Episode 8 - Mental Health & Pregnancy During COVID19
Dr Nicole Highett, psychologist and founder of COPE joins us for a 2 part interview on perinatal mental health, changes we are seeing amidst COVID19. She shares her top tips for staying on top of your mental health in Pregnancy and the first year of your baby's life.
You can find Cope’s website here: cope.org.au
[00:00:00] Welcome to the Mama Matters podcast. Whether you're expecting you've recently given birth, or you are just starting along your fertility journey, it's time to get down to the nitty gritty and sort fact from fiction. I'm your host, Rosie Dumbrell, physiotherapist and pregnancy expert. Mama Matters aims to provide an easily digestible, up to date and evidence based approach to pregnancy, birth and motherhood with a side dose of humour along the way, interviews from the industry's leading experts and experience of my own adventures as a mother to three gorgeous boys under four. I want to share the stuff that helps to grow confidence throughout motherhood. Mama Matters is a podcast by Lenny Rose Active. And this is what you can expect to hear in upcoming episodes.
[00:00:41] The final thing is obviously just really looking at yourself. What can you control? What preventative strategies can you put in place? So things like regular exercise, eating well, good sleep hygiene, good strategies, all on the quite website and obviously embedded throughout ready to cope things that you can probably do to look after yourself. So you're not only not your end getting the physical health benefits, but also the emotional mental health industry.
[00:01:09] Welcome back, ladies. I do really hope that you're loving what you're listening to. Getting some great feedback along the way, which is so, so great. And it really is our mission to help educate and empower me through a positive experience in pregnancy, birth and motherhood. So one topic that is obviously so important for us to cover and to be able to share resources on is mental health and pregnancy and motherhood. Already places us under increased both physical and psychological stress. And we add a pandemic on top of that. And so, so important for us to bring you these episodes. Today's episode is part one of a two part series around mental health, where the amazing doctor Nicole Hiatt and today's episode focuses more around pregnancy. And then a subsequent episode will be looking more into sort of postpartum and strategies around that. So Nicole has a doctorate in clinical psychology and specializes in the community approach to treating postnatal depression. She joined Beyondblue in 2001 just after the initiative began, where for 12 years she led a range of programs, campaigns and activities. And one of her most passionate endeavours is the success of a National Perinatal Depression Initiative, which combines her broad skill set as well as research experience and aims to insist the quality of life for those women and their families who experience mental health disorders during pregnancy or following the birth of a baby. She also launched not for profit organization COPE - Centre of Perinatal Excellence in 2013 and COPE provides the dedicated focus to reduce the impacts of emotional and mental health problems experienced by mothers, fathers, infants and families. And really, it focuses on increasing awareness, reducing stigma and supporting health professionals by equipping them with the knowledge and skills to provide timely and effective care for women and their families. So it is with such awe and pleasure that I introduce today's guest, Dr. Nicole Highett
[00:03:05] We know that in the perinatal period, which is defined as the pregnancy to age one for an infant, already poses quite a lot of challenges to a woman in a physical sense, it’s an emotional and psychological adjustment. There's a lot going on and that perinatal depression is unfortunately relatively common. The effects of perinatal depression reach further than just the woman itself, potentially to her unborn baby, to family and close relationships. And, you know, there's obviously a risk of increased risk of postpartum depression as well. And this is just the tip of the iceberg. So what are the biggest causes of perinatal anxiety and depression and what sort of signs can women and their partners look out for?
[00:03:42] Well, first of all, Rosie, the main there's a number of risk factors. So things that we know increase the likelihood that someone will develop a mental health problem during the pregnancy or in the first year after having a baby. That's the strongest risk factor, is your previous mental health history. So you're someone who's had anxiety or depression or another mental health condition in the past or you live with another mental health condition. This places you at greater risk at this time. And there's a lot of change, a lot of transitions and a lot of adaptations. And so that's really the number one factor. So it's very common. You should be asked as part of your antenatal care a series of questions. And one of those is really looking at your personal history or family history or mental health problems, other things that, you know, might impact or certainly impact on your likelihood of developing a condition like anxiety, depression, your support networks, having a supportive relationship if people do have a partner. And is that an emotionally supportive relationship? Do you have access to emotional support, practical support from family and friends? So these support elements, both emotional and practical support, is another respect for those who don't have access to that. And of course, we know that family violence, unfortunately, often occurs for the first time in pregnancy and also increases generally in pregnancy. So this is another major risk factor, of course, and relates to the relationship.
