Episode 9 - Postpartum Health In 2020
Part 2 of this interview series with Dr Nicole Highett touches on postpartum mental health, what trends are emerging as a result of many crises' we are facing in 2020 and how to seek support as well as build out your support network in this incredibly challenging period.
[00:00:00] Welcome to the mama. Matters podcast, whether you're expecting you've recently given birth or you're 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. With 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] We know from our own research that up to 70 percent of women with postnatal depression or anxiety didn't seek help because they didn't know what to look for. They didn't know what to ask about, and they thought it was just a normal part of whatever their experiencing was normal after having a baby.
[00:01:01] Welcome back to Mama Matters. Ladies, if you haven't already I highly recommend you go back and listen to the prior episode with Nicole on the perinatal period. A really insightful episode.
[00:01:13] This is part two, of a two part series where we talk about mental health in pregnancy and motherhood or what's called the perinatal period. So highly, highly recommend listening to that episode either before jumping on this one or just after you listen to this one will also suffice. But some really great information and tools for wherever you are along that perinatal journey. And so it is with such great pleasure that I introduce today's guest again. Nicole is back on today to help us through the second part of this sort of perinatal journey, which is that of birth into early motherhood. So Nicole has a doctorate in clinical psychology, specializing in the community approaches to treating postnatal depression. She joined Beyond Blue in 2001 just after the initiative began, where for 12 years she ran their programs, campaigns and activities. And one of her most passionate endeavours is the success of the National Perinatal Depression Initiative, which combines a broad range of skills and research experience to assist to improve the quality of life of those women and their families who experience mental health disorders during pregnancy or following the birth of a baby. In response to this issue and the need for an increased focus in perinatal mental health, she launched COPE in 2013. COPE is the Centre of Perinatal Excellence and provides a focus to reduce the impacts of emotional and mental health problems experienced by mothers, fathers, infants and their families. And their big goal is to increase awareness, reduce stigma and help to support health professionals and equip them with the knowledge and skills to provide timely and effective care for women and their families. So as I said in Episode 1, I am absolutely in awe of Nicole and the great work that she's doing is such great pleasure to introduce her today - Dr. Nicole Highett.
[00:03:06] Thanks so much for coming back on the show. Nicole, today we're segueing more into the perinatal period from birth and beyond. So we know a lot of what we do in terms of setting up our support networks, staying physically active in pregnancy and postpartum, can help to boost our mental health. But even so, the incidence of postpartum depression is relatively high, reported between 15 and 20 percent and women and just shy of 4 percent, in fact, in fathers. Which is I certainly didn't realize that either. More than half the women who have a depression diagnosis in pregnancy will be those that go on to experience postpartum depression and things like that. So, yeah, this whole kind of topic and our prior conversation as well, really kind of put a lump in my throat. Quite shocking to realize that one in five women suffer from postpartum depression and I’ll reluctantly admit that I'm probably in that sort of mild category after having both my second and third sons and probably really only realizing it retrospectively.
[00:04:11] And you know, I've got ample access to every resource. We don't have any sort of huge risk factors, although I'm listening to your conversation earlier. I do think that perhaps mental health in my earlier years and having suffered from an eating disorder, I now realize that might have been a risk factor for sort of feeling perhaps unsteady and having some mild post-natal depression, even knowing this. You know, it's still can come up. And it's obviously quite a tricky thing. So can you speak to the figures that we've spoken about? And are we seeing any change in terms of incidence, you know, given the current situation of COVID19
[00:04:47] So in Australia, our figures around, we saw that around one in seven women will experience postnatal depression. So one in 10 during pregnancy and one in seven in the postnatal period. So when you think about it, you know, there's going to be two or three people in a mothers group with depression alone in the postpartum period. It's also important to recognize that anxiety is even more common and it's very common for anxiety and depression to exist at the same time. So in fact, up to 40 percent of cases women are experiencing anxiety, which those feelings are feeling overwhelmed and things are out of control. And that constant worry and apprehension as well as experiencing symptoms of depression, which is feeling very sad or down or lack of motivation, finding it so hard just to get through the day, not really any pleasure or way out of anything. So experiencing these two types of conditions at the same time, which is very common, you can imagine is a living nightmare for someone. So, you know, when we look at the statistics, this is going to be a large number of people. We also know with men that, yes, figures around the prevalence of depression in men in the post-natal period, a very variable. That's the first thing I'll say on the studies and the way that they are selected, but it's common enough that we need to be aware of it, we need to certainly be looking at the depression in men.
