggling, self-silencing much more than we would like to see we would like to see.

Speaker 1: 10:29

I resonate with a lot of what you say and I think my personality is always like okay, I want to know what I can control, what I can't control. And in your book which, again, I've honestly not seen risk factors broke down the way you've done it. It's excellent. And, listeners, I'll link the book for our podcast, so don't worry about that, we'll link this for you. But in the book, the risk factors, because we know, you know, some statistics say one in five, someone say one in three. You know this day and age I think it's much more probably leaning one in three, just with everything moms have against us. Right Of, are we going to experience maternal health disorder, right. And then the risk factors of can control versus not. Can you talk through, when you so say, your daughter. She comes to you and she's like mom, I'm pregnant or you know I'm trying to get pregnant. What would you tell her risk factors wise, that she could start doing now to control, versus maybe things hypothetically in her past, her family's history, path that she can't control?

Speaker 2: 11:23

Great question and thank you for your very kind words about when baby brings the blues. I really appreciate that. It resonated with you. That's my hope and that was my hope and that continues to be my hope.

Speaker 2: 11:34

So I think it's really important when women are struggling to, when anyone is struggling with a mental health issue, to feel you have control over certain things. So that's why I wanted to position it like that. We don't have none of us has control over our family mental health history, whether or not we've already had depression or anxiety or another mental health issue prior to getting pregnant. So that's what I tell my daughter don't fuss about those things Like we can't control what our genes bring to the table, so to speak. So don't worry about those, let's try to minimize those and let's try to balance those out with things that we can control. So the main factor that I tell people they can control is whether or not you are well during pregnancy. We can control that to some degree, and by well I mean mentally stable.

Speaker 2: 12:23

Have your mental health symptoms in remission? So you know, be in therapy, be on medication. There are many medications that are safe to take during pregnancy, that are compatible with pregnancy If you need to be on medication, which many, many women do take it because the number one you know thing to prevent postpartum mental health problems is to keep yourself mentally well during pregnancy. See your psychiatrist, see your therapist follow through with the therapy, follow through with taking medication if you need to. That is something people usually have control over. So focus on that and then do other things that are going to help you. Try to get sleep, maintain your sleep. Don't take alcohol or drugs that are a major negative on your mental health. Try to line up your life with good supports, good people in your life personally, family relationships with people who are really going to be there for you and can help you out when you're in a pinch. Those are things that most of us have control over Not everybody, but most of us do.

Speaker 2: 13:29

Try to limit any major life changes or stressors. You know, don't move to a new house right when you have a newborn, don't take a new job or move to a new city right at that time. So limiting external stressors. Obviously, life happens. There are some times we can't control these things, but sometimes we can and so we want to keep life as sort of stable and boring as possible in pregnancy and the postpartum period to limit any external disruptors. Because when you bring a new baby into the world, whether it's your first, second, third, fourth, fifth, it is extremely hard, it is extremely challenging and it is, you know, it upends a lot of things for your mind, for your body, for everything. So we want to keep life boring. That is so important. I always tell my patients, I tell my daughter, I tell my friends anybody thinking about having a baby. So those are some of the factors that we really can try and take charge of to reduce the likelihood and limit the likelihood of developing postpartum mental health problems.

Speaker 1: 14:39

And I'm sitting here and I'm listening. I'm like, okay, we moved, I was away from my family, I transitioned jobs. I was like chick, chick, chick which again, I say this to people all the time If I would have just heard this and this is our hope with the podcast is that this is, even if you're not pregnant, your friend is you share this and say, listen, there's things you can do. These are risk factors, right, and knowing your risk factor is such an important empowering move and it opens a conversation for people who you know they may say, well, that's probably not going to happen. To me, it's like, well, but look what you're experiencing in life and anybody who experiences a move, a job change, a divorce, a relation, whatever, they're going to be more prone to this. So I think it makes tons of sense. It's just no one ever kind of says this to you when you're pregnant or trying to get pregnant. So thank you for that.

