Birth, Baby!

Transcription for: "BBEp12PMADs.mp3" (Uploaded File) (New Transcription)
Samantha: Welcome! This is Birth, Baby! Your hosts are Ciarra Morgan and Samantha Kelly. Ciarra is a birth doula, HypnoBirthing educator, and pediatric sleep consultant.

Ciarra: Samantha is a birth doula, childbirth educator, and lactation counselor. Join us as we guide you through your options for your pregnancy, birth, and postpartum journey.

Speaker 2: Today we have Cheryl Reeley with us. She's a licensed clinical social worker specializing in perinatal mental health and she here to help us understand what PMADs are and how to know if you have one.

Samantha: Thank you so much for being with us today, Cheryl.

Cheryl: Yes. I'm so happy to be here. Thank you for inviting me.

Samantha: Absolutely. Can you tell us a little bit more about you? And kinda how you how you got into this work?

Cheryl: Sure. So my name is Cheryl Reeley. I'm a licensed clinical social worker, and I have a private practice here in Austin and I specialize in maternal, mental health care. I have been a therapist, well, I've been licensed as a clinical social worker since 2011, but I started out in medical social work. And so I worked in the hospitals, and did a lot of case management and crisis management.
But the end goal was always to go into therapy. And so when I decided that was the next step in life, I really had to sit down and think, like, okay, who are we gonna work with? Who do I work best with? And, you know, what do I wanna talk about all day?
And that is how I got into maternal, mental health. And it's been great ever since.

Ciarra: So is that before or after you had kids? That was after you? Nope. And how old are your kids ?

Cheryl: Yeah. No. My kids are they range They're fourteen, eleven, and four. So, yes, I worked in the hospitals before I had kids or while I was having kids, I guess. But the maternal mental health came kind of during my pregnancy and fertility journey.
I had a couple of miscarriages and yeah, it was a strange road and I felt like, man, I really wish I had been supported better or had more support available to me. And so, again, when I was going through the process of figuring out who my population was gonna be. And again, what I wanted to talk about all day, it had to be maternal help because it was something that was so personal that I went through and I was just like I need to make sure that this is out there for others.

Ciarra: Isn't it so neat how so many of us come to our calling by a personal experience in our lives? Like, so many of the people we interview for podcast are saying the exact same thing. Both Samantha and I came in to birth work because of the same reasons in our own lives. So it's really neat to see how that evolves for people.

Cheryl: Oh, yeah. And especially for helping professions, like, you don't get called to a helping profession unless you have personal experience that somehow, you know, brings you there.

Samantha: Definitely. Yeah. So tell us a little bit about how yeah. I guess just a little bit more about how you became a therapist, what that, like, process looked like of schooling and all of that.

Cheryl: Sure! So I originally went into undergrad thinking I was gonna be a chiropractor. And quickly realized that was not a good fit for me. And so I was like, well, we need to pivot. And my minor at that point was psychology, so I just switched over to psychology, and that was such a better fit. For the way that I learned and the things that I, you know, grabbed my attention.
So I graduated my undergrad with a degree in psychology, and also very quickly realized that I was gonna need a master's degree to do anything that really felt in the way that I wanted to go in my career, I was gonna need a master's degree. So I applied to this dual degree program at the University of Illinois, and it's a degree that has a master's degree in social work and a master's degree in human and community development. Which basically means I just learned how to research really well and read research, yeah, really well. And also the practical parts of social work. But in the social work part, they had different specializations.
And at that time, I was really afraid of mental health and I was like, nope, not gonna go down that path. So I chose healthcare. Because again, I started out wanting to be a chiropractor so that made sense in my life that I was like, oh, I can, like, put this healthcare piece and the social work piece together and work in healthcare. And that was great because the hospital system gave me so much experience with all different populations, all different ages, all different diagnoses, like I got so much experience. With people at the hospital system.
So I felt much more confident at that point that I could go into mental health after that. But for me, like, grad school straight to mental health was very scary, so a little buffer zone to go on.

