Selected Podcast

Perinatal Mood and Anxiety Disorders (PMAD): Help for Parents at Twin Cities Community Hospital

Perinatal mood and anxiety disorders (PMAD) affect women from all walks of life. Michelle Blanc and Mishell Whitacre discuss this condition.
Perinatal Mood and Anxiety Disorders (PMAD): Help for Parents at Twin Cities Community Hospital
Michelle Blanc, LCSW | Mishell Whitacre, RN
Michelle Blanc is a Licensed Clinical Social Worker who has worked in the mental health field for 30 years in various capacities. She has facilitated approximately 100 support groups ranging from Mental Health Wellness to Depression and anxiety management. Michelle has a bachelor’s degree from Cal Poly and Masters Degree from Cal State University, Fresno in Social Worker and is licensed by the Board of Behavioral Sciences. Michelle Blanc, LCSW is PSI Certified which means, she has specialized training
in PMAD conducted by Postpartum Support International. 

Mishell Whitacre, RN has worked with mothers and babies since 1984 when she received her midwifery training in Texas. She has been at Twin Cities Community Hospital in Templeton, California for four years. She teaches Lactation and Education, with a passion for PMAD and for parents to find purpose and receive the support that they need, to parent with joy.

Prakash Chandran (Host): This program is community service and is not intended to be a substitute for medical advice. Listeners having questions about their health should make an appointment to see their personal physician. Any opinions or statements made during the program are those of the individuals or physicians making the statements and are not the opinions or statements of the hospital.

Women from all walks of life can develop perinatal mood and anxiety disorders. Symptoms can appear anytime during pregnancy and the first 12 months after childbirth. The great news is, is that there are effective treatment measures to help you cope and recover during this difficult time. Here with us to discuss are Michelle Blanc a licensed clinical social worker and Mishell Whitacre an RN Lactation Consultant; both at Twin Cities Community Hospital. Michelle and Mishell, thank you so much for educating us today. And I have to start by saying this is especially relevant for me because my wife and I are actually expecting our first in July. Thank you so much. So, I want to actually get started with the basics. What are perinatal mood and anxiety disorders and when do they occur.

Mishell Whitacre EN, I BCLC, LCCE, LM (Guest): Well this is Mishell Whitacre so, I can answer that. Normally, if a mother has a history of anxiety or depression prior to pregnancy; she’s most likely to suffer from that during pregnancy. And then it can rear its ugly head even more postpartum period. Some moms have never suffered from any of that before. All mothers after birth, can have a period of about two weeks called baby blues where they cry really easy, they are emotional. You know the little puppy crosses the street and stubs its paw and they are crying. That’s normal. That’s just the hormones took a big dive after the baby was born.

But third week mom still is depressed, crying, isn’t taking very good interest in the baby. That’s different. Then we’re seeing more of a chemical imbalance in the brain. And that’s why it’s paramount that her partner is eyes and ears to keep a close watch on her to see if she has that disinterest in the baby. That’s the only issue we'll see. Now, months after the birth, it can also appear. She may have had no signs or symptoms at her six week postpartum visit with her OB and suddenly three months postpartum, bam, she’s just not herself. And I work in lactation clinic and I also teach childbirth classes so a lot of the dads I always say in class, call me, call the lactation hotline if she’s not acting herself and we will get you into clinic and I’ll call your OB and we’ll talk about stuff. There is a lot of help for moms out there.

Michelle Blanc LCSW (Guest): And I’d like to add something with that if I may. So, women of every culture, age, income level and race can develop perinatal mood and anxiety disorders. It does not discriminate and like Mishell said, symptoms can appear anytime during pregnancy.

Host: Yeah, you mentioned that when there is a history of that depression and anxiety that it’s more likely to rear its head during the pregnancy and Mishell I’m also so glad you broke down the timeframe and when to look out for it being a problem after pregnancy occurs like the three week mark and then potentially months afterwards. But I want to actually focus right now on during the pregnancy. Because I’ve even noticed in my wife, there can be severe mood swings and also just getting sad very easily. So, what are specifically the symptoms to look out for when women are experiencing some of the PMAD things that we are talking about today?

Michelle: Well a lot of the moms that suffer from PMAD symptoms, sixty eight on stuff. They might be a little bit so anxious about something that they just can’t get it out of their head. It might affect their feeding. It might affect they’re being obsessed about their weight or exercising or worry about the baby developing inside of them. We do have a perinatal mood anxiety depression support group for moms after they have had the baby, but currently, we have had some moms come during pregnancy. Those moms suffer more from anxiety in pregnancy. One of the moms did say she got on medication during pregnancy because she couldn’t stop obsessing about worrying about the baby. And it helped wonderfully to help her to be able to cope with the rest of her pregnancy and I would imagine she’s is going to stay on that in her postpartum period. So, does that kind of answer the question a little bit?