Speaker 1: 15:30

Next up, I'd love to what we were. You dove into just kind of like our thought patterns and recognizing how we think and maybe have thought our whole life. But you listed out kind of you know, personality, traits and actual steps and I wanted to touch on a few of them, because I think this aligns with majority of women, right. Like we are multitaskers, we're managing things, we have jobs, we may be the generation where we have our parents, or maybe get older, we have our young children, right? So let's talk a little bit about those, like our negative thinking patterns and why it's so important now, or even if she's like two or three years postpartum like myself, to say, okay, wow, I think like that and I probably should do a little work.

Speaker 2: 16:19

Yeah, so really important to try as much as we can and this is why therapy is often helpful, because it's hard to do this on our own to look at what, how we think about things and how we approach the world. So one of the main factors that I talk about my book in terms of thinking and approach and personality type, is the sort of type A, what we call neurotic personality disorder, and this is not to disparage anybody, but it's for us to really take a close look in the mirror and say does this suit me? Well, it certainly suits me. So when I speak about this, I speak about what the literature says and I can also speak about it from personal experience.

Speaker 2: 16:59

Those of us who approach the world with a need for high control, a need for order, a need for a schedule, a need for, like, check, check, check, check, tick this off my list, as you were saying, the multitasker lots on the go. We are used to feeling good about ourselves when we can check, check, check things off our checklist, when we feel in control, when we feel like we have some, you know, a way to control the chaos in our lives and that makes us feel good and that's how we feel good and that can be a very adaptive personality trait and way to approach life in many, many scenarios at work, at home, etc. But it is a disaster when you bring a baby home, when you bring your newborn home. There is nothing worse than that personality type and way of approaching the world, because babies are unpredictable, they're not going to be on a schedule, they don't know that they need to eat at this time, sleep at this time, not spit up all over you or throw up all over you right when you're trying to get to an appointment.

Speaker 2: 18:01

And so someone who approaches the world generally as a very perfectionistic, like type A type, that's a very big risk factor for postpartum anxiety and depression, because when you can't control things and you can't control a newborn and the experience with a newborn, it's very, very destabilizing and unsettling. So I talk to women day in and day out with this approach and this mindset and this personality type and we talk about like, how can you let go of certain things, how can you still feel good when you are out of control? Because you are out of control, the baby is in charge, especially in the early days, and you want to see that as okay. This is okay.

Speaker 2: 18:43

Nothing terrible is going to happen if I'm not on a schedule, so to speak, or if I'm late, or if you know my house isn't spick and span, or if my meals aren't all prepared, like we need to help people let go of the fact that they'll only feel good if A, b and C is already done or they look a certain way. So letting go of those things and saying, okay, it's okay, I'm a new mom, I have a lot on the go and at any time in life, frankly, I'm going to give myself permission, just to you know, go with what is. And I always say to people who are pregnant and maybe at risk and my patients in pregnancy and postpartum, like flexibility as a mindset, as an approach to life and time is your best friend, because the more we can let go, the less we're sort of fighting against what should be and we're going with what actually is. And I think that's true in general in life, but particularly for the new mom, with that type of mindset and that approach to life.

Speaker 1: 19:47

I love that. What is some signs, you see? You know I was thinking about myself and I can definitely say, okay, yes, I did this. I was very rigid about a sleep schedule. I was very rigid like it would just really send me over the edge in, you know, and I suffer from depression, anxiety, you know, if things didn't really go according to plan. You know, what are some other things that you've seen that maybe just examples, because the moms who are listening going huh maybe, but like what other? Like what's what's? Some of your patients tell you that fit this kind of mindset, personality of you know, type A or perfectionist. Or you know, maybe high functioning anxiety that we've cooked with all our lives right and now it's kind of, I say it calls you out. Babies really do.

Speaker 2: 20:33

Yeah. So I would say I mean, the sleep is a great example. I am a huge proponent of sleep training and a sleep schedule, but there is a time and a place for that. Like you're not doing that in the first month necessarily because that's going to drive you crazy. So I think you have to be realistic about when you want to introduce things like a sleep schedule and talk to your health care provider the baby's health care provider, when is it?

