Kinder Mind
Kinder Mind
Exploring Motherhood Through Maternal Mental Health
Struggling with the complexities of motherhood? Join us for an eye-opening conversation with Robyn Klein, LCSW, who sheds light on maternal mental health and its profound effects on both mothers and their babies. Discover the critical signs to watch out for, including increased anxiety, depression, and the fear of being an inadequate parent. Robyn guides us through the fine line between typical early motherhood challenges and more severe mental health issues. Learn how these difficulties can strain familial relationships and why open communication and effective screening tools are vital for supporting new mothers.
Facing barriers to mental health care? We delve into the significant hurdles such as stigma, socioeconomic challenges, and the lack of support systems that new mothers often encounter. Robyn shares practical self-care strategies and emphasizes the importance of accepting help. Explore community resources like home visiting programs and organizations like WIC that can make a real difference. Additionally, get insightful tips on booking consultations through KinderMind and Headway, ensuring access to professional help in several states. This episode is an essential guide filled with supportive advice for navigating the journey of motherhood while prioritizing mental health.
If you or someone you know may be struggling with Postpartum Depression, the Edinburgh Postnatal Depression Scale (EPDS) may be a helpful tool for identifying and sharing symptoms with medical and mental health professionals.
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Thanks so much for tuning in to another episode of the KinderMind podcast. Today we're exploring motherhood through maternal mental health, and I have the pleasure of being joined by Robin Klein, lcsw, to talk about this subject. Thanks so much for joining us today, robin. Thank you for having me. What is maternal mental health and why is it a crucial aspect of overall maternal well-being?
Robyn Klein, LCSW:Maternal mental health focuses on the quality of life for moms specifically, and in this conversation we're talking about the perinatal and postpartum periods that bookend a pregnancy. The impact of poor mental health can have detrimental effects to a growing fetus, leading to more difficult delivery, suicidal ideation, poor growth for the fetus and an overall sense of helplessness during pregnancy and then, once that baby's born, those symptoms sometimes get better or sometimes get worse, and moms who didn't have issues while they were pregnant can also face issues, and we rely on the medical team, both at the hospital, at the postpartum visits and at the pediatrician visits, to be checking in with mom as much as baby, because it is through mom's health that babies can thrive and be successful, and what we're seeing is that many women are falling through the cracks and their families are suffering because of it that makes a lot of sense that anything that the mom is going through while she's pregnant is going to have an impact on the baby.
Dr. Elizabeth Barlow:So what are some common signs and symptoms of maternal mental health issues that new mothers should be aware of?
Robyn Klein, LCSW:Definitely an increase in anxiety and depression. When you're pregnant. It's super scary, right, especially if it's the first time that you're doing it. You don't know what to expect and for some reason, women have been doing this for hundreds of thousands of years and we act like the first time somebody gets pregnant, it's the first time that it's ever happened, and so there's resources everywhere that are incredibly overwhelming. Every woman's experience is different and, especially if you have a more difficult pregnancy, some anxiety and depression is to be exhausted and with the right support system in place, those can be mitigated. So feelings of sadness, excessive worry, fear that you're going to be a horrible parent or that you're inevitably going to mess up your child that's something that we all feel during pregnancy to some degree. It's when those feelings start to impair our ability to get through our day that there's something to be concerned about. So if we can't stop worrying about what we're doing or how we're affecting the baby or what kind of parent we'll be, those will be super concerning.
Dr. Elizabeth Barlow:So it sounds like worrying about what type of mother will I be, or am I going to be a good mom? Stressful worries and thoughts and anxiety might be something, like you said, every mother worries about, that every mother worries about. So then, in terms of differentiating between the typical challenges of early motherhood and more serious mental health concerns, it sounds like those things that kind of look more like depression is something that you want to be on the lookout for, and those are signs and symptoms of not wanting to engage with other people and staying in your room and isolating. Are there any other kind of particular behaviors that you could see that maybe a partner or a family member or even a friend could be on the lookout for?
Robyn Klein, LCSW:Absolutely. Hormone changes occur in the body, perinatal and postpartum, and so after the baby's born, it's expected that your mood will fluctuate within those first six weeks Tearfulness, crying, freaking out if the baby is crying because your blood pressure is going up, and what are you going to do? Those are all super normal signs postpartum. But when you can't sleep because you're afraid that the baby's going to stop breathing, or you don't trust anyone else to take care of the baby so you can do something like sleep or take a shower so not trusting anyone else, if you have feelings that you could or potentially want to harm the baby, those are signs to be concerned about.