Ciarra: I really love that you have all of that experience and that's why I love referring people to you because it's like even if you couldn't help them or maybe didn't feel like you were the perfect fit for them, always know you know how to tap into that and that community relations or whatever you said portion of that is probably helpful. For those that don't know because a lot of people listening may not be in our HypnoBirthing classes. I have you in to talk in my HypnoBirthing classes on class five, which is our last class. And I always love for you to explain things to people because so often we have people not really understand who might need perinatal therapy?
Or how do you even know if you need it? And a lot of people just think that everything is the baby blues. Like, oh, it's not a big deal because everyone has this afterward. And I know you and I talk a lot about common versus normal. And so it's very common, but not normal.
So can you talk to us a little bit about how to know the difference if someone was having baby blues or if it's a PMAD and what in the heck is a PMAD?

Cheryl: Yes. For sure. So a PMAD is a unfortunate acronym for perinatal mood and anxiety disorders. And it's really if so PMADs are anything in the perinatal period, which is pregnancy through the first year postpartum. And then you have our mood disorders, which include depression, our anxiety disorders, which are, like, generalized, obsessive compulsive, panic.
And then it also includes postpartum psychosis. And then a disorder on a general explanation level is anything that negatively impacts your day to day life. So that's kind of the baseline for is this just something that we're experiencing that's temporary and, you know, it's uncomfortable but not diagnosable. Versus the disorder where it's like, this is affecting my day to day life. So, yes, we talk a lot about the difference between baby blues and PMADs.
Actually postpartum depression and Okay. So baby blues typically the two or the two differences are timing and intensity. So the baby blues typically start around day three, four, postpartum and typically resolve around day fourteen, postpartum. And intensity wise, we're looking at mild symptoms. So mild teariness, mild feelings of sadness, maybe a little bit of lack of motivation.
But again, taking into context that we have a two week old newborn and we're probably also not getting a lot of sleep. So that's our baby blues. PMADs are, especially postpartum depression, typically come in after those first two weeks. They usually peak around month four. But again, anytime between pregnancy and the first year postpartum will consider a PMAD.
And then the intensity is much more is much higher. So we're looking at, like, really struggling to get things done day to day. Like, just don't wanna take a shower, not feeling motivated to feed the baby. Yeah. Just all of those things are are taking so much more energy to get done.
And then, of course, we have not of course, but Also, we have, like, intrusive thoughts become problematic where they're, like, really distressing or you know, thoughts of I'm doing such a bad job and my family would be better without me. So anytime those kinds of things come into to play, then we wanna talk more about, is this a PMAD? And what should we do next?

Ciarra: Are there ever times where you see people that didn't really have a whole lot of signs of baby blues or PMADs in the early stages of that perinatal period and then you know, six months or nine months in, all of a sudden it happened. And I'll caveat here that the reason I'm asking is because I know I definitely had postpartum anxiety and didn't know it. But I think that the older my son got, the more intense my intrusive thoughts became, on the bad things happening to him. It was at first, it was like sleep related. I just had such anxiety around sleep.
And how much sleep am I gonna get? But then it it became, like, I'm walking upstairs near the edge of the rail and, like, what if I fell right now and he went over or, like, crazy. We don't like the word crazy, but to me, it was just like, what in the world is going on with my brain? Is that common that it would kind of intensify over time?

Cheryl: Right. Yes. Common, normal. Yes. You know, they the symptoms of PMADs are really all over the board and they're so individualized to each person, especially timing wise because so much is happening in your body and so much is happening around you like Are you going back to work?
Are you not going back to work? You know, is baby sleeping through the night? Is he not sleeping through the night? Feeding. Like, there's so many other things to put into context.
And so sometimes these symptoms really ramp up at the beginning because we know that mom's going back to work at six weeks, and so all those feelings kind of get jumbled up at the beginning. Versus, yeah, maybe baby's getting older. And so now you're like, oh, well, there's these new transitions and that's really scary. Right? So it's the other thing I will say about when symptoms seem to get more intense a little farther along in that postpartum period is that sometimes your, like, ability to handle it is just depleted.
And, you know, like, you have push through and power through and I've made it this far and we're doing so great and like you're just tired, you know. And your brain is like, we need more help than what you're giving us and you can't push anymore. And so sometimes those symptoms peak later because you just don't have any more energy to give to it to keep them under control. Like, you've tried so hard and then, like, at some point, you're gonna reach that breaking point.