Speaker 2: 20:57

reasonable to introduce structured sleep, which I am trust me all for, because sleep is so important for the mom and for the baby. But it's about timing and being realistic with that. So you need to have a little bit of knowledge. You need to have a good healthcare provider. You can ask questions to like is it too early to sleep train? Or what am I going to get out of you're trying to sleep train a three week old. I think that's a recipe for a lot of stress and I see that a lot. And then also later on, when people get so, so, so nervous about introducing solids and what is the perfect way to do this. So, again, you need information, you need to talk to your healthcare provider and figure out how to do that. Or about you know, is my baby achieving its milestones?

Speaker 2: 21:45

People get very, very stressed and nervous about that. People get stressed and nervous about okay, well, I see all these people and these other moms on social media and they're back working out and why do they look so good? And they've lost all their baby weight and they're lifting all this heavy weight and they're making all this food, and why can't I do that? So, again, like, turn off social media. Those posts are not your friends. Those posts are just unrealistic and great for the people who are posting them if that's how they feel and that's their authentic life. But often those are very curated. They're not realistic and they're especially not realistic for new moms. So you've got to shut down the triggers, whether that's social media, which is a huge, huge problem, or whether that's other friends or family or, you know, a major culprit is your mother-in-law for many people. You've got to shut that down and not listen to those people and find your own source of comfort, because you know all of those are sources of too much information, too much stress, unrealistic expectations. So really helping people narrow down what is, who are your triggers, what are your triggers, and limiting those and diminishing those or just shutting those down entirely.

Speaker 2: 23:01

So those are either what does my body look like? What does my house look like? Is my house a mess, like I'm having people over and what's the state of my house and you know that gets people very, very nervous and stressed out and anxious about you know. And then all the other things about you know, as I touched on the milestones before and then often with that is am I stimulating my baby enough, am I taking them to the right classes? And it's important to take a step back and again. Talk to people who you trust, who are more on your wavelength, and talk to health care providers. Do your work on reputable sources as to trying to understand what are the milestones my baby has and knowing there's a huge range of milestone accomplishment in babies and I wonder also if a lot of our listeners who had babies or were pregnant during COVID and you know that's taken a toll on people, depending on where you live and how long things were shut down or access to healthcare services was denied that's taken a toll on people and maybe on their baby's development or their kid's development in certain ways and I hear about that day in and day out we're still dealing with the after effects of COVID in our mom community, in their babies, in their kids and developmentally.

Speaker 2: 24:22

So I know I've thrown a lot of things at you, but I think it's sort of important to just put all these things in because I really want people, and your listeners, sarah, to feel like they're not alone and you know chances are someone else is struggling with what you are struggling with. So, finding a good community of other people who are respectful, who are supportive, who are knowledgeable is really and so that you don't feel alone is so, so important at this really tough life stage.

Speaker 1: 24:53

No, it is. And I love, too that we set a lot of examples, because I think what happens in general right is maybe and I've noticed this I'll go well, I don't have the traditional postpartum depression. So, like it just was me and me think I don'll go well, I don't have the traditional postpartum depression. So, like it just was me and me think I don't have that, or I don't have exactly what she described it to be, so I don't have anxiety, right. So it's like I try to tell people I'm like, wow, awareness is super great. We shouldn't be diagnosing ourselves off TikTok or Instagram and like you know, going to professionals and don't, just because someone's experience was X doesn't mean you don't have the same thing. It's just like you know you could be more, the milestones I could be, the more sleep, how it shows me.

Speaker 1: 25:31

So I think that's a good relay into if they're listening, right, and they're like okay, so what are symptoms of postpartum depression or pregnancy depression, right, like, and this could be just for family friends, to everybody. And you know there are kind of three main categories. And again, we're going to reference the book because, guys, I'm telling you, if you're going to read one thing, please read this book and it is very much so like physical, you know, emotional, and then kind of our thoughts. So just kind of give us an overview for things to be aware. And again, listeners, this doesn't mean you check every box, you check just one box. It's stuff that we want you to start thinking and have open conversations with a health care provider you trust or with your family. So let's just, when you're listening to this, just it's not all or nothing or you know kind of situation.

Speaker 2: 26:15

Yeah, I just want to pick up on one point. Really really importantly is that, at the end of the day, a diagnosis is important. It's not. The most important is that, at the end of the day, a diagnosis is important. It's not the most important. If you are worried about yourself in any way, shape or form, as a new mom, reach out.

