Ep. 152 | Postpartum Anxiety: A Real Story of Intrusive Thoughts, Shame, and Getting Help

Welcome to Everyday Therapy, where simple and practical concepts of therapy meet your everyday life. Hosted by licensed marriage and family therapist Brett Cushing and doctor Karen Ryan, we're here to help you unlock tools and strategies you need to become the best version of yourself. Whether you're looking for guidance, inspiration, anecdotes, or actionable advice, you're in the right place. Let's dive into everyday therapy.

Hello and welcome back to another episode of Everyday Therapy. I am Brett Cushing, licensed marriage family therapist, and I'm here with my co-host, Doctor Karen Ryan, and we are continuing with just a really inspiring and helpful podcast with mother Rachel and talking about her experience. So we're going to elaborate more on that. And we have a professional with us. Doctor Stephanie Corry. Hi. Right. Cool. Hi. Right. The first time, sort of. And you're going to get us. Right, with this whole idea of postpartum depression. And can you tell us maybe a little bit about yourself? Yeah. And your doctor, what does that mean? And special things at cetera. Yes.

So, yes, I'm a licensed psychologist, and I specialize in perinatal mental health. So perinatal is fancy. It's for, moment of conception. So from pregnancy to a year following delivery, perinatal mental health. It's a very intensive kind of like, in any sort of mood or anxiety disorder around that period. Yes. Right. Yes. Broad, broad spectrum of difficulties, symptoms, etc., that can. Yeah. So you're trained in mental health, right. You're like yes. But then you also have additional training in the perinatal. Yes. What does that mean exactly. Yeah. To specialize in perinatal is to work with birthing parents. And notice my language. Right. So I wanted to be conscious because not everyone who gives birth identifies as female. But yeah, this is for those who go through reproduction. Great to have that, experience in their body of growing a baby, delivering no matter what format, that, that baby's delivered and the emotional difficulties, behavior that can come.

So what, what how long have you been doing this?

I have been doing this for as long as my daughter has been alive. So for going on five years, that's a good indication. I remember that, yeah, yeah. And so postpartum. Right. Like we talk about it's often joyful, but but for many parents it can be overwhelming isolating emotionally heavy. Right. And we wanted to have you on here to really talk about kind of postpartum depression and postpartum anxiety and really try to normalize that and highlight, that you're not alone if you're going through that and that there's support. And so will you share with us a little bit about kind of the emotional reality of the postpartum period. Right. What is that actually like for most birthing and new parents? Yeah, it's, you know, absolutely. Especially for nearing focus on like, this is my first experience there are for the birthing parent. I call it body stuff. Oh my gosh, so much is changing with your body. Identity stuff. Knowing yourself now you're relearning yourself. Like, who am I as a parent? You know what kind of parent to I want to be? Sometimes we're also reliving our own childhoods to make these decisions. So sometimes we're reliving some of our joyful past and some of our not so joyful. Yes. And you're doing this all while learning on the fly. Oh, learning on the fly. How do I change a diaper? How do I put clothes on someone else? So, you know, how do I invite people into my baby's world that want to know and form a relationship with my baby? How do I negotiate that? And how do I now tolerate or maybe think differently, act differently around things that I can no longer handle? Like, for example, I'm thinking of, like, boundaries when I think of this. Like, maybe it wasn't an issue before. I mean, I hear this a lot, but now that I'm a parent, now that baby's here, this is the moment where I have to think about this differently. Sure. And why that? Yeah. Like boundaries of, like, who touches my baby? Yes. For my baby. Yeah. How much do we protect? Bedtime or nap time or who comes over like. All those things. How do I feel about illness? Do you come over, do you not, how what are my beliefs around that?

I remember difficult conversations, and my kids were little. I remember a book when my kids were first born. What to expect when you're expecting. Yeah, a big, thick book. And you thought it contained everything. And I'm listening to realizing you could probably do a book just on all of the things you're talking about. Like there's so much that sort of comes up and you're probably not even aware that you're having to make those decisions that you're yeah, you're thinking about this and that can be really taxing. And I'm sure there's a lot of second guessing that happens. And we're not even aware of all of that because it's you're doing it on the fly, like you said.

Absolutely. I absolutely you're starting to think about these questions during the pregnancy phase. And once you give birth, it's game on. So many things happen right away after birth, like, just even thinking about, like, if you're having a boy, are you going to circumcise, are you not? What are you going to do? You know, so many decisions right away. A lot of, small procedures happen this fast. Yeah, absolutely. And sometimes we can. I think people say this with the best of intentions. Like, oh, it's such a wonderful time and baby bliss and just radiating joy. And are you just loving the cuddle time? And, you know, we hear that. And I even think about it as I'm saying this and thinking about like, welcome baby cars. Right? And people aren't trying to be unkind. Right. But what do you feel like people should know about how that can kind of reinforce shame or, like, not normalize the range of emotions that most feel?