Samantha: So what types of PMADs are there and what signs are what are the signs to look out for for those different diagnoses?

Cheryl: Sure. So our mood disorders are going to include depression. And the anxiety, like I said, it's general anxiety, panic disorder, obsessive compulsive, post traumatic stress disorder. And then also not in the acronym is postpartum psychosis. So the symptoms that we're looking for are in depression are lower mood, lower motivation, not eating as much as usual, sleeping too much, sleeping too little, things that are out of the ordinary and generally just a lower mood, less motivation.
And it's not that moms and other people who are experiencing PMADs are not getting things done, it's taking a lot of energy to do that. Like, we know that we need to feed the baby. And it is taking so much energy to get that done. So those sometimes I think we think we have this picture in our head of depression where it's just like laying a bed and crying and not going to work, not getting our things done, but it might not actually look like that. It might look like we're getting our things done, but it is draining and depleting, and the thoughts that are running through our head are just very negative.
And Yeah. Just very negative thoughts.

Ciarra: I love that you say that real quick because actually one of the people that I sent to you for this I thought was a great mom. And then she called me and she was bawling, feeling like she wasn't good enough and really, like, critical of how her partner was doing things and felt like he was really critical of her and he was like, I feel like I'm being supportive and, you know, from the outside, I thought everything was fine and I was so surprised when she called me crying. Actually, her husband messaged me and said, can you please check on her? I think something's wrong. And then I was like, Cheryl.
Yeah. Here's her here's her information immediately. But yeah, from the outside, it might look like everything's going fine, so I love that you say that because internally, she was not okay.

Cheryl: Right. And that and part of that, you know, is cultural and societal that we put so much pressure on moms to have this perfect birth experience and perfect postpartum experience and, you know, the minute the baby comes out, you just love them so much and, you know, you're connected and that is just not always the case. Like, this is a new human who you've never met. They've never met you, and we have this expectation that we just are connected and bonded and everything's perfect. And I actually was just talking to a client yesterday and she was like, wish someone would have told me that it was okay to not be completely in love the first day week that the baby came out.
Like, it might take time for us to learn how to love each other and to have that bond and that, you know, he's I wanna say, like, four ish months now and it's very different, you know, her experience, but she felt so much pressure and felt so like something is wrong with her because she doesn't have this immediate bond to the baby. And by no means did she have postpartum depression. She just had met her new human, you know, and she had never been among the fold. And so it's a lot of transitions that we don't give grace to, you know, and we just expect everything's supposed to be perfect and wonderful.

Samantha: Yeah. Definitely. I feel like it can be hard to, you know, as a as a parent, but also as a partner, I would imagine, it would be hard to kind of figure out what is the what is the norm. Like, you know, Is is this all going beyond the range of normal? And who do I go to for help?
And I feel like that's why it's so important for everybody involved in in the care, you know, the providers, and the doulas, and partners, and everybody to be asking the questions and kind of going through the things and identifying. Oh, I think this person is struggling a little bit more than what would be the typical And, yeah, just kind of going through all of that together as a team because one person may see it and another person may not and that one person that saw it could be, you know, the difference in identifying one of those.

Cheryl: For sure. And that's the thing, like, you know, during pregnancy and postpartum, we should be asking, you know, are you experiencing any of these things? Like you should be getting a screening tool done at least once during pregnancy and at least once during your postpartum period. But what I'll say about that is the one screening that is typically given is the Edinburgh Postnatal Depression Scale which is great scale for postpartum depression, but it's not super great at catching anxiety, which is a lot of what I see. Is though are those intrusive thoughts, the counting the hours until, like, how much sleep am I gonna get, you know, and So, yes, we are pretty good about screening for postpartum depression, but we're not super great about screening and identifying anxiety until somebody mentions it or we've reached that breaking point, like, I feel like I'm going crazy.
And like, am I crazy? Because I feel like I'm going crazy. And then by the time they get to me and I'm like, okay, well, it's anxiety and like, let's talk about that. You know, it's they've been experiencing it for a long time.