Robyn Klein, LCSW:And not letting other people help you right. Being a new mom super stressful. We're all afraid that we're going to, you know, screw up our kids in some capacity. But at some point we have to realize that we can't do this by ourselves and we need the support of others, even if it's just to take a nap or take a shower, and so not letting anybody else in would be a major indicator to partners, friends and family that something is going on with mom that needs to be addressed.
Dr. Elizabeth Barlow:And I know you mentioned it's a very hormonally raced time. Things are going on. Maybe you have a short temper, maybe you're highly emotional, thinking about maternal mental health issues. How can they affect relationships with partners, family members, other children?
Robyn Klein, LCSW:No one likes to see mom in a state of disarray. Right In many families, mom is the one that is the household manager that is kind of corralling everyone, and to see her in this unstable environment can be worrying for all members of the family. So the best case scenario would be to have a conversation before the baby arrives about things that can be expected beforehand or once the baby comes, and you can also stay in touch with your family and do check-ins. There are postpartum depression screens that are administered typically when women discharge from the hospital and when they're at their postpartum visit, and so it's easy for partners to get a hold of those and know what to look for when they're at home and to reach out to the providers when there's something in need.
Robyn Klein, LCSW:Being able to support mom in the best way possible will kind of help well everyone. But if mom is unwilling or unable to receive that support, there can be tension in the household. Like you said, the instability can cause other children to act out. There could be more fighting between partners, which only increases the stress level for all parties involved, and so doing your best to stay on top of it as a mom and also recognizing that your loved ones are there to support. You is super important.
Dr. Elizabeth Barlow:I love that you mentioned there's a screening tool, and my mind immediately goes towards. You're getting ready to discharge from the hospital. You've got a brand new baby, everything's kind of in disarray and there's a screening tool Based on your work and knowledge. Is that the most effective time for the tool, or would it be better if that was delivered, maybe at the child's first appointment? What have you seen to be the most effective for accurately capturing that information?
Robyn Klein, LCSW:Well, it's really hard because there really is no good time. You're absolutely right. When you're discharged from the hospital you're freaking out because, like you have this new human being that you are responsible for keeping alive. You have a million things going on in your head and then the nurses show up and are like here, please take this like 21 question assessment to let us know how you're doing. And so it's really easy to get false positives in that sense because, of course, your anxiety is going to be up and you're going to be on edge.
Robyn Klein, LCSW:So the biggest thing that the nursing team is looking for at that time are thoughts to harm yourself or your baby, because those are the biggest things that put your safety and the baby's safety in question. So when women score high on those tests, instead of a six-week postpartum visit there's often a two-week postpartum so that the doctor can do a check-in with mom and make sure nothing is out of the ordinary or worse than those postpartum baby blues. If you score high in those at-risk-for-harm categories, they'll often keep you admitted for another day or two to ensure your safety and potentially start medication. But a lot of moms are reluctant to answer those questions in the affirmative because they don't want to be separated from their baby. A lot of OBGYN offices do administer them at the six-week visit, but not all of them do, and it's currently not routine for pediatricians to do those trips as well. But the pediatricians see the baby at such frequent intervals that first year it's really a missed opportunity to be checking in with mom and making sure that she's getting everything that she needs.
Dr. Elizabeth Barlow:Is there a particular postpartum screening tool that you think is like the most accurate or effective in capturing that and, if so, could we maybe share a copy on the podcast page for anyone listening who might have a loved one or might actually be going through something that they think might align with postpartum that they could take?
Robyn Klein, LCSW:Absolutely. The gold standard right now is called the Edinburgh Postnatal Depression Scale. It's also given prenatally. It's just most commonly given in that postpartum period. It's 10 questions. It's really a snapshot of how you're doing and how you're feeling and gives the staff an idea of how close of an eye do they need to keep up on you. So this is the gold standard that we can absolutely post on the podcast page and it's a really good thing for partners to take a look at so they know what to be keeping an eye out for when mom comes home with baby as well.
Dr. Elizabeth Barlow:I'm trying to think of it from a mom's space, of where I'm stressed out and I think as I don't want to say like as moms especially, but I'm going to say as moms especially we put a lot of weight on ourselves and expectations to keep it all together.