Speaker 2: 26:30

I always say to people who I'm seeing in pregnancy OK, don't worry about ticking all the boxes to get an official diagnosis. If you're wondering, if you're worried that you're not feeling as you had hoped, as you had wished, reach out for help. It's always better to reach out to a health care provider saying you know what? Let's just keep an eye on you. There's nothing you need to do differently right now, but let's keep an eye on you. Then you're in the system and then hopefully you're connected.

Speaker 2: 26:59

So you know, even if you suspect this is not feeling quite right or how, I think my best friend went through the new mom and you know, speak out about it. So that's an important point that I just want to highlight that you made is that there's an array of experiences and a huge diversity in symptoms of depression and anxiety, and depression and anxiety are both illnesses, like most mental illnesses, that affect our minds and our bodies and our thoughts and our feelings. So you know, in terms of the physical things, often if people have anxiety they might feel very jittery or they might feel on edge, they may feel panicky, they may feel like a tightness in their shoulders, like their heart's racing too much, like they're just keyed up on edge, can't settle down. That can often be the physical symptoms of anxiety, and anxiety is very, very physical. When people are depressed as a new mom again sometimes they may feel like they're a little bit sped up, they're agitated, they can't settle down, they can't just sit, they can't just sleep because they're too keyed up and on edge or sometimes feel in the opposite direction. They feel leaden, they feel like they're lethargic and they just their body doesn't move as it does in the past. So pay attention to how your body feels. And again, this is tricky when you're pregnant or when you're postpartum, because our bodies don't feel like they normally do. But if it continues and it lasts too long, or if it feels really extreme, or if you're even wondering, talk to your doctor. And it's never normal.

Speaker 2: 28:34

Then, to add on the mood component, if you're extremely worried and you can't turn off the worry. That can be a part of anxiety. If you're having thoughts that you just don't enjoy anything. You can't get any pleasure being a new mom, out of anything in your day. That's a concerning symptom and that's a symptom of depression.

Speaker 2: 28:57

It is normal and I want to say it here for the record and loud and clear you are not going to enjoy every second of your motherhood. None of us enjoys every second of anything in life. And it's okay to have negative feelings, it's okay to have angry feelings, it's okay to feel upset at times, but we want to have the whole range of experiences and when we have those, we want to be able to get back to a better place. After we talk to someone, take a break, have a better night's sleep, to a better place. After we talk to someone, take a break, have a better night's sleep. If we don't, that's when we get concerned. So I've digressed from my list of symptoms but I just thought, that's important to say it's very important.

Speaker 2: 29:34

And then if we just feel bleak, if you feel like the future is going to be terrible, you can't do this, you're not equipped for this. Those are normal symptoms to have in glimmers here and there, but if they persist and that's all the way you think about your experience as a new parent, that's really concerning. And again, with anxiety, some of the thinking is if you can't make decisions, if you can't focus, if you can't decide, okay, I need to take my baby out. I cannot make a decision about how to dress them, whether that's in the extreme heat or the extreme cold that we have up here in Canada. You guys don't have that and people are paralyzed with decision making about something like that. That's concerning in terms of thinking. And you know, if you get zero joy and all you can feel, or the majority of your feelings, are worry or dread or fear of being alone, those are sort of the broad brushstrokes of the symptoms of anxiety and depression. And then also physically, I want to highlight sleep.

Speaker 2: 30:36

Disruption is very big and very sensitive symptom of both depression and anxiety. With anxiety, and much often with depression, people cannot sleep. Sometimes people with depression find they cannot not sleep, so all they want to do is sleep. They feel exhausted and too, too tired. People may often lose their appetite and have an appetite change and not be able to get any food in their body because they're too revved up or they're too down and depressed. Those are also symptoms that we worry about. Having an inability to focus as well is what we call a cognitive symptom, and lack of memory as being so, so forgetful is another problematic symptom. And then in both those cases, as psychiatrists, what we worry about most is if someone feels like life is not worth living, if they can't go on, if they have thoughts to harm themselves or take their life. That is an emergency.