[00:05:06] Are we seeing more of that at the moment with the sort of current situation? Do we have any sort of understanding of that?
[00:05:12] Yes. So certainly the COVID19 pandemic is putting a lot of extra pressure and strain and stresses on individuals and on partnerships. So we are seeing increases in family violence during pregnancy and across the broader community as well. So this is something that's very important, that health professionals are still doing the mental health screening and asking you about these factors, because a number of these factors are likely to increase with the pandemic. Another major risk factor is whether you've had major life stresses in the last 12 months. So, of course, the pandemic itself right now is a major risk factor. It's putting a lot of pressure on different families. Depending on your situation, you or your partner may have lost their jobs or more secure income. So this is putting a lot of financial pressure on the family at a time when you're going to be expanding your family, generally needing more access to finances. So this can put stress not only on the individuals, but also on the relationships as well ,and that is certainly contributing to family violence. So major life stresses are also a major risk factor. We also know that having certain personality types puts some people at greater risk than others.
[00:06:22] So particularly people who might describe themselves as being a worrier or having to have lots of control or order in their life. Having a baby often leads to things not quite going as we might think they can or will. Whether that's the pregnancy itself, whether it's conceiving, whether it's the birth. Things don't always go to plan. So we know that those individuals who are used to having a lot more control or order will likely find this more of a difficult adjustment. And they will also be more prone to conditions like anxiety, depression. Then finally, the other sort of group of risk factors relate to your own personal upbringing in your own life experiences. So if you've someone who has been emotionally abused by growing up sexually or physically abused or didn't have a supportive relationship with your own mother. We know that when you have a baby or expecting a baby, often it's a natural thing because there's no reference point that you might look back at your own experiences growing up and drawing on those experiences and if that was a very negative or traumatic time. Often those feelings resurface and that can make women more vulnerable and susceptible to conditions like anxiety, depression at this time.
[00:07:33] It's a bit of a minefield, isn't it? Sure it is. Luckily, we have some amazing resources which we will tap into towards the end of the interview. And that's just really that's really hitting a chord with me, because the next sort of Segue, you know, I am very, very passionate about addressing mental health in pregnancy and postpartum. I've got three of my own little kids, the oldest, which is four. And, you know, I really was jumping around the place trying to get an interview, then I remembered you, actually, Sophie from Australian Birth Stories triggered me to contact you guys. So, so grateful that you said yes. Because obviously, you know, there is so much going on and I'm sure you're completely inundated at the moment. But can you speak to if we've obviously had a little bit of insight there into how things have changed with the rise of COVID19, but what sort of issues or what the sort of patterns that you're seeing women sort of seek help for particularly? Is there anything that you can sort of tag there?
[00:08:26] Yeah. So when we look at those risk factors, we can see how the event of COVID19 is going to actually increase the rates of anxiety, depression for pregnant women and families right now. But when we look at what impact this is actually having, what are we seeing on the ground? The first thing I'd say that we're observing is certainly heightened rates of anxiety amongst pregnant women, with all this change. You know, when you're going to have a baby and you're going through your pregnancy, you have expectations about what that's going to be like. You often might have planned things like you planned your baby showers. You're planning to have visitors in hospital after your birth. You're planning your christening, you're planning go back to work. You're planning to have other visitors. And it's quite normal that you have those expectations. And suddenly that's all changed. And the fact that that has all suddenly just changed and your expectations of being of what you would have been offered, not having to adapt, it's really leading to a feeling of uncertainty. And that culminates with feelings of greater anxiety, feeling out of control. But also, I would say a sense of grief as well accompanying that about this is not the experience that I thought I was going to have.