Samantha: We had a funny moment in the last HypnoBirthing series where when Cheryl was in class. One of the people said, well, if no one's asking me these questions at my appointments, how do I know if I'm having this? Because she's like, I've never been asked and so far in my pregnancy. And I was like, well, there's a website you can go to and it had the depression scale, and then it also has the one for anxiety. And she goes, okay, so I can do them myself.
And you were like, yeah. And then she goes, so, like, how how often should I take them? You know, I said, well, and I said, I wish had an IP address log where it's like it would only let you look at a certain number of times in a month or something. But I said, well, I think that if you are wanting to do it, you know, once a week, then maybe that's a sign you might have anxiety.

Samantha: And we can link those in the show notes, those two websites just so if you don't feel like somebody is looking out for you, you can do it. Right?

Cheryl: Absolutely. Like, they're so self explanatory.
They'll just, like, pop out the number at the your score at the end, you know. And usually, it'll have, like, a indication of what the score means, but for the EPDS, the PHQ nine and the GAD seven, which is general anxiety disorder is the seven question. For all three of those, really anything over a ten, we're like, oh, okay. Let's talk about this. Right?
So it's it's not anything that takes rocket science to go through and do and decide if you know, this is something that you should be getting checked out. Now that being said, if you go through one of these and you get like a six, but you don't feel good, and you still feel like this is impacting your impacting you in some way, then, okay, great. Like, reach out. To your OB or your doctor or if you have a therapist and say, hey, I did the GAD seven online and I got a six, but I still don't feel good. Can we talk about this?
Right? Like, it's just a screening tool. It's not a diagnosing tool.

Samantha: Yeah. Definitely. So what what what are some of the risk factors of PMADs? And like, is there anything that anybody can do to kind of reduce their risk?

Cheryl: Oh Gosh. I really I wish there was.

Ciarra: Do you remember? Is there a vitamin I can take? Are there foods that I can eat?
People ask the best questions in my classes. So you have to answer. Is there a vitamin we can take? Is there a food we can eat?

Cheryl: I mean, there's just not. I'm sorry. If there was a magic pill, I would give it to you. I promise.

Ciarra: But then you wouldn't have a job.

Cheryl: I know. And then I'd be like, oh, now what am I gonna do with these skills? Thanks, guys. Yeah. People in these classes, every time somebody asks, like, is there something I can eat or is there something I could take that will prevent me from having this?
And honestly, I do wish there was. And my answer every time is you're gonna eat the things that you're gonna eat safely during pregnancy, that that all stays the same. There's not a supplement that is going to prevent it. Are there things that we can do to mitigate the risk Yes. But again, that's still not a hundred percent saying, like, if you do this, you will not get postpartum depression.
So our risk factors that we're looking at are any trauma in your personal history puts you at a higher risk because birth and postpartum are inherently out of your control in some ways and can feel very risky and scary, and there are times where it is traumatic. So any previous trauma puts us at risk. Socioeconomic, instability, again raises that stress level, and so the transition in the parenthood is harder. Any history of anxiety or depression beforehand or any family history, especially in mom or sisters with postpartum, Mood disorders, mood and anxiety disorders puts you at a higher risk. And then also remembering that it's not just the pregnant person that can get a PMAD, we can we also see it in dads.
One in ten dads has a PMAD, which is probably higher, and we just don't identify them or diagnose them. And then also grandparents or adoptive parents can also experience these things because it's not just about the hormones and what's happening in the pregnant person's body, it's so much more that we're taking into context.

Ciarra: Same sex and non birthing parents. Right? So if it's two moms, if it's two dads, it adopted a baby. Adoption still both parents could could experience that. A a or a a heterosexual adoption.
All of it, everyone could get it. A foster parent could get it.

Cheryl: For sure. Yeah. Absolutely. Because there's again, there's so many things that are happening during this transition that can that really throw off your mental health and and your own self care that you're probably neglecting a little bit during this time.

Ciarra: I always think it's so important for partners to know that this is possible because and I make seriously, I think that's one thing that I without fail and told every single partner because I always tell them, if I were to come to you after you have this baby, and I say, I really think that you might be experiencing a PMAD really think you should reach out to x y z or whatever. Or here are some resources. If you never even knew that was a possibility, but like, what are you talking? That's ridiculous.
Right? And you're also already in a heightened date of anxiety or whatever, so you're even less likely to be receptive of what I'm saying. However, if I already told you and I already warned you that you would have this reaction, then you might go, oh, shoot. Ciarra thinks, wow, I'm not one. Like, they said one in ten.
That's me, I guess, you know, and they would be a little bit more softened to receiving that information. So I'm so glad you said that.