Yes, yes. The story right that we talk about and we hear is, you know, it's this blissful experience, so much joy. And it can be that and we don't talk about the flip side of the story. I even love talking about it specifically, even about birth. When you watch first that come up in television movies, it's the it was really hard, but I'm so great and I'm laughing and giggling and elated to have euphoria. Yes, yes. And you know, that's one story that can happen. And that is not what always happens. We can have actually any range of emotion, any range of emotion that you feel after birth, from nothingness to relief to or just even going to your thoughts first of like, oh, I didn't think baby would look like that. Or is that what does that mean? Having questions right away instead of that instant? For love at first sight feel. You just see the trauma that women can experience giving birth. Yeah. And then maybe feel like I have to turn that off and be all blissful and wonder, hate and really deny and ignore that whole traumatic experience for women?

Absolutely. I think the phrase major medical comes to mind is major medical. Something that happened to you. And, there's this image that comes to me of like, when it comes to animals, we, you know, they give birth and they move on. And. I mean, giraffes give birth standing up and and, they move on and, you know, and their babies are so much more developed at the time of birth. We are different. And that's a unique part of humanity is that we give birth differently. We need a lot more recovery time. There's impact to the body. We have this mindset of hit the ground running and it's just we are not giving space to heal. I would say is a big opportunity. Yeah. Absolutely backed, you know, thinking big picture your question, Karen, is like, it can be hard to have the joy and but your body is, like exhausted. You're recovering, you're questioning, there's, once birth happens, it's not done. That's when it starts. And there's. Yeah, I mean, like, there is a lot of pain there. There's pain and absolutely, there's so many stories that, you know, and decisions for parents right away, just even from pregnancy to, like, how did I give birth? And a lot of the shame, I think around decisions. Right, right. Sense of control. Right, right. Good parent. And I do things right. It's going to go just this way. Yeah. You know, in reality there's so many things that are actually out of our control making it happen. Yeah, absolutely. I really want to validate what you said too. This is this is when it starts. And I know with my first child, when it started, I felt like just as the dad, I felt like I had run a marathon. And then they said, okay, now it starts. And I had nothing in the tank and they're waking us up at the hospital all the time, every time we fell asleep. And, and my poor wife, I mean, so you say it starts. But for some women, is it accurate to say they they're starting almost totally depleted, and now they're starting.

Absolutely. I think of a risk factor for, you know, who gets postpartum, who gets, mood anxiety concerns. One risk factor is something called hyperemesis gravidarum called hCG for short event and one more time hyperemesis gravidarum. Yeah yeah yeah yeah. Sounds like something from Harry Potter. Yeah. It is anything but magical. It is, you know, it's common, right? We know the story of first trimester. We vomit, and then this, there's this promise that that lifts in the second and third trimester somebody with h g doesn't experience that relief. They experience persistent vomiting throughout their entire pregnancy and often on a daily basis. Kate Middleton right. Yeah, I believe so. Yes. And talk about starting depleted. Yeah. You know, maybe some relief of like I'm no longer nauseated to that degree. It's not guaranteed. And, you know, that's a, you know, I think major medical right there, like, you've already had it. Complicated pregnancies, lots of visits, having complications like gestational diabetes, having to completely change your diet or, you know, to compensate or, absolutely. So many things can be part of the just getting there and then it's like, and you're not done that. And the mental health. Yeah. Like perinatal. Yeah. Yeah. Will you share with us doctor. Cool. Hi. It kind of what you would say are helpful things of knowing like what are baby blues. And then what is the partum depression. And then we'll also talk about postpartum anxiety. But we first going to talk about post like baby blues versus postpartum depression for us.

Yes. So baby blues is something I think a lot of birthing parents can relate to. They what happens in the body is a slow climb during pregnancy. It might not feel like a slow climb because it's really not you. It's the nines. Your hormones are doubling, tripling, especially in that first trimester, so it doesn't feel like a slow climb up a really steep mountain. I feel really steep, I love that, yes, exactly. And you're making that climb. And then about around seven days, around 7 to 10 days after you deliver, the body says, oh, wait, I'm not pregnant anymore. I don't need this. And it decides to shed those hormones all at once. And you slide down the mountain, you slide down the mountain. And that look like, what can that look like and feel like. Yeah, yeah.