[00:09:33] And there is some sense of sadness, I think, and grief being expressed by women, particularly around that. You know, they feel like they're being robbed of the experience that they were intending and hoping to have. And I think also we also need to recognise that the pandemic itself and the concerns about what this is going to mean. What does this mean to my baby if I get COVID19? What are the risks for my developing baby? What are the implications for the birth? Will I be more precious to have a caesarean? Well, breastfeeding be safe if I have contracted COVID19. So there's all these other underlying health concerns, not only for the mother herself, but also the impacts on the developing or new baby. This of course, is also obviously unsettling in itself and likely to be culminating in higher levels of anxiety at the moment.
[00:10:26] Yeah. So actually, just to note there, I have covered a lot of those topics already in the podcast. So what are the risks around pregnancy and COVID19 and breastfeeding, what are the current changes to antenatal care in COVID19? So if listeners would like to go back in and to some interviews with obstetricians, midwives and lactation consultants, you can certainly go in and do that. Give a little bit more information. But it sounds like it's very normal almost at this point to be feeling anxious. How do we know what's a healthy level and what is perhaps a little bit too far?
[00:10:58] Yeah. Look, I would say I wouldn't use the word normal in relation to anxiety. I would say understandable that people are stressed. So stress is – there is a big difference between stress and anxiety, which is often very not well understood. So stress is really a response to a situation or circumstances where we feel that things are beyond our control and that the impact of that stress, we feel, is greater than our ability to cope with it at the time. So our bodies try and develop new resources to try and cope with whatever that thing is and overcome it, I think it's completely normal. You know, we experience stress from time to time. You might go to a job and have a very stressful job and then you come home and the stress passes. A stressful event passes, and it goes away. But anxiety is different to that because anxiety is a condition that is constantly there and it's different to stress. Anxiety is something that a condition that really can take over. It takes over all aspects of yourself. It takes over the way you think, the way you feel when you way behave. And it really can become very overwhelming. And it could become this cycle where you might have, you know, very worrying thoughts about something which, of course, makes leads you to react and feel very worried and anxious. And then that might lead you to certain behaviours to try and manage that.
[00:12:24] And this is a cycle that can really become really exhausting and really start to take over. So we would say, well, in terms of, well, what’s normal and what's healthy, it's normal to have stress. It's healthy to have stress that extends ourselves to overcome those stresses. But anxiety is different and anxiety. Once it gets to the point that it really takes over your ability to function from time to time, then it is becoming a problem because anxiety can be so overwhelming and exhausting. Obviously, when you're pregnant and or have recently had a baby, this puts a parent under immense strain. Not being out of sleep is a common symptom of anxiety, for example, and need that sleep to restore yourself. And if you don't get that sleep, obviously, then it impacts on your quality of life and your ability to function, your ability to look after yourself and your family. If this goes on for a period of time. So just as a general rule, I would say that once it begins to those feelings of feeling overwhelmed, that constant worry and apprehension is really undermining your ability to have a quality of life and function effectively from day to day. Then it's time to really get help. And there's great treatments and strategies to really learn how to take control of anxiety because it is a condition that less to take control of us.
[00:13:42] If we don't learn how to manage it, then someone feels like they're in this sort of, I guess, cycle where anxiety is starting to take hold. What is the sort of easiest kind of touch points to get some help with this, especially in the current climate where everything is done virtually and it's, you know, perhaps we're not having the same level of Face-To-Face contact that we've health practitioners that we usually would have.
[00:14:05] Well, the first thing I'd say is really important is to understand these conditions and how they work. Quite often people have everything, anxiety or the anxiety sort of creeps up on them. And I think all this is normal. And particularly in pregnancy, for example, often people put the symptoms anxiety down to hormones. I just thought it was just hormones. I just thought it was part of the pregnancy. So often the condition is not identified and understood in its own right. And as a result, people are not getting the information they need. The prevention of strategies or the treatments. So number one is to understand these conditions, understand what the signs and symptoms are. Understand how they affect your thinking and how you're feeling, and the COPE website covers this well, gives you an immense amount of understanding and insight into how anxiety in pregnancy might present, what it looks and feels like, and how you can engage in strategies to really prevent these conditions happening. But also then if they are there, how to nip it in the bud. And if it is becoming overwhelming, when and how to get on top of anxiety and what type of health.