Speaker 2: 31:34

You need to tell someone you need to go to your closest emergency room, call a crisis line, reach out for help as soon as possible, because that is never okay and that is never something that you should live with and struggle with and be silent about, because your safety and the safety of your baby. So, along the lines of that, if anyone has thoughts that they have to harm their baby or that the world is so terrible my baby cannot live in this world. I know this is hard for people to hear, but that is another sign of emergency. So go to the local hospital and get yourself help as soon as you possibly can if you have thoughts about self-harm or about harming anyone. I do want to say, just before I get off this topic, about intrusive thoughts postpartum. They are very, very common and they are very different from what I'm talking about right now.

Speaker 2: 32:31

Many and most new moms have intrusive thoughts, and what I mean by intrusive thoughts and again, this is hard to hear, so I just want people to know an intrusive thought postpartum very commonly is if you're bathing your baby and you have like a vision pop in your head of like, what if they drown? Or, you know, if you're preparing a meal, what if I take this knife and do something to my baby, those very awful, harmful, violent or unpleasant thoughts. They often pop in and pop out of new mom's heads. Many new moms have them them even if they're not struggling with depression or anxiety. We don't fully understand why, but they happen and they're common and they're worth paying attention to.

Speaker 2: 33:14

If someone has those coming a lot and if they can't get rid of them and if they come fast and furious and they start to feel very, very nervous about them, very, very worried about them, such that they won't bathe their baby, they won't be alone with their baby in the house, they won't go out with their baby, that is problematic and that is what often part of what we call postpartum obsessive compulsive disorder.

Speaker 2: 33:37

Those are the intrusive, unwanted thoughts of postpartum OCD. People do not need to have child services come in those situations and I always say to people if you have those thoughts and if you feel really nervous and anxious about them, that is a sign that your brain and you know the difference between right and wrong. And people who have this are not the people who actually harm their babies. They are people who are struggling with postpartum OCD and they need help and there are many good treatments available, often medication, often medication plus therapy. So I really want your listeners to understand that if you're if that is you having those thoughts, it's important to talk to someone, it's important to get on that as soon as possible and it's important to really understand what's happening in those situations.

Speaker 1: 34:28

I mean, I had no clue what an intrusive thought was and I remember I don't remember specifically what my like first intrusive thought was I, but I remember my response was oh my god. I can never tell anybody what I just thought. I was terrified of myself. I was like, am I going crazy? And it was, you know. And people generally say, oh, you know, it kind of can maybe start like you're walking down the stairs with a baby and you're like what's if I trip and fall right?

Speaker 1: 34:54

And then we have had, you know, women who said you know, I've had unwanted, like a sexual thought has came through my mind about my baby, of like you're like, oh my God, what is this happening? Or like my baby's crying, what's if I accidentally toss my baby over? You know all these very extreme things that you may. If you're listening to this and you're like I've never had intrusive thought I'm not pregnant. Oh my God, am I going to think this about my child? You know it's. I always say people it's like listen, you'd rather know what it is. Name entertainment, situation. So you, we don't want this to happen to you, but research tells us majority of moms, like you said, are going to experience it.

Speaker 2: 35:41

So I just think it's shameful if you experience something like that and you don't know what's happening. Yes, absolutely. It feels very shameful and people feel like, oh, I must be a witch or I'm not cut out for this, or I must feel I'm an awful person, and that silences people, when instead we want them to speak up, as you said, and we want them to get help and you know it's very hard to open up about these things, but it's absolutely essential to your point, sarah, and then I think, too, like you don't, if your family and friends and support.

Speaker 1: 36:09

I mean I didn't tell my husband. You know, much later we were like, and then I realized he had intrusive thoughts, you know, as like a dad, you know, and it's like, but we never we lived in this kind of silence, error of like. We both felt a certain way, just like. I think we both experienced anxiety and depression post-child that we just never talked about it. And I think that's a good time to bring in the partner. There's such importance here. I always tell people you know you should almost it's like, instead of what your nursery is going to look like, you kind of really get a mental health plan in place for you and your partner. But everybody wants to tell you, you know, get the zip there. One thing, which I still tell people that, but I'm also like, listen, you guys both got to be on the same page. So what? And again, your book goes through this really well, but what do you tell let's talk about your daughter, your patients with their partners? What do you say? Let's get on the same page. How do they do that?