[00:06:06] We also know that men are 50 percent more likely to develop postpartum depression if their partner is depressed. So this is why it's so important that we screen every pregnant woman and new mother for mental health conditions. And also now the government is also making that screening, particularly in the place period available for fathers as well going forward, because we know these conditions are common. And if they're not identified and treated, they can go on and on. It's really interesting. You're saying, you know, with your own experience that perhaps you did, looking back, have some experience of some marked moderate, potentially, depression. And this is what's happening too often because people are in this context, which is all new of having children, the busyness, it's just a natural thing to try and attribute what you're going through to what's going on around you and the things that you can see. So you're likely to be putting it down to just sleep deprivation. It's just adjusting to another child. It's just the fact that I'm having problems breastfeeding. It's just the fact that I had a traumatic birth or I'm just recovering from birth. So it's very easy to put it down to situational factors or things that we can see. But often there might not be those factors. And so the depression can sort of creep up on you and take over. And so this is why screening is so important. We know from our own research that up to 74 percent of women with postpartum depression or anxiety didn't seek help because they didn't know what to look for.
[00:07:29] They didn't know what to ask about. And they thought it was just a normal part of whatever they're experiencing was part and parcel of having a baby. So it's very important. And on top of that, we have things like stigma and shame with high expectations than having a baby is going to be such a wonderful experience. It's going to be like the ads in the beautiful magazine. That's what it's going to be like. And when that doesn't happen, people often deny the symptoms they hope will pass on its so that any intervention will treat it because they just so badly want that experience and they want to convince themselves that that will come. But as a result, symptoms are denied and people are not getting help. And of course, depression can get more and more severe to get to the point that it begins to again impact on your ability to really function from day to day. Living with depression is very, very difficult at the best of times, let alone when you trying to deal with the demands of a newborn baby that is totally dependent on you. You know, it just that is likely to really exacerbate the symptoms and potentially the severity as well, because you've got those additional demands as well as the illness itself.
[00:08:33] So, you know, it obviously sounds like so much of it is sort of brushed under the carpet. So what can women and their partners look at?
[00:08:42] Well, the best thing to do is be aware of anxiety and depression and be aware of how common they are. Be aware of the signs and symptoms. So what does it look like? What does it feel like? How would I identify this to myself or someone else? Be aware of the risk factors like having a previous history and familiarize yourself with the signs and symptoms so you can get on to it early. That's number one. That information, because the faster you get onto it and the faster you treat it, the faster you will recover and prevent yourself getting into that slump which is so much harder to get out of. So just like, you know, treating some other conditions early, getting onto an infection early with antibiotics before it gets to the point that your legs are going to drop off. It's the same sort of analogy where treating mild to moderate anxiety or depression is far easier and the range of options is far greater than if you've waited until the condition has become very severe. And as mentioned, with all the demands that come with a baby that can that can escalate the rate of becoming a more severe depression. And this is why universal screening is so important. The mental health conditions, just like we screened routinely for blood tests and ultrasounds and pregnancy monitoring, monitoring blood pressure in the same way. We also need to be looking at screening for mental health conditions. So, you know, being aware if you've noticed changes in yourself or your partner checking in with each other about how you going. And again, you know, signing up to the ready to cope guide. Which is drip feeding you the information about being aware of these conditions and what to look for at different stages of pregnancy and after having a baby are all very important ways to give you that information and insight, to help give you the tools to recognize these conditions as early as possible and also seek help early yet again.
[00:10:26] That's coming back to that knowledge really is the key, and that sort of understanding. It's interesting. I mentioned earlier that I had a history of mental illness as a teenager. And so when I first got pregnant with my first son, I was like, I'm going to go and see the dietician because I want to make sure that, you know, I can stay on track with nutritional side of things being, you know, worried that it is a potential time for relapse. And, you know, that was very helpful. And she was very amazing. I didn't sort of think to perhaps and have more psychological help or screening, which is, you know, it's interesting, isn't it, because that's the basis of everything. So hindsight is a beautiful thing. And fortunate to not have any sort of issues in pregnancy. Interesting. Anyway, I digress. So what are your top tips for managing postpartum depression if someone sort of feels like they are tapping into that sort of feeling?
[00:11:16] Look, again, my top tips were revolve around really being informed and educated at a preventative level. So the COPE website, armed with information about understanding these conditions, understanding how common they are, what they look like. It will give you so much more power. And that being on the front foot, should these conditions arise, knowing whether you're at risk and knowing the symptoms will give you that information to then seek help early. And as mentioned, the faster you seek help, the faster you recover. And it's certainly a much more likely to be at a nip it in the bud when it might be a much more mild condition rather than waiting till it becomes more severe. And then it is very much more difficult to get out of it. People describe depression, as I say, in a in a deep black hole and you're trying to cope with the demands of a newborn baby. And getting out of that hole is very difficult. So if they armed with information and and getting on to it early is the key again. We know that social isolation, high expectations are also likely to increase your risk of depression in the period becoming a new mum. Being deprived, and often being socially isolated are major risk factors. So I myself, I mean, looking back and when I have my children or my family is in Western Australia or my house with families all in Ireland, didn't have any family here. And I think that for me was one of the most challenging times of having children was the loneliness that came with motherhood. So this is where I would really encourage people to join a tribe or an organization like that, which you can connect you with other mothers. And I think that's very important right now in the pandemic where there's not necessarily mothers groups, etcetera happening, but there is online communities.