[00:15:09] So understanding the condition is, number one, the type of help. But once you get into understanding the type of help that you need. Really depends on the severity of the condition. So at a very low level of anxiety, you can do things that are preventable. Also might yet treat the actual conditions. So very effective things like exercising, deep breathing, muscle relaxation. And again, there's a whole lot of stress strategies on the website to rationalize your fears, strategies for mild to moderate anxiety. And once it gets to sort of moderate to severe, it's really becoming overwhelming. You can't even think straight. You can't rationalize and the feelings, the physical feelings of anxiety are absolutely taking over. Then I would recommend professional intervention, and that can include things including, for example, structured therapies like cognitive behaviour therapies, as well as some indications for medication to really start to get those physical symptoms under control and give that person. And the opportunity to start managing this happens and learning how to take control of those physical symptoms, as well as the psychological all the mental symptoms that really perpetuate anxiety.
[00:16:19] What are your top three tips for managing stress and anxiety in pregnancy in particular, and especially as it relates to our current situation?
[00:16:28] The first thing I'd really recommend for all pregnant women would be to sign up to ready to cope. So ready to cope is out free a newsletter. Women can sign up to at any stage and their partners as well. Any stage from six weeks pregnancy. And this will give you free updates and insights into tips for coping and managing anxiety, depression, but also the various other challenges that can come with having a baby. Things like managing your expectations, preparing for birth, managing advice from other people that we know can impact on our emotional mental health and wellbeing, as well as understanding more about these conditions. So Ready to Cope is a fantastic free resource that I really encourage every expectant parents to be signing up to. The other thing I would really recommend is this can be a very we've talked about a lot of expectations that might not be met in isolation. So the other thing is about connecting with other people who might be in a similar position. And so I would really recommend signing up to the Mama Tribe, Mamatribe.com - And this is moms all around the country where you can sign up a via a Facebook group as well, and linked with other mothers in your area. And you can just share in the conversation and feel like you're not so isolated. And obviously, once the social isolation has lifted, there can be meet ups and things like that will resume. But in the meantime, you have an online network of other mums. So that's very important, just reinforcing that you're not alone. And there are other people around you and you can share tips and strategies and really just support each other. The final thing is obviously just really looking after yourself. What can you control? What preventative strategies can you put in place? So things like regular exercise, eating well, good sleep hygiene, good strategies all on the website and obviously embedded throughout Ready To Cope things that you can probably do to look after yourself. So you're not only looking after your getting the physical health benefits, but also the emotional mental health benefits, too.
[00:18:24] So, yes, so much so much great information there. And it's such a pleasure to get to chat to you around this. And here are all the links to the resources you mentioned:
Ready to Cope: https://www.cope.org.au/readytocope/
Mama Tribe: https://www.mamatribe.com.au/
Help and support line for Family Violence: 1800 RESPECT on 1800 737 732 (24/7 counselling).
And stay tuned for part two in which we will talk a little bit more about the area immediately following Bird and some specific to that timeframe. And thanks so much. Thank you.
[00:18:52] Well, I really had a lump in my throat his entire time chatting to Nicole today. It's just it really is such a sensitive time and such a sensitive topic. And, you know, we have to do all that we can to reduce the stigma and talk to each other and normalize the ups and downs of pregnancy and motherhood. And I'm really looking forward to sharing both parts. Episode one and part one and part two. I definitely open up and share my own vulnerabilities a little bit more, especially in the postpartum period. And even if you're not pregnant at the moment or you haven't got a newborn, we're in really tough times. And so, you know, even if you've got a great support network and you still have your job, you know, there is just a lot of extra kind of stuff going on. And, you know, we want to be able to pull on good quality resources to help us get through as well as our support networks. And if we don't have a great support network around us in terms of our own friends and family creating those links. You know, Nicole mentioned some really great resources and links for, you know, creating new relationships with other mums going through the same thing as you at the same time. So get on board those (above) and come back for part two of this interview with Nicole. If you are enjoying listening to the podcast, please give us some love. You can give us a review on iTunes or shout us out on Social's by screen shotting episode. You're listening to and tagging us @lennyroseactive or using the hashtag #mamamatters. Thanks so much, ladies. We'll see you in the next episode. Bye.
[00:20:35] This episode is brought to you by Lenny Rose Active, Australian owned three times mum and physiotherapist designed luxe active and technical wear foe the Pregnancy to Motherhood Journey.