Tricia Rausch, a nurse at AdventHealth Shawnee Mission, is the coordinator for the hospital’s Perinatal Bereavement & Postpartum Emotional Support program. Rausch has spent 10 of her 13 years as an AdventHealth team member helping babies’ families with various facets of mental health around birth – and loss.
In the Q&A below, Rausch shares her perspective on the recently reported increase in postpartum depression during the pandemic.
Research shows that the number of mothers experiencing postpartum depression has nearly tripled during the COVID-19 pandemic. What factors have contributed to this increase?
Isolation is one of the biggest contributing factors. Some mothers had to deliver without their partners in the room, without their support system. It looked so different than they had planned or imagined. Many moms feared testing positive for COVID-19 and possibly being separated from their baby. After delivery things looked very different too. Grandparents, family, and friends didn’t come to help the new mom or see the new baby. If they did, it was masked and from a distance. Many moms I worked with shared their new babies with family through a window, which felt like the best way to protect everyone. But all these things led to more isolation and an intense feeling of loss. Support looked different too. Doctor visits were via telehealth, making screening for perinatal mood disorders a little more complicated. Lactation support after hospital discharge was virtual, too, which led to moms feeling like a failure when breastfeeding didn’t go as planned or, unable to access the help they needed, they had to stop breastfeeding because of the added anxiety or pain it was causing. Even when they could be seen in person, they were so scared their baby would get exposed to COVID-19, they opted not to seek in-person medical attention.
- What are some of the most common symptoms you see in mothers experiencing postpartum depression? Has that changed in the past couple of years with COVID-19?
The most common symptoms are:
- Changes in appetite
- Trouble sleeping when you can or trouble falling back asleep
- Feeling disconnected from baby, spouse, loved ones
- Cannot concentrate or focus
- Moody and irritable
- Weight changes
- Intrusive thoughts
- Physically not feeling good, headaches, stomachaches, etc.
- Thoughts and feelings of hurting yourself or your loved ones
This is not an exclusive list but can get you started on self-examination. I always tell moms of newborns to expect to feel those baby blues the first two weeks after delivery. After that, if they are not feeling like themselves or find themselves struggling with any of the things above, they need to reach out to their obstetrician or primary care provider. It can be difficult because having a new baby can make you exhausted due to lack of sleep and the infant’s feeding schedule. So many moms feel like these signs are just due to sleep deprivation. Talk to your partner or a close friend or family member and ask them to share what they are seeing. Talk to your medical provider about your concerns. If you are having thoughts of harming yourself or your loved ones, act immediately by going to the nearest hospital or calling 911.
Women with a history of depression at any point in their lives or who are currently being treated for depression will have an increased risk of developing postpartum depression. Emotional factors include those feelings of doubt new moms can have. Lifestyle factors, such as a lack of support, as well as stressful life events – the death of a loved one, illness, loss of job, loss of relationship, a move to a new home or job – can greatly increase the risk of postpartum depression. This is where COVID-19 comes in. New moms have lost so much during the pandemic.
We have seen an increase in anxiety and depression since COVID-19. We have also seen an increase in the number of mothers reaching out for medication and therapy. The increase in the number of mothers experiencing postpartum depression and anxiety is reflected in the shortage we are seeing of providers to care for them.
At AdventHealth Shawnee Mission we use the Edinburgh Postnatal Depression Scale to assess our moms before and after pregnancy for postpartum depression and anxiety. This is a nice tool to see what they are struggling with. We use this in support groups as well to see where moms are improving and maybe to indicate other areas they are struggling with as time goes on. We encourage all our OBs and pediatricians to use this in their offices as well.
- We know that the mother-infant bond is important. Do you see signs that the pandemic has significantly affected that process?
I have not seen a significant change in that mother-infant bond. I feel like more mothers have struggled with breastfeeding and felt they didn’t have adequate support due to COVID-19, which may have affected some bonding. I feel like the pandemic has increased the level of anxiety in new mothers. They have been afraid to leave the house with their baby for fear of the baby getting sick. I also think social media has caused a lot more anxiety and depression in new moms. Isolated at home, many of them have turned more to social media for socialization, and the things they see or hear there leads to an increase in anxiety. The pandemic has caused mothers to be more fearful of leaving their baby with a family member or loved one, anxious something will happen while they are gone or that they will bring a sickness home to the baby. All of this has led to more isolation, fear and anxiety.
- What are some of the ways your program at AdventHealth Shawnee Mission is seeking to address the issues faced by those with postpartum depression?
The State of Kansas and the Association of Women’s Health, Obstetric and Neonatal Nurses began a fourth trimester initiative to better support moms in the first year after delivery. AdventHealth Shawnee Mission is one of the hospitals involved in that initiative and serves as a reference for other hospitals in the state. Our postpartum support program began in 2013.
The fourth-trimester collaborative that AHSM is part of is called the Kansas Perinatal Quality Collaborative (KPQC). Being part of this collaboration has helped us in so many ways. Monthly meetings allow for the sharing of resources and ideas. Our biggest challenge was that there were not enough therapists available, especially therapists who take private insurance or Medicaid. KPQC worked with us and found several therapists willing to work with AHSM to take our referrals. Now, when I have a patient who needs a therapist or medication management, I can send the patient’s information to these providers, and they reach out to the patient to get them scheduled quickly.
We also recently started using the services of Community Health Workers in several of the counties in our service area. CHWs are frontline public health