[00:13:00] And thank goodness we're living in a time where there is online and we do have access to those important resources. So going to Mamatribe.com, I would really recommend as a way to connect with others and just reduce that sense of isolation and make sure, you know, realize that we're all in this together and we can be there. We all have good days and bad days. And when you having a good day, you can then support someone who might be struggling on a particular day and just having those open and honest conversations with sometimes the online environment can really allow. And the final piece of advice I'd give there is if you are struggling, get help early. It's no different than if you're not getting help for diabetes or hypertension or anything else. Everyone's experience of motherhood is different. Even every child experience of motherhood with a child or birth experience can be very different. Children are different. Experience is different. I really encourage people not to compare themselves with others. It's not a competition. Focus on yourself and your family and your own needs and put yourself this. Motherhood is a very selfless thing. We're always putting everyone else's needs first. But you know, as I say, you've got to fix your own oxygen mask before you can help others. So it's very important that we look after ourselves physically, mentally, giving ourselves time out, giving ourselves breaks, connecting with others. And by doing that, we'll be giving ourselves the best chance to be the best that we can be for ourselves, but also for our families.
[00:14:25] So important. And so, yeah, I 100 percent agree with all of that. It's taken me probably the third child to realize that I don't need to ask for help more often and that there shouldn’t be – well getting to a point where there isn't as much guilt around taking time out and, you know, making sure that I am in, good, good physical and mental shape to be the best ti can be for the kids, you know, as it has a big flow on effect to them, if you're not, I guess, you know, feeling as best you can. So, you know, taking that time out will benefit everybody. Yeah. And so you've obviously given some great resources already, which I know I'll make sure everything's in the show notes. But given that we're restricted in that sort of face to face setting at the moment, is there any other easy to digest, easy to access information or resources that you can suggest?
[00:15:13] I also really recommend people just for just this small bite sized intermittent information just to sign up to the COPE Facebook page and Instagram pages, for example. There we're absolutely keeping everything up to date, making sure people have got access to the latest recommended guidelines. The evidence and a lot of the time that evidence around the impacts of COVID19 on unborn children and new babies is very reassuring and that we do look at that evidence because it is actually a very positive story. And it's also important that we contextualize that for the Australian context. We're not going through what America is, what Britain is going through. So it's important that we don't look at it. We manage the amount of news that we're looking and look at our own context, which is very, very different, because that could create a lot more anxiety than it needs to. So by following the COPE social media pages, COPE on Facebook and on Instagram. That's a great way to keep up to date. We will keep publishing the latest information, which is very reassuring and contextualize for the Australian context. But it's also is getting insights and reminding people on a daily basis that they're not alone. And a lot of people are going through these different experiences where they can get help and direct people to different help on different topics. In short bursts of information.
[00:16:32] It's amazing. Yes, it is fabulous. And I can’t find the right words for the amazing, amazing stuff that you're doing. And yeah, especially just given how inundated you would be at the moment. I'm just so grateful to grab a large snippet of your time. So thank you so much.
[00:16:49] Such important work that Nicole is doing and, you know, such an important area to provide resources in, but also can just get out in the open. I think as I mentioned in the interview, it probably wasn't until after the fact that I've realized that I certainly did struggle a little bit in terms of my own mental health following the birth of my second and third children. And, you know, at the time, you just sort of like knuckle down and carry on. I think with knowledge and understanding about what's normal and what's not, you know, when is a great time to seek and, you know, where to seek help. Hopefully we can all kind of carry through with a little bit more ease.
Here are the details for COPE: https://www.cope.org.au/
Mama Tribe: https://www.mamatribe.com.au/
You can sign up for the ready to cope newsletter at: https://www.cope.org.au/readytocope/
You can find Dr Nicole Highett on @cope.org.au
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[00:18:23] So we do hope that you're loving it and can't wait to continue to share some amazing experts in the field of pregnancy and motherhood. This episode is brought to you by Lenny Rose Active, Australian owned three times mum and physiotherapist designed, luxe active and technical wear for the pregnancy to motherhood journey.