Cheryl: Yeah. And, you know, we're not screening partners. We're not screening grandparents. They're not going into postpartum. Appointments.
They're not going in well, they might be going into the pediatric appointments, which sometimes the pediatrician will screen mom but it's highly unlikely that they're also screening the partner. So, yeah, the doula might be the only person or, you know, a lactation consultant. Somebody who's in their business in the best way possible. Right? Like, might be the person to identify it because no one else is looking for it.

Samantha: Yeah. That's so that's so hard. I think as, you know, as a do life, often we'll walk into postpartum appointments and, you know, mom is in that newborn baby baby bliss stage and she's just living it up and you just see dad hurt and, you know, going through all of it because it is such a big transition and those moments of transition can be so hard for them. So how can partners help when someone is experiencing a PMAD?

Cheryl: Yeah. That is a hard one because, again, like, I wish we could just, like, take it away for that person, you know. But being supportive and validating that this is something we will work through is gonna be super helpful. And I guess the opposite of validating would be invalidating the and that I think is where a lot of, you know, typically moms are feeling like this, like I feel like I'm going crazy. You know, and if I say that out loud, people or, you know, the partner, like, this is just how it is to have a newborn.
Like, it's really hard. This is just how it is. And mom's like, not all, like, this is not normal. What I'm I'm, you know, trying to explain, like, I think something is wrong. Having that partner hear them and support them and say, okay.
I hear what you're saying. Let's move forward in, you know, calling the doctor, calling the therapist, maybe bringing up the idea of some medication. Maybe we need some anti anxiety. Maybe we need some anti depressants to get through this stage. But the more supportive that partner is, the more receptive, maybe the person who's experiencing some of these, symptoms would be to getting the help that they need, whereas if that partner is like you're fine. This is just how it is. And it's not going to be as helpful as texting the doula just like that client that did for me. I mean, honestly, that was just his first preliminary attempt of, like, I don't even know what to do. But here, maybe Ciarra can help.

Ciarra: And I'm immediately texting Samantha and letting her know that one of our clients is struggling. And I think that Another thing that's so important is, you know, yes, what can help, but what can harm?
And you're saying the invalidation also making them think that they're not a good parent because of it. Like, I've had some people say, well, do you think she should even be around the child right now? Like, she's crying all the time. Don't you think that that's bad for the baby? And then the mom feels even worse about, oh my gosh, see now I'm hurting my child by crying around him, and I'm impacting him.
And I had to say, look, you know, I am not a doctor, I am not a therapist, but I would bet my life that your child is not in danger from being with his mother. And like he thinks I shouldn't even breastfeed because I'm just crying while I'm nursing him. And I'm like, she still needs to be breastfeeding. Gosh. And if anyone needs it, mom needs him to still be breastfeeding because she's really struggling. And he meant well.
He was trying to protect everyone. But then I'm sure looking back, he was like, oh, shoot. You know, I didn't know what to say.

Cheryl: Right. Right. Because we're not preparing partners for this well you know, in your prenatal appointments, you know, is your doctor talking to the partner about this? No, especially in the past couple of years when partners couldn't even be in, you know, some of those appointments, and we couldn't talk to them specifically about this. I know when I was working in the hospital and I was covering labor and delivery and the postpartum units, we would get a referral if mom's EPDS score was over ten, they would call the social worker in to just you know, follow-up and see what's going on. And I mean, yes, would I talk to mom about what she's experiencing and what why she answered the questions the way she did? Yes. But the second part of my conversation was to the partner to say, you are now on the lookout because you're the one that's gonna be with her. And you're the one that's gonna see the changes with her.
So if you see something, you need to talk to her about it, and you need to call the doctor, you need to call me, you need to call someone because now I'm not trying to put the pressure on the partner, but just to be like, this is part of your responsibility, you know, to be aware that this that we already know that this is a risk factor because we're a day out of birth and we're already seeing some signs.