Dr. Elizabeth Barlow:Look like you have everything under control, you know. Not admit that you don't, because then maybe that scares. You think it's going to scare other people in your life. So I'm trying to think of if I'm a mom and I do have some concerns about am I okay? What are some recommendations that you can give me to really be honest and check in with myself? What steps should I then take? And I guess, like the barrier there that I keep thinking about is how do I get to a place where I can be comfortable admitting that I'm not okay and how can I come out of holding back because I'm worried or I think I've got it all together as a clinician, what are some recommendations that you could make for someone that's feeling stuck or feeling worried but afraid to really admit it?
Robyn Klein, LCSW:That's such a good question, because so many women come into my practice and did not realize that they were not okay. So they don't remember the first six months of the baby's life, and it's not until six months later that they're like hey, wait a minute, like something is going on and it's not okay. A lot of women will also be resistant if a partner or family member says, hey, I don't think everything's okay right now because the sanctity of our motherhood feels threatened. Right, how dare you tell me that I am not being the best mother I can be? It's like one of the worst things that someone can say to us, especially when we're not in a good place and we feel like from to our child is the worst possible thing that can happen. And so a huge portion of it is going to be having those conversations with your partner or your family and being open to their feedback. So you go over the postpartum depression scale. You say, please, let me know if these things are happening, and then being open to them, saying, hey, I've really noticed that you're blaming yourself for a lot of things lately that are not your fault, and being receptive to that feedback and having that open dialogue, that's going to be critical.
Robyn Klein, LCSW:Some women reach out to their obese and get on medication, which is absolutely a viable option, even if you're breastfeeding. There has been so many studies talking about the minimal risk to the infant if you're nursing and the benefits to mom's mental health that outweigh those minimal risks. For example, if you are in a constant state of stress and you're not dealing with it either through therapy, support or medication, your cortisol levels, your stress hormones, are just flowing all throughout your body. It's changing your breast milk and ultimately that's changing what goes into the baby. So the pros and cons of going on something like medication while you're nursing in my professional opinion, the pros are absolutely of way more benefit than the potential of risk that could happen while you're breastfeeding. The other portion is knowing where to go to help, because ideally the OB's office will be like yep, let's get you in for a visit, let's talk about what your options are and let's take the next steps, but that doesn't always happen.
Robyn Klein, LCSW:One really great source of support is your company's EAP. Lot of companies right now offer employee assistance programs to their staff and their dependents, which typically offers anywhere from three I've seen as many as 10 free therapy sessions at absolutely no cost to you, and so if you're working or your spouse is working and you have access to EAP, that would be a great inroad to getting somebody to talk to. Postpartum Support International is another fantastic resource. They have a hotline that you can call they also you can also text in the middle of the night and they can provide support. They can answer questions, they can connect you with providers that are available in your area, and there is certification through Postpartum Support International for perinatal and maternal mental health. So these women and men have very special training that makes them even more able to support moms going through maternal mental health conditions.
Dr. Elizabeth Barlow:I know we discussed some of the common barriers to potentially seeking help could be admitting to yourself that something is wrong and having to admit to yourself that you're not perfect. I think, as humans, we all struggle with because we get into our heads about this constant chase for this imaginary unicorn of perfection. And what does it mean if I can't? X? Does that make me weak? Am I less than what are some common barriers that might prevent mothers from seeking help for mental health issues?
Robyn Klein, LCSW:help for mental health issues.
Robyn Klein, LCSW:So stigma is probably the biggest one, right?
Robyn Klein, LCSW:Like, as far as we've come as a country within the last five to 10 years talking about mental health issues, there is still a stigma attached to them, and if you come from a family where you weren't allowed to have emotions, let alone mental health problems, then being comfortable asking your family for help can be a major fear of the response that you're going to get.
Robyn Klein, LCSW:Another barrier would be socioeconomic status and job. So do you even have the benefits available to you to access free or low-cost mental health services? And then, even if you do have that access, do you have the support in your household to be able to utilize them? Right? If you're a single parent or a parent of multiple children, you have limited help in the home and you work and or your partner works, the kids are in school, they have their own mess. Right Like, there are plenty of therapists that work evenings and weekend hours, but those spots fill up fast, and so if you don't have the support to be able to get help during the day and are limited to when you can get those services, the options get smaller and smaller and you're left with kind of holding the bag and saying, well, I can't get this help and so I'm just going to have to. Power threat.