Speaker 2: 37:12

partner to our next appointment, or at least one appointment, so that we can all be on the same page and have this conversation. Because I think you know, partners, as you said, do need to know, and there's a lot of data. Some people are like, oh, I'm embarrassed or I don't want it, and there's a lot of very good data to show that having a very supportive partner is also a protective factor against postpartum mental health issues and mental health in general. Support is one of the most important things to help someone get better from a mental health episode. So that's really important for people to know. So, you know, bring them to the appointment, let's have the conversation, and often when that happens, the partner's in shock and says, oh, yeah, okay, I really get it now.

Speaker 2: 37:54

And so I talk about what the symptoms may be with a partner, and it's always better to have these conversations when a pregnant woman's feeling well and feeling stable and to give fair warning to everybody. So we talk about the symptoms so they can notice, notice if your spouse is different from their normal self. Here are the symptoms to look out for, and once they have a sense of that, I want to say to them don't blame them, don't criticize them, don't have expectations about the house and meals, etc. So we want to understand what the dynamics are up front in terms of expectations and roles, and then I want to say your support is really key.

Speaker 2: 38:39

Here are ways that you can help. First of all, by limiting expectations, not judging, being supportive and then by lending a helping hand in a very practical way. You prepare the meals, you clean the house, you take the baby so she can have a break and go for a walk, go to sleep, go do whatever she wants to do. To be honest, and you know, don't be shy to step in. I'd say that to the partners a lot and I also say to usually a pregnant mom like you are going to have to let go of some control Because again we get back to the sort of type A and a lot of us moms want to do it all.

Speaker 2: 39:17

We want to do it all right, we want to do it all our way. That is not a good way to be when you want someone else's support, especially your spouse's support. So I often say to both people members of the couple, to the usually it's the mom and the woman I say you know, you've got to loosen the reins and let him because usually it's a him that we're talking to let him do things.

Speaker 2: 39:38

he's not going to do it your way, he's not going to do it necessarily exactly as you tell him or do it, but he's got to learn and he's going to have to pitch in and do it, and then you can't criticize him for how he does it. So, so really important the dynamic there let go of the reins and the husband has to pick up the reins and do things. Often, new dads let's be honest are usually the secondary parent and they're scared. They're scared of the newborn, they're scared to hold them, they're scared to help them. So we want to get them involved right away learn how to change the diaper, learn how to put on that onesie and do up all those snaps, learn how to bathe the baby, learn how to wash bottles or you know, learn to do all these things right away so that you can be a partner and hand off really easily.

Speaker 2: 40:26

So we want to get them involved in the thinking about the how to be supportive and actually the doing, because there's so much in the doing, especially in the early days when everybody's working around the clock to, you know, keep this baby going. So those are some of the things that I always talk to my patients about and talk to partners about, and we really work on that.

Speaker 1: 40:52

What do you say? What do you see when you've seen a mom who she's postpartum and let's put this out here too. I have seen it, you know. And so people have this myth of like, well, what's my? Depression, anxiety, OCD, whatever, PTSD only happens, you know, early postpartum, no, no, no, Right, Like it can happen and does happen. You know, I've seen past a year. You know, myself was six months, was really when mine peaked. You know, some research even says three, four years postpartum we can still have unresolved symptoms. So let's talk to like that. What do you see in those situations where you're, that's your patient, she's further out, postpartum, right, and this partner really has. No, they've never had that meeting with you, you know, because she never saw you until now. We're kind of in this, we're in the trenches here and they don't understand it, right. So what does that conversation? Because I can feel probably some of our listeners going okay, I'm over here, We've never had this. How do we get the same page here, Dr Delphine? Like, what can I say now?

Speaker 2: 41:58

Well, I think it's the same things we can say. You know, you've been going along on this route and road to date. It's not working for you guys. And then we go back to basics. First of all, educating the partner about postpartum mental health issues. These are the symptoms. Don't be critical, don't be judgmental to your partner. You know we can still do that at a later date.