Mishell: Our culture puts a lot of pressure on women to be perfect. There was a recent article in Time magazine called The Goddess Myth and so, there’s this idea that we’re supposed to feel wonderful during pregnancy and actually, a lot of people feel sick a lot of the time and tend to isolate and not want to tell anybody because they are supposed to be so happy during pregnancy. But that’s just not true for all women.

Host: I think that’s a really good point that you made because I can even attest to the fact that my wife does feel like she’s alone in this and it’s amazing. So many women that I know that go through these disorders do feel like they are alone. So, it’s great to hear that there is a support group that they can go to, to get some support and just really understand from their peers how to deal with some of the symptoms they are experiencing. What is the support group called at Twin Cities and how can people learn more about it?

Michelle: It is From Birth and Beyond. It’s every Thursday at the OB department third floor. It runs from 10-11:30, but it often goes much longer than that because mommies just want to sit and visit and talk and a lot of mommies are isolated and alone, so it’s a great place they can come and just learn about perinatal mood and anxiety disorders and also get some psychoeducation about what that means. Plus we also do a lot of playing. We do some art therapy. We do a lot of meditative exercises. We watch funny movies and videos. We try to normalize their situation because they don’t feel normal and it is very prevalent like I pointed out and Mishell pointed out. So, they are not alone and so getting that support is so important and we have been running this support group now, I was just doing the numbers, for almost two and a half years.

Mishell: Also, I just want to bring out that in our support groups, some of the moms will have anxiety or depression but some of them also have PTSD or I call it that post traumatic birth syndrome. They had a birth that was not their optimal idea of how their birth should go. So, they are a little traumatized. Some of them have lactation issues, breastfeeding issues. They triggered in our outpatient lactation clinic where they just came in for a one on one after the baby was born and they were just really down, really having a hard time. And we invited them to group. Because they are having breastfeeding issues. Again, societal comparison looking at Facebook, oh this is just such a great thing, breastfeeding is so easy. Well it’s not easy for everybody and then some people, it’s so hard on them that they get really depressed about it.

So, this is a great support group for that. Because there’s no judgement, no shame. We just want to be supportive, come around as a village, help them find the tools they need in their handbag to get better. We network with other agencies in our county whether that be one on one counseling, whether that be a psychiatrist for medication management, whether that be even just an exercise program. Good nutrition. So, the support group is a great place for them to just let their hair down, feel safe in an environment where what we say stays in that room, doesn’t go out of that room and make new friends.

Host: Yeah, the ability to go about and as I was mentioning, just talk about what you’re experiencing I think is something that really can’t be matched, and I think also both of you had mentioned it being societal. I think that all the stresses that we go through especially that women go through in having a baby and also everything is exacerbated because you’re probably not sleeping as much, it is just very high tension. This is something you’ve never done before. You need that outlet and you need that support, wouldn’t you say?

Mishell: Definitely and I know Shelley mentioned one in seven worldwide suffer from the post perinatal and postnatal depression but men also, one in ten can suffer from it. just for example today, in our PMAD group, we’re talking about how the mother and the father, their relationship changes once the baby is born. Here they’ve been too single people, basically singles, married, no children and now they have children and how do they balance that triangle where the mother and father are at the top and baby in between them. What happens is baby gets way there at the top and mother and father don’t know where their relationship is in conjunction with one another.

Some of the moms brought up they get depressed, the dads can get depressed, they don’t know what their role is now. The mothers get depressed because maybe they had a high career prior to having the baby and things have completely shifted now. Now they are at home with a newborn who doesn’t talk with them, basically eats, sleeps, poos and then cries, and they have no adult relationship during the day. Classic question, what did you do all day? And she just looks at him with that super tired stare like I have no idea, but your child’s alive. That’s all I know. It’s so hard for the two of them to reconnect. You have a dynamic. Isn’t that true Shelley?

Michelle: Yes, it’s definitely true. And we talk quite a bit about relationships and how to include dad so that dad feels like he’s part of the team and not left out because he can’t nurse the baby and he can’t do some of the things that mom can only do. So, that’s a big part of what we focus on in group.

Host: I feel like you both are talking directly to me right now because it’s something that I think about a lot and it’s so funny that you mentioned that. Heh, what did you do all day? I can totally see myself asking that question and so let me ask a question. What would you recommend let’s say pre-childbirth, how can I as a – attempting to be a supportive husband, how can I best prepare for what is to come?