Dr. Elizabeth Barlow:And I know another kind of effective strategy for mental health across the board is really engaging in self-care. What are some effective self-care strategies that new mothers can do to support their mental health?
Robyn Klein, LCSW:One of the mantras that I heard when I was pregnant and just had an absolutely miserable experience was that you can't take care of the baby unless you take care of yourself, and that follows the whole thing. You have to put your mask on first, on the airplane, before you put anybody's mask on you. By caring for yourself, you're caring for the baby, right? So an exhausted mom is less able to provide her infant with the support that it needs if she can barely keep her eyes open. Hasn't showered is probably like munching throughout the day and like barely exceeding 500 calories, right? So by not taking care of ourselves, we're doing our children a disservice, and ultimately it all comes back to wanting to be the best mom possible. And so to do that, you have to take care of yourself, and constantly repeat it.
Robyn Klein, LCSW:The next step, I would say, is being willing to accept and ask for help. So a lot of people will call and say, oh my gosh, the baby's here. Let me know what I can do. And nobody wants to say, like, can you come over and do four loads of laundry, right? Like, that's not what most of us have in mind, but the majority of people I would like to to think just truly do want to help. So take the opportunity and say can you do my laundry? Or ask them did you have anything in mind? Right, some people are willing to bring over meals. Some people may watch your other children. Some people may want to spend time with the baby so that you can take a nap. Figure out what needs to get done so that you can, you know, pull yourself out of that survival mode and be willing to accept help from other people.
Robyn Klein, LCSW:Now, granted, that requires that you have a support system and not everyone else does. One thing that's available to low-income families and, in some communities, higher-income families and in some communities, higher-income families, are phone visits with a nurse or a social worker. These are often through the health department or a local hospital. They're called home visiting programs, where a nurse or a social worker comes to you and ensures that you have the tools that you need, and these programs start prenatally or you can pick them up postpartum. They can help you acquire car seats or pack and plays. If you don't have a crib. They have access to programs with free diapers and other baby supplies. So there are resources in the community that are available to you. You just have to be willing to ask for them if they're not presented to you by someone else.
Dr. Elizabeth Barlow:I love that there are resources available and I like that you called out to where it's the point that you have to ask what is available. When I was the director of a WIC program and when I lived in Massachusetts, we kept a pretty nice sized list of resources that were available to moms that they might not be aware of, and we made it a point to share those resources with all of our new moms like diaper pantries really, you name it. So that might be another resource that you could use If you qualify for WIC and you utilize those services. Ask them hey, like I need help with this or I need help with that, Do you have any resources I can reach out to? I know in a lot of communities there are nonprofit organizations that can provide things that you need. There's also religious organizations that can provide things that you need. So, definitely asking for help and I also like that you pointed out when someone calls to offer help and you're maybe afraid to say, yeah, can you come over and do my laundry, Instead asking I would love help, what did you have in mind?
Dr. Elizabeth Barlow:I think that's a really great way to maybe overcome that fear or stress associated with looking like you're admitting that you need help, which again, like it's a human thing that I think a lot of us deal with I know that I do. I like to put myself in the mindset of some of the topics we talk about and think about okay, what would be my barrier? What would make me feel cringy? And I think it's my first reaction when somebody asks like hey, how are you, is there anything I can help you with around a topic, and especially when I had my kids, my first reaction was always oh no, thank you, I'm good, but was I really good? I just I struggle with accepting help. So I think that's such a huge recommendation to put that question on the person to see if they are willing to do certain things, so then you don't have to then ask.
Robyn Klein, LCSW:That makes it feel better at least from what I can see, absolutely, and I think your call out to WIC is a great one, because for two reasons. Right, a lot of women are reluctant to use WIC, even if they qualify, because they think that it sends a signal but we go back to, you're trying to be the best model that you can be, and that means nourishing yourself and your baby, and WIC gives you free money to spend on those supplies. I also know when I was living in Virginia, wic had access to free breast pumps that or like through that the women might not have otherwise known to get, and when I worked in the hospital setting, we were always having different nonprofits and religious organizations calling and saying we offer these things. Please spread the word.