Samantha: So I guess, you know, from there, how do you suggest reaching out if someone is struggling? Like, is it helpful for them to preemptively find someone before there's an issue? Or is it better for them to, you know, not prepare for that so that they don't put it in their mind? Or what does that look like?

Cheryl: I love preparation. And I see this in all of Ciarra's classes also. If you can before you have the baby connect with a therapist, that's all I'm asking. Right? Like, call a few, have a consultation, see who you fit best with, see whose personality jives with your their style, their tone, you know, if it's important to you that you speak to a male or female therapist, like, just get in contact with someone and let them know, like, All I'm doing is just making sure I have someone to reach out to in case this is an issue.
A lot of therapists right now are overbooked and full, and it can be very challenging to get in when you need to get in, especially if you're looking for a therapist that has a specialization. So, yes, if you can prepare and just reach out and, you know, know that, okay, If we need it, we have them. If that's not possible and it's not on your radar or you are postpartum already and you're not there, then the same things apply. Right? Like, there are resources that have specific directories for therapists that are specialized in perinatal mental health, so you can go down that route.
You can call your doula. You can call your lactation consultant. You call your OB, but just take some time to find a therapist that feels like a good fit and maybe not necessarily just the first person that can get you in.

Samantha: Definitely. Yeah. Thank you for that. I think that's something that we try at least to focus on in our prenatal period is is just helping them prepared not just for the birth and for pregnancy, but for postpartum and everything that, you know, can come with that. So if you had one piece of advice that you could give to everyone listening in regards to mental health in the perinatal period.
What would that be?

Cheryl: I would say, what would my one piece of advice in the in the perinatal period be? I would say if it's taking you a lot of energy to do things that normally wouldn't take this much energy, then use that as your bar to decide if you should reach out for help or not. And also and I guess this is two things. Recognizing that you don't have to have a diagnosis to benefit from therapy, during any time in life, but especially during the perinatal period. Right?
Like, this is a humongous transition it oftentimes brings up past trauma, childhood trauma, relationship traumas, Right? And so all of the sudden, some of these feelings are coming up and you're like, whoa. What is happening? I thought I was just gonna have a baby. And you know, live my life and go on, but now I have all of this other stuff coming up. So just listening to your body and not being afraid to reach out for help. And maybe that's my piece.
It's my piece of advice. It's just don't make yourself feel isolated, know that there is a community out there, and we will connect you. So if your connection is Ciarra, then reach out to her and she will point you elsewhere. If your connection is me, I'm a social worker at heart, so I'm going to connect you with every single resource I could ever find, you know, and I'm not afraid to reach out to other therapists or you know, whatever system you need, I will get you connected. But I need to but you need to get to me first or you need to get to Ciarra first.

Ciarra: Or Samantha!

Samantha: Yeah. And that's a perfect segue to our last question for you, which is we would love to know how people can find you. We will also put these in the show notes on your website and how they can follow you on socials. But What how would you like people to find you if they needed to? Sure.

Cheryl: I do have a website. It's CherylReeleylcsw.com. And I have a little bit about my specializations on there, also some information about myself and my story. There's a contact page. So, yeah, the website is great.
I do have Instagram as well. It's @cherylreeleylcsw and I post some occasional tidbits here and there.

Ciarra: Great content. She's lying. It's great content and I love it.

Cheryl: Thank you. I appreciate it.

Ciarra: I'm not pregnant or in my postpartum period, and I find value in it.

Cheryl: Yes. I do try to go a little more general in that realm to see what we can get out to people. But, yeah, those are the two main ways to get a hold of me.

Ciarra: Awesome. Well, we really appreciate you being on with us And I just now you said, you know, people aren't teaching these things prenatally, and people don't know, partners don't know. Well, now they can just send this podcast link and go, hey, just like I used to do with everyone else's podcast.

Cheryl: Sure.

Ciarra: So we're really excited that people have the opportunity to listen to you and we will talk to you soon.

Cheryl: Yay. Thank you so much.

Ciarra: Thank you.

Samantha: Thank you. Thanks for joining us on Birth, Baby! Be sure to tune in next week as we talk with Amanda about her birth story. Thanks again to longing for Orpheus for our music. You can look him up on Spotify.
Remember to leave a review, share and follow wherever you get your podcasts. See you next week.