Mishell: Good question. That’s a great question. We talked a little bit about that in group today and talking about empowering the fathers to have a role that – with a role with the baby when you come home that you can bond with your own child. We talked a little bit about dad taking like an active part in bathing the baby, maybe that’s your little time. You can take a bathtub with the baby and just play with the baby in the tub. Maybe mommy is going to pump a little bit of milk so you have some human breast milk that you can give the baby if mom just wants to go for a walk around the block for a half an hour by herself with not being touched by anybody. She’s touched all day by that baby. She just gets a little breather and daddy has milk whether baby wants to take it or not. Of course, once breast feeding is well established, then we would introduce a bottle. But after a few weeks, daddy can have a bottle if mama wants to go out. Maybe she wants go to out and get a little foot massage or a little back massage and he can watch that baby.

But finding times where dad has a time that he can decompress from work and mother has a time she can decompress from her work which is watching the baby all day and then coming together as a couple. I highly recommend all couples to find time then go out on a date night by that six week postpartum period. Grandma, grandpa, someone watches that baby for just a couple of hours. You just get out. You have to keep that relationship tight so that you are able to parent together and still find what brought you two together because your relationship goes through this huge change when baby comes onboard.

Michelle: I mean you can read all the books you want to read and that’s great. But finding your cohorts, your friends that are already fathers and have been through that experience is really helpful because they went through the exact same feelings and so you might ask them what did you do. How did you get through the first year and get ideas from them because they might have had a great thing that they did with their child that gave mom a break and then also helped them bond with their baby. And so reach out to your people too. I don’t think there’s a support group for men yet. That’s in the works. But I really think finding your bros and your brothers and talking to them about it because they’ve been down that road.

Mishell: And it’s really important I usually talk to couples. I do teach childbirth classes here at Twin Cities and it’s so important for a couple to go to a good childbirth education class together, learn to work together as a team, what to expect while they’re expecting. How to coach during labor. How to be together as a couple in labor but I talk with the moms and the dads at class that we prepare a lot for pregnancy and then we prepare a lot for the birth, but I think the hardest part is our fourth trimester which is our postpartum period which is that one year after birth.

That is the hardest part to prepare for and that’s parenthood. That’s when rubber meets the road and we switch into parents and we have this little human being that needs us 24/7. No one is going to come take that baby away. It’s our job 100% and it is a fulltime job. And that stress for any mom that’s suffering from anxiety or depression or some PTSD is intense because it doesn’t go away. It’s not a job that stops. It’s a job that’s always there. It can exacerbate those conditions if she has that and kind of throw her into it even more.

So, our job in our support group is not only helping her identify triggers that might be making that worse, but also some moms do benefit from medication. Some moms just it’s a dietary change or increasing her exercise or finding a decent support group. Or one on one counseling. Counseling is incredibly helpful. But anyways, that’s our tool, that’s our – how we roll in that group is trying to help connect them, connect to other sources in our county.

Host: Well I truly appreciate this and part of – I mean I really love what I do because I get to have these conversations and it’s extremely relevant to me right now. And what I’m hearing from you for the women that are listening, this is normal. It’s very, very common for you to be experiencing this both during your pregnancy and afterwards. And there are support groups and there is help in your community that you can turn to.

And even for the men, I think like you said, finding my tribe, finding people that have done this before and being proactive about establishing those roles before the baby comes so we know what to do like you said in the hardest part, the fourth trimester. So, I really want to thank you both for educating us here today on perinatal mood and anxiety disorders. Is there anything else Shelley, we’ start with you, that you wanted to leave our audience with?

Michelle: Well I’d just like to put a shout out to Twin Cities because they use the Edinburgh scale which is worldwide, one of the best tools to measure a woman’s chances for getting PMAD symptoms and then also the follow up they do, phone calls and then every person that tags high will get a social work consult and then will get a referral to our group and then to a psychiatrist and also to a private therapist if that’s warranted. So, I think they’ve done a wonderful job at supporting the women in our community. So I want to put a shout out to them. Thank you.

Mishell: Right, and I just want to go alongside with that. Twin Cities has been extremely supportive in educational programs for the community and our support groups, all free. Not only childbirth education classes, the PMAD, the Navigating Motherhood Group, Newborn and Parents Support Group, but also just supporting – I mean we are the first one in the county to have this group. So, it’s pretty amazing and we’ve – I don’t know Shelley, how many people have we seen? At least 45 women have gone through here.

Michelle: Yeah, over 200 women have been screened and over 50 have participated; of the 50 that participated we did a post survey a 100% reduction in anxiety and depression. It didn’t completely go away, but it was reduced significantly based largely on the group experience. So, we’re having very good outcomes. So, if we could drop the stigma and get more people involved, I think we would see a lot less stressful mommies and daddies in the world.

Host: Well thank you both so much for the service that you do for this community. I truly appreciate it. For everyone else, for a referral to a board-certified physician and to learn more about all of this, please call the Sierra Vista Regional Medical Center and Twin Cities Community Hospital Physician Referral Line at 866-966-3680. My guests today have been Michelle Blanc and Mishell Whitacre. I’m Prakash Chandran. Thank you so much for listening.