So this is what I felt and I've heard described by others going along feeling maybe neutral, maybe even happy, joyful. And then all of a sudden things turn. And there's just, you know, yourself and you're like, nothing happened. I, nothing changed. What is that? And I felt a surge. I felt a surge, almost like a wave of like, almost like electricity. My vision narrowed a little bit because that was just the start. The big, like drop of, like, oh, this is really different. Yeah. Something changed. Something shifted, and all of a sudden just tears, sadness. Oh my goodness. Overwhelming. And that that is your body doing what it's supposed to do is trying to shed those hormones and it does releases those clear water. Yeah. So you will urinate more frequently. You will sweat and so on. I call it unexplained sweat and unexplained tears. That's so.

Well, my daughter was my first was born on December 22nd. And it was New Year's Eve. I mean, so you are. It was to the day. Yeah. And I was washing dishes and I started. Sorry. Yeah. And my husband came and he's like, are you okay? And I knew because we have a mother baby program and I work with her. And I was like, I think this is normal, but holy God, holy cow. And then I kind of like stopped for a little bit. And then I remember I was sitting on the Ottoman and it was and I was sobbing because I wasn't watching fireworks is there are some fireworks on New Year's Eve. And I sobbed for like three hours and I was like, I think I'm still okay, but holy cow, again. And just about absolutely. So that was absolutely my experience. Yes, I love that story. I was in a rocking chair holding my baby and my daughter was looking on. It was a beautiful moment, but all sudden it was tears and not the happy kind. And I was like, this does not make sense. Yes. Yeah, yeah.

And so some of that like knowing like those hormonal flashes. So these like like these range of emotions and feeling lots of emotions is to be expected. Right. And part of what we do and and you're not alone if you have baby blues that which is like 1 to 2 weeks. Right. Typically. Yeah. Like how do we know when we're shifting into postpartum depression. Yes. So absolutely, if if you experienced it before this threshold and if you experience it after, it's not quite that two week threshold. And I think about frequency, like how often do I feel down there's that increased. Am I having doubts like am I bonding with my baby? Do I enjoy this like having frequency of those questions, having opportunities to take care of yourself like so that maybe someone comes over an awful day before you can go take a shower. No no no no no, you can go nap. I can't sleep anyway. So even if you have an opportunity to sleep, I can't fall asleep. I can't stay asleep. Feelings of just like this isn't me. I just feeling outside of yourself too, you know? Absolutely can start to feel like maybe we're looking at something else. And is it just one last is too much like, it's just trying to think about nappies. Too much to even think about that. Yeah, yeah. The reason we talked about that in our previous podcast is in a very objective sense. You can see one can't function very well. Just. Yeah, every day kind of things. Just an inability to do that. So I appreciate you highlighting more internally what's going on. For people to be aware of that. Yeah. When we think about postpartum depression and then how it shows up in daily life, can you elaborate just briefly on that? So people could have a visual, so to speak, of that? Yeah, absolutely. And I absolutely want to appreciate together there is adjustment. And that's where it gets tricky I think, is this postpartum because you guess what? You are going to sleep the same way you did before. That is a change, a very valid change. You are literally caring for a baby that's on a two hour schedule.

Yeah. Right. Yeah. Yes, yes. You absolutely will lose some self-care. And so but on a daily basis, day to day, this might look like, reluctance to do self-care and thinking of, you know, I have an opportunity. I could do some baby bottles, but I just can't. Yeah. Hey. Yeah. Maybe you have postpartum care in your neglecting it. You know, like doctors, you know, get postpartum whether you had a vaginal delivery or C-section. You have postpartum care. Yeah, I follow up a follow up appointments, home tasks you need to do, maybe a medication regime. And I can't do that. That's too much. So it looks like not enjoying joyful moments, you know, that's that's that emotional thing of people might even notice, like, you know, some a lot of moms will talk about, like, I feel like more like a zombie. I'm going through the motions. And so, like, inside and out, you might be able to see someone like, they move more slowly. And it doesn't seem like injury related birth injury related. This just seems like they're walking so slow. Yeah. So this this helps with understanding that postpartum depression you don't hear about people don't hear a lot about postpartum anxiety. What's that? How does that play into all of this? Absolutely. I so appreciate this conversation because as we were saying in the very beginning, there is mood and anxiety disorders that come with this. So there's sadness, but there also can be anxiety, which is more of sort of that slow down feel. It's more of that up feel like game on.

