The Fourth Trimester: Redefining the Reality of Post-Partum Depression
Jun 15, 2022 | 13:53 | Health

Post-partum depression has been redefined because we have learned it is so much more for a new mom and her partner. And it can affect anybody.  Anybody. It looks like you. It looks like your sister. It looks like your friends. Your coworker. But most important – you are not alone. Listen and learn more about our Maternal Mental Health Support Group.

Interviewer:

These are the voices of Saratoga Hospital. Shared moments and insights to help us all understand a little bit more about the constantly changing world of health and care close to home. The concept of postpartum depression has been redefined. We have come to learn it is so much more for a new mom and her partner.

Kelly Mosher:

It looks like you. You look in the mirror, it looks like your sister. It looks like your friends. It looks like your coworkers. Absolutely anybody can be affected.

Interviewer:

Two of our nurses have a conversation and share experiences about how important it is to reach out for help and to understand you're not alone.

Kelly Mosher:

I can think of a couple that I took care. I was in the patient's room. The support person kinda very quietly, "I have a question." So I turned around and was like, "Yeah, what's going on? How can I help you?" And I could just see their face had changed. I was like, "What- what's going on?" And just the tears started and, "I don't know what's happening. I don't know why I feel this way. I- I've had kids before. I- I've never... Something's wrong. It... Why do I feel like this?" And it was just such a great opportunity. It was right after we finished our training, which touched a lot upon support people, and we had not yet started offering services. The program was still really in its infancy and planning stages, but we had been trained. And I sat down and I said, "Look, this is normal. This happens. This isn't talked about a lot, but it's something that happens." And I was able to at least give resources, really great resources, for families, patients, support people, same sex couples, single parents.

Courtney Keller:

And funnily enough, I took care of them the day after you provided that tender loving care, and they were so grateful. And she said that she already felt better just because she had the resources.

Kelly Mosher:

I am Kelly Mosher. I'm a registered nurse at Saratoga Hospital. I work on our women's health unit. You might hear it called lots of different things, C1, Labor and Delivery, Maternity. It's where people come to have their babies.

Courtney Keller:

My name is Courtney Keller and I am a nurse on C1, and I work as a labor and delivery, postpartum, and nursery or newborn care nurse. What postpartum depression used to be called we now call it perinatal mood disorder, and that encompasses the journey from conception through pregnancy through the first year of life. And that includes major and minor depression, anxiety, OCD, PTSD and even postpartum psychosis. What used to be called just postpartum depression now encompasses a lot more in the perinatal mood disorder category, from conception through the first year postpartum.

Kelly Mosher:

Anybody can be affected. Everybody.

Courtney Keller:

Yeah.

Kelly Mosher:

Anybody. It- it looks like you. You look in the mirror, it looks like your sister. It looks like your friends. It looks like your coworkers. It's absolutely anybody can be affected.

Kelly Mosher:

We got an email about a donation for the Fourth Trimester program which has evolved into the maternal mental health support group. I replied immediately that I wanted to be involved in that.

Courtney Keller:

We received a grant from River Farm America Foundation. Part of the donation was to certify staff members so that we can better support our families and our community. The training was one of the most influential certifications I have received and been a part of my entire nursing career.

Courtney Keller:

I was in first grade and a woman came in and described how she takes care of babies all day, and I was absolutely crazy about babies at that time. And I came home, in first grade, and said, "I'm going to be a baby nurse." And so when I applied to nursing school, it was to become a baby nurse. I always say I'm living my dream. (laughs)

Kelly Mosher:

(laughs) It's funny though that Courtney says that she wanted to be a baby nurse, because our unit is LDRP which stands for labor, delivery, recovery and postpartum. It's funny because I have that memory of, "I want to deliver babies." And Courtney said, "I want to be a baby nurse." And everybody has their passion within our unit. Courtney and I do have a lot of common interests.

Courtney Keller:

You become a nurse because you love people and you want to help them. You want them to find wellness, and people connecting. And this program allows us to further connect with our patients in our community and go back to the reason of why we become nurses, of wanting to help them and make them feel better, and continue that deeper connection.

Kelly Mosher:

I think connect is such an important word for so many reasons, because like you said, we're nurses. We want to connect with our patients.

Courtney Keller:

I have three children, and my pregnancy was great and I thought I had everything all set. I had been a maternity nurse for a couple of years. I was a overnight nanny. And I remember sitting in a rocking chair, rocking my daughter and crying and thinking, "Oh, my gosh. This is how I'm supposed to feel." I had tremendous anxiety. I just felt so overwhelmed with everything to the point where I had to leave grocery carts and go back to my car. And some pieces finally started to click. I'm like, "Well, Courtney, you had a hard time with your first postpartum experience. Although it's different, this is not normal." And I was also very open with my family rather than, it sounds cliché, but suffering in silence. I told my family members, "I have a hard time postpartum and I might need you." And so my hope is to provide the resources and the support that so many women deserve. So many people are affected by perinatal mood disorders, but many go without treatment.

Kelly Mosher:

It's not just postpartum depression. There's so much more to it than that. My own personal experience postpartum was not dissimilar from Courtney's. I was happy. Everything was going well, but I remember them saying, "Oh, write down your feedings and the wet and dirty diapers. When you go to the pediatrician, they're going to want to see that." So I'm like, "Oh, I better write this down." And I really took that to heart and I focused so much on the things that I probably shouldn't have been focusing on. I was so focused on, "Well, I have to write this down. I have to schedule this. I have to plan this nap." And I was so focused on this routine and this structure, and in retrospect, I'm like, wow, I was really focusing on the wrong things. I- I wish I lived more in the moment. And I wish I had a group of moms, a group of caregivers, just to sit down with and have them say, "Me too." Just to find people that I shared common ground with.