Speaker 2: 42:17

We say, you know, postpartum mental health issues can happen up to a year postpartum. They can begin at any time in the postpartum year and it's not just in the first. You know, the first six weeks, the first three months are the highest risk times, but some often that it happens then and maybe people don't come to help till later. So we say to people you know, we just go back to basics, even at a later date. We say it's not too late, it's good that you're reaching out now. And then I sort of review some of those other things that we talked about before we got to change it up here. People, this is not working for either of you and it's not too late. And here's what you can do, husband, to step in now and to you know, make some changes and to be supportive. And here's what you need to do, mom, to you know allow the help to happen.

Speaker 2: 43:08

Don't be critical to your partner, because that's often that dynamic that we see, you know happen. Don't be critical to your partner, because that's often that dynamic that we see, you know. Eight months in, I hear her say you know what, he's never helped, he won't help. And I say, well, have you tried? And she said yeah, I've tried a couple times. And then he does it all wrong, he doesn't get it. And then I say, unless there's a safety risk with him, like if he's drinking or he's drunk or he's like leaves the house with the baby or there's another major safety issue, it's okay. It's okay if he cleans the bottle in a different way, it's okay if he puts the diaper on in a different way, and if there's not a major safety concern in terms of his capabilities or his capacity, then you cannot criticize because that just shuts the husband down right away. So you know we have to do some reworking of that dynamic a little bit later on in the year.

Speaker 1: 44:01

It is very hard I resonate with. Don't be critical, and just because it ain't my way doesn't mean it's not an okay, acceptable way, and that is something I will take to heart from this conversation and try, and I mean I guess you know, I think this is a good time to just talk about. So let's say she's our listeners, they're fine, they're just in motherhood, right, they're not suffering from a mental health condition, but maybe they, you know, or just have falsehoods, right. Like you know you say in your book, motherhood is a lightning rod for fantasies. And what is some advice you give your patients in your personal circle, like how do you manage it? Right Of not getting caught up, like we've mentioned social media, or what are expectations? Or oh my gosh, my mom did all of this. You know I should be able to do this, right. What do you speak to? That?

Speaker 2: 44:52

So that's one of them. I mean and I think I'm going to sound like a dinosaur here, but at the risk of sounding old social media wasn't a huge factor when I wrote this book. I would have a whole new chapter on that. So that plays into it and, as I said earlier in our conversation, that is a very big problem about false expectations of motherhood that I am going to lose all my way. I'm going to be able to, you know, make all my food from scratch. I am going to breastfeed exclusively. I am going to be doing these workouts. This is what my house is going to look like. I'm going to become an influencer or I'm going to do.

Speaker 2: 45:25

You know, those are such harmful things that weren't even a factor when I wrote the book many moons ago. I do think the book has aged well. I would add a chapter on social media, though. So I think that is just amps up all of those ideas. So it's our fantasies about reworking our own childhood and, you know, maybe being the mom we never had, or doing everything exactly as our mother did, or as we have the fantasy recollection that our mothers did. Oftentimes, people actually talk to their moms and their moms are like I never did that or I didn't do that, and they have

Speaker 2: 46:00

developed a fantasy with hindsight about that. Or you know thinking I'm going to be the perfect parent in terms of, you know, doing all the right stimulation and classes and I am going to be perfect at this, and again it gets back to the type A, like this is how I've excelled in my work, I've excelled professionally, I've excelled in whatever else I've done in life, and now I'm going to excel as a parent. Like you know, none of us excels as a parent as a parent.

Speaker 2: 46:30

And I always bring up the idea to people of the good enough mother, which is not a concept of mine, but it's a concept of a very famous psychiatrist called DW Winnicott that that is what moms need to be the good enough parent. You've got to be as good as you can most of the time and the fantasies can be very harmful. Listen, it's good to aspire to be good and to do the best for your kids and to really want to take care of your kids and all of their needs. But again, I think in our culture and our society that's imbued with it must to be good is to be perfect. But that's not true.

Speaker 2: 47:07

Let's break this down To be good is to be good to be. You know, as I said, we want to take care of our own mental and physical health so we can engage with our babies. We can interact with our babies, we can keep our babies fed, we can keep our babies clean, we can engage with them, we can give them socializing, intellectual stimulation. You know, demonstrate love and demonstrate caring, and none of us is going to be able to do that all the time, every single day. But we have to take it down from the ratcheted up ideas of perfect motherhood into good enough parenting, good enough mothering and that has really good outcomes.