And I will say, this is my brand of experience that I work with quite a bit with moms of like, oh my gosh, is my baby going to be okay? It looks like and I one thing I want to normalize together is that we as parents experience that anxiety. That body is saying game on, I am responsible now, right? I'm in the driver's seat. It starts. So absolutely that wraps you up in a good way. Right. And caregiving. Yeah. Yeah, yeah. And you're going to see some of the same things you see in depression. Right. Like it's hard to sleep when the baby's sleeping. But the different it might be slightly different. I'm kept up because I'm so worried. What if I shut my eyes and something bad happens? So I think Rachel articulated so well that anxiety experience of like, what if something happens to the baby? What if I forget this? This is it could be generalized anxiety. You know I'm right. You name it, I can find a way to worry about it. Sickness stuff on this, that and absolutely can be baby focused. Absolutely. The health of the baby. Is the baby warm enough? Is the baby fed? You know, like is can I really rest? And the answer often when we have anxiety where were we looking at a problem? If you answer yourself no, a lot of the times like no. So insomnia, lack of sleep, even if you have opportunities to do that, it can also show up in reluctance to delegate. So yeah you have you examples of reluctance to delegate or you know, I know my baby best and I just don't want to hand my baby to someone else. They won't know the things. And maybe it's just easier if I do it or it makes me so scared on side and it's so hard to tolerate just even the idea. Yeah. And even unexplainable like rationale is like the end has to be. I have to do that. Right. Sometimes you recognize it doesn't even make sense, right? Yeah. You just have to. Yeah. Like feels like it. Yeah. Absolutely. Yeah. Yeah. And we know that it can also be anxiety can be intrusive. That's right. Where it could be I fear for my baby's safety. And then it can turn into what if I do something to harm my baby and then oh my goodness, I want to harm my baby because I had that thought. Right. I think that's an important thing. You can't speak enough to right of like the intrusive thoughts. Yeah. With. Yeah. You know perinatal or postpartum anxiety I'm so have you brought up intrusive thoughts? There can be postpartum anxiety. There can be a postpartum OCD, obsessive compulsive disorder. You can have intrusive thoughts. And not to have OCD. And, study I really like that came out I think two years ago, said 96% of parents, whether you're the birthing parent or the non birthing parent, experience intrusive thoughts. So it's part of that game on. Your brain is going wild saying in what ways can harm come to my baby and you're getting all these. It can be vicious to try and prepare you like yes yes your your mind all of a sudden you scan every room for hazards. Yeah, this is adjustment. This is health. In some ways this is really great. We want this. You are starting to think about the environment. Is it suitable. And we can get weird and wild. One thoughts as well. Likely and unlikely. Intrusive thoughts. Absolutely. Yeah. So yeah I kind of get the sense that for a lot of people going through this, it's the cognitive way of absorbing everything is the pressure is always all on me all of the time. Yeah. And wow, that is exhausting. And people don't understand how much stress the, people are going through with this. Whether it's the anxiety or the depression in our closing minutes. I just want to comment that we have, we have the opportunity to also recognize this affects the whole family. Yes. I mentioned briefly in the podcast with Rachel, it does affect men to, as they're are walking alongside. And it's interesting because men's testosterone level actually drops and it can drop considerably. And that's considered to be a good thing because that helps them to get into more of a nurture mode. However, for men, a lot of times with that drop in testosterone, we are conditioned to externalize where it seems like women might internalize a lot that's happening. Some of the research I read indicates that men tend to externalize. And so we're the women. It can be this pressure like, what's wrong? You need to be happy for men. It's why are you such a jerk? Why are you maybe depressed down to. But you're avoiding going home? You're not getting up at night to help with the baby and things, and they might be irritable. And so I just want to highlight that it can really affect the entire family. And it doesn't mean you're less of a man. If you're having this either. I mean, one thing we've highlighted is that these women are pretty tough, what they go through. And so, guys, don't don't be, too insecure to admit that. Yeah, that could affect you, too, as well as kids. Everybody in the family. You're so right. And I love highlighting fathers, men, partners. 1 in 10. Yeah. For men? Yeah. 110. Yep. And, gosh, if I were a betting person, I would say that's an underestimate. Yeah, I would, I heard it goes up, like, 25%. And then about four months or so in 1 in 10. But then the increase for men goes up by like 25%. Yeah. Yeah. So really watching within that full year. Right. Yeah. Right. So your partner right. Whether that's yeah, you've had the baby or you've adopted a baby or you're, you know, have welcomed a baby into your family. Right. Taking care of everybody. Yeah. And I love your sharing and I need that perspective a you know what I'm hearing too. It's like for partners sometimes that game on is provider ship and how depending on how you define provider ship. Right. And so sometimes for, for men it might look like yeah that reluctance to come home taking extra shifts working extra hours, you know, and how that expression of anxiety or whatever it is, you know, internally for that person of like, how do I provide and how do I do that all the way right? And and absolutely, these dynamics can play off of each other. Like if I have reluctance to delegate. Yeah. What does that tell other people? You know what. What signal does that send including men. It's you know, we call it. Want me to help? Yeah. Or I'm not good at that. Yeah. I see this dynamic often of of women taking babies out of men's hands. Like you don't care for that or. Oh, that's my job. Or what have you. Or no one wants to hold a fussy baby. So. And depriving men of opportunities to develop their skills. So I will say one thing. I preach often you'll hear he's here. Often is like, I like to view parenting as a skill. Yeah, and not an innate talent. Right. That has to be developed. Yeah. Figure it out. Yes. Many layers. Yeah a learning curve. Yeah. Even for women I think this is important to embody of like there's a learning curve to it. Absolutely. Well we have a learning curve for women as well with our postpartum or I should say postpartum. But with our the what is it prenatal that we do here at Sergeant or is it postpartum? Why don't you describe a little bit what we do? Because people are listening. Yeah. What do I do? And we've got a terrific treatment program here. So. Yeah. You in closing? Yeah. They can do. Absolutely. So one myth buster I would say is that postpartum is post. So like it can occur in pregnancy. And absolutely if you have a history of mood anxiety, I think it's great to not only partner with your midwife your OB but also connect with a perinatal psychiatry. They're specialized not only in your pregnancy. So what? Medications work with pregnancy and breastfeeding postpartum. They they really know their stuff. But at the end, they know their mental health. And. Yeah, yeah, they're going to really help you weigh the pros and cons. They're really up to date and square on the data about what we know about medications, how that impacts, development, delivery. So start right away. It does not you do not have to wait till you give birth to start service. Yes. Yeah. And then you have somebody established, you have care, you know, somebody you trust. And so as you go through that feeding adjustment, what did you call a medical. Major medical. Yes. Transition for the family. You've got the support in place? Yes, ma'am. Absolutely. Yeah.