Courtney Keller:

This perinatal mental health support group is not just for moms that are struggling. It is a place to come and find that common ground and just have a conversation of, "Gosh, I feel so overwhelmed." And hearing that a couple other mothers say, "Oh, me too," is just that connection and takes away a lot of the feelings of isolation that sometimes can happen postpartum. So this support group is really meant for anybody who wants to join.

Kelly Mosher:

I think it's becoming easier for women to say something's not right. I think there has been a shift in the culture where it's become more acceptable for people to say to their nurses at the hospital, to their providers at their appointments, whoever it might be, "Hey, I think I need a little bit of help with this."

Courtney Keller:

I feel like it's a little bit of a wall that some women do create.

Kelly Mosher:

Yes.

Courtney Keller:

In, "I am an organized person. I am put together. I am professional, and therefore I am going to figure it out." And that is who they are known for by whoever they surround, their circle. And so that set of strong women, um, so I feel like they have a harder time coming forth saying, "Something's going on here." Sometimes we just think that it's very maternal oriented, but it does affect the partner as well.

Kelly Mosher:

I think the birth mother's support person, partner, plays such an important role in their experience, and that's something I often tell patients when I'm getting them ready for discharge from the hospital. I turn to the support person and I say, "If something doesn't seem right, you might be the first one to notice it because this new mother is so wrapped up in her day to day, her learning this new role, learning her new self, her baby, she might not be able to take that step back and notice this isn't right." And I always say that the support person, I always tell them, "If something isn't right, if the behavior isn't quite herself, say something." I don't know if the mother can always notice it when she's in the moment. I think the support person plays a huge, huge role. You know, we always tell them there's baby blues. That's a real thing. You might feel emotional and weepy for a week or two after the baby is born. That's normal. That's okay. That happens.

Courtney Keller:

Mm-hmm.

Kelly Mosher:

But if that's continuing on and you're a month, two months in now and you're still feeling that way, it's oftentimes tends to be someone else in their circle, in their family, that notices that, hey, something doesn't seem right here.

Courtney Keller:

When I teach childbirth education, I do take that time to talk about the emotional change that occurs with the partner due to increased responsibilities, with taking care of mom, baby, financial, managing the job. And so, one in 10 partners experience postpartum mood disorder.

Kelly Mosher:

I can even, to a point that you said, where this mom has been growing this life for the 40 give or take weeks, and has kind of evolved into this role, and yes they are suddenly thrust into, okay, now you're a mom. But for the support person, they know this change is coming. They're anticipating this change. But then it's more of a sudden switch, I feel like, for them, to all of the sudden be, "Okay, it's the two of us." Now it's, "The three of us all the sudden," or four, or whatever it might be. So I feel like it's just such a drastic change that happens so fast for the support person that it can really catch them by surprise.

Courtney Keller:

I have talked to a couple of, in this instance, fathers that had a hard time bonding with their baby. And again, they thought that it was just them. But by voicing their experience, which took a lot of courage, found that other, in this case fathers, were experiencing the same thing. Being able to voice how you're feeling, you can find that connection and decreasing the sensation of isolation.

Kelly Mosher:

I think the value of a hospital-based program, something through Saratoga Hospital, is so important for the patients that we're seeing, because they'll have that home base. They've have that continuity of, "Okay, I was going to my doctor here. I had my baby here. I am continuing receiving support with these other women that had this shared experience here." And it'll just be this very safe space for them.

Courtney Keller:

Our patients are screened in the perinatal period. They are also screened postpartum while they're in the hospital, prior to discharge.

Kelly Mosher:

And this is how we are going to help them, this support group.

Courtney Keller:

Our providers have a lot more awareness now and are eager to hear our patients and offer the support that they really deserve, just with this greater awareness of perinatal mood disorders and the Fourth Trimester.

Kelly Mosher:

So it feels really good to be identifying patients in the hospital now, through screening, and being able to say, "Wow, look. I'm concerned about what you've told me here, and I would like to offer you some help here while you're in the hospital." They can say, "Please, yes, that would be great." They can say, "No, thank you." Some of them already have a plan. But for those people that didn't have a plan, and all the sudden are in this position, it's really a relief to be able to offer that.

Courtney Keller:

The postpartum support group is open to women who have delivered outside of Saratoga Hospital as well. And I feel like there is great value in being able to experience any kind of support whenever there is a need or a desire, but also being able to meet in your own community.

Kelly Mosher:

What I would tell somebody right now who is an expectant parent is just that we see you, we have been you, we know you, and we know that it's not always what the kind of mainstream media portrays new motherhood to be. It's not always easy, and there are ways to find that support that you need. We're going to be launching this postpartum maternal mental health support group for moms in our community. That theme, that is so important for the new parents with other parents, for the new parent with their child, just to find that connection and support and realize that they're not alone in their experience.

Interviewer:

To learn more about the Fourth Trimester and the maternal mental health support group, call 518-580-2871 or visit saratogahospital.org/fourthtrimester. All episodes of this podcast, Voices of Saratoga Hospital, can be found on our website, saratogahospital.org/voices, and on your favorite podcast channel.