Robyn Klein, LCSW:A lot of insurance companies now, if not all of them, offer case management services, and more and more of them are offering them specifically during pregnancy, and so one of the things that moms can do prenatal postpartum is call up their insurance company, ask for case management and say, hey, I'm pregnant, is there a nurse or a social worker available for me? And so they call at regular intervals. The nurses are wonderful because they assess all of those medical pieces. The social workers are making sure that you're maximizing resources in the community. Of course, you have to be able to pick up the phone when they call, so that sometimes there's trouble when we have a lot going on. But there are plenty of people in the community that are begging for the opportunity to provide you with support. You just need to be willing to accept it and able to partner.
Dr. Elizabeth Barlow:That's a really great point. And while we're talking about WIC again, I wanted to address a common myth and misconception. Common myth and misconception there were a lot of moms who would say I don't think I really need WIC because I should be able to make it, I should be fine, even though they qualified for WIC services, because they felt that they were taking away from other moms that they thought might need the help more. And that's not how WIC works. So if that mom doesn't use the benefits, it doesn't free up benefits for someone else. So WIC is actually funded by the USDA and it's based on need. So if the moms aren't utilizing WIC services, then the funding gets reduced.
Dr. Elizabeth Barlow:It's not a situation of you're taking away from someone else who may need it more. If you qualify for WIC services, definitely utilize those services. It can take a situation of you're taking away from someone else who may need it more. If you qualify for WIC services, definitely utilize those services. It can take a lot of stress off to have formula covered. So definitely look into taking advantage of those benefits if you are a mom and you have an infant or kiddos and I can't remember specifically the cutoff age, I think it might have been five years old- I think, so that sounds right.
Dr. Elizabeth Barlow:How can expecting mothers prepare themselves mentally for the challenges of motherhood?
Robyn Klein, LCSW:I think the biggest thing is knowing that whatever you expect, it's going to go differently. So one of the things they tell you to do during pregnancy is to create your birth plan, and I think that's a really great opportunity to learn about the birthing process and all of the different scenarios that can go on and to highlight your preferences, right. So a birth plan is really your preference of how your birth happens. But I have yet to speak to one mom in 10 years whose birth plan played out the way they intended, and I think having that perspective for your pregnancy and your delivery and then the postpartum period is a great way to prepare yourself for the unexpected, because that's what being a parent is right Like no day is the same. You think your child's gonna do one thing. What being a parent is right Like no day is the same. You think your child's going to do one thing. They do something else, right. Like they love yogurt. And then you buy the yogurt from Costco and they don't love the yogurt anymore, right? That is parenthood in a nutshell.
Robyn Klein, LCSW:So understanding that things are going to take twists and turns is step one. The second step, I would say, is checking in with yourself. How am I feeling right now about my pregnancy? If I'm in a partnership, if I have a family, what is my support system like? Am I getting all of the things that I need to keep my well full in the event things don't go as I plan? And if not, what do I need to do or what needs to happen in order for me to fill that up?
Robyn Klein, LCSW:As you go through the prenatal and then postpartum experience, those check-ins should happen regularly, and that means with yourself, with your partner or other support system that you have in place. Am I doing everything that I think that I need to do in order to be the best mom that I can, and do I recognize that being the best mom that I can be means taking care of myself? And if, at any point, the answer to that question is no, then you work with your support system to identify where those gaps are and the best way to fill that, because not addressing them leads to longer-term complications for mom and for baby and for the family at large, because the situations only continue to exacerbate and the problems that you have get worse and instead of just plugging a leak, you are trying to put the overflowing toilet you know the water in a sink as the water keeps flowing, and so it's so much easier to take care of that stuff beforehand or as it arises slowly, than trying to fix it on the back end when you feel a mess.
Dr. Elizabeth Barlow:Thank you so much for sharing all of your insight and knowledge with us today. Robin Robin is a provider with Kindermine in Virginia and Pennsylvania, so if you would like to book a consultation with Robin, you can absolutely do so at Kinderminecom and Robin. Did you want to share with our listeners how they can book a time with you if they are in any of the other states where you're licensed?
Robyn Klein, LCSW:Absolutely, if you are in Colorado, idaho, iowa, delaware, new Mexico or Vermont I think I covered everybody. You can reach me on the Headway platform, headwaycom. Just find a provider by name. You can plug in my information and request a consult. I would be happy to meet with you and talk about what's going on and if I'm not the right provider for you, I will help you find somebody who is a better match.
Dr. Elizabeth Barlow:Wonderful. Well, thank you so much again, Robin. I greatly appreciate your time.
Robyn Klein, LCSW:Thank you so much for having me. It's been a pleasure.