And so our program here at Sage Behavioral Health. Yeah, it's Rachel to talk about that. Can you quickly tell people what they would experience here? Yeah, absolutely. We have levels of care. So multiple types of service and intensity of service for your needs. So in the pregnancy phase we have medication management. You could work with somebody who is trained. We have lots of people like myself who specialize in perinatal mental health. Yes. Therapist. So one on one therapy we have my class. I do a little to our class once a month called preparing for baby. It's mental health informed. So you're that's where you're going to go to learn your mental health. I won't train about birthing. That's your other types of classes. But I'm going to focus on some of the common pain points now to support your mental health. Yes. Then we have other levels of care as well if needed. So we have a support group. They meet once weekly. Moms need other moms. Sometimes parents need other parents to feel healing and to feel that support. So we have that. We have a support group. We have low intensity outpatient programing. So you get to stay at home. It's by video. But you also meet in group, but it's stepped up a notch. You're learning some skills more, focus on skill work. You are paired with an individual therapist as well, and you meet in a group setting, and then we have high intensity as well. Where you meet more often. It's 3 to 4 times a week. Three hours. Lots of moms are overwhelmed by that. I will say we embrace mom here. You do not need to be fully formed, poised, feel successful with your baby. I encourage fussy babies to be with us. You are not going to have somebody witness you be a bad mom. I have not met a bad mom once. Say that one more time. Thank you. I have never met a bad mom. Yeah, yeah.

And so you can come roll out of that. And because if that's the support you need, you would be paired with an individual that will work with you privately as well as your group that lasts eight weeks. And you also work, you consult with their psychiatrist if needed. We also have people that join us for skills that are wonderful. We have dietitians, occupational therapy that can talk to you about pelvic floor recovery. Sensory overload. We have and then we have, circle security training that focus on attachment and bonding. There is a lot there is there's a lot we we provide and then truly come as you are, right as you are as a new parent. Getting support in you're all in it together. Yeah. Right there. Yeah. And the converse we try to involve family. We also have a non birthing support group. Yes. Yes we try to do a lot. You've been a wealth of information for us today and there's a wealth of resources for people here. We encourage you if you'd like to learn more about this or get involved with, this form of treatment, you can go to, Sagebh that's behavioral health. Sagebh.com. And you can look more into this program. Doctor Cole. Hi. Thank you so much. It's very relevant if this has been helpful for you or you think of somebody this might be helpful for, please like share and subscribe. And we look forward to connecting with you next time. Thanks so much everyone.

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