Speaker 1: 47:44

And I will say to people.

Speaker 2: 47:45

That doesn't mean don't care about yourself, and you know I hear so often from my patients oh, I'm not sleeping because my you know I have to do this for my baby, I have to make all the food and I'm exhausted. And you know, forget that like. You have to take care of yourself first and foremost. And in my book and I'm sure you've heard it before and I'm sure every listener has heard this, but if not, I'm going to repeat it, because I always use the airline analogies they always say if you're traveling with a baby or a young person, put on your own oxygen mask and then take care of those around you. That is what parenting has to be. If we're not taking care of ourselves, we're not going to achieve even the good enough mothering status, because we're not going to be able to.

Speaker 2: 48:24

We're going to be exhausted, we're going to be burnt out, we're going to be depressed, we're going to be anxious. So part of being a good mom is taking care of yourself, filling up yourself in your own bucket before you can, you know, be good for those around you. So you know, I spend a lot of time myth busting on all those things that I mentioned and bringing it back to. Let's refocus here. Let's, you know, focus on what are you doing?

Speaker 2: 48:48

What can you do? How are you taking care of yourself to be who you want to be in this situation?

Speaker 1: 48:54

I love that and this has been so. I mean just so many nuggets of just like gold knowledge that I mean it can just really and that's the whole point. And now we I'm going to ask you a question, we ask all our guests, so this is just a you question. There's no wrong, right answers. What would you, now you know you said your daughter's 23, go back to when you first found out pregnant with her? What do you wish you would have known about motherhood that you now know, that you could tell yourself?

Speaker 2: 49:23

I mean, I think the advice that I give to everybody is the advice I probably could have used is take approach with much more flexibility and much less worry. And you know, if they don't, if they're not potty trained by a certain age, don't stress about it. Or if they're not doing this by a certain stage, don't stress about it. Have a longer term picture picture of what raising a child looks like and what that means, and also worry less because it's a long road. You know, god willing, we're all on a long road to parenthood and we have a long life with our children ahead of us.

Speaker 2: 50:05

And to try not to get too fussed and focused on any one stage, whether that's like the sleeping or the feeding or the potty training or the you know who their friends are in nursery school or kindergarten to college applications to you know it's like it's a long road ahead. And if we get so worried about everything which I have, and I've tried very hard not to, and I keep on having to remind myself of that and I I think that's the best thing we can do as parents is to take a deep breath and to give the situation more joy and more flexibility of outcomes and options that are also okay and, you know, loosen the white knuckling a little bit. I wish I'd known that, I wish I'd been given that advice and I wish I did that more, and I'm trying to do that more now.

Speaker 1: 50:59

So, it never ends right Because you know, she's far from the potty training, but it's a you know. I always say people are like, well, it's gonna get easier when they get to this age, and I always say I don't think so. I think it's just new challenges that we, we figure out, you know, as we go along.

Speaker 2: 51:15

Yeah, and the sooner people can figure out their approach to anxiety at a different stage the better. And I say to people who are so fixated in pregnancy I need to have this kind of delivery or they're so worried about delivery, you know, I say this like let's use this as practice to de-stress the situation, Because if it's not this, it's this, If it's not this, and if we have that mindset in life to everything, it's a very, very long and stressful road. So the more all of us can like figure out how tools to manage our anxiety or sadness about certain things, the better we are all going to be. So, figuring out what is your personal toolkit of management of stress? What do you, can you do personally? When do you need professional help? Like, think about that and get the help and, you know, make the time for you to be able to do that.

Speaker 1: 52:08

I love that such great advice and I appreciate you and your insight and thank you for keep. And you know listeners, no matter where you are on the spectrum of women's mental health. Dr Delphine, she has got you, so I will link on her website her book and I will try my best to convince her to come back and we'll talk more. So thank you, dr Delphine and listeners, we'll be back next week.

Speaker 2: 52:31

Thanks so much, Sarah.

Speaker 3: 52:39

Maternal mental health is as important as physical health. The Preview 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 Parkhurst and licensed clinical social worker Whitney Gay, each episode focus 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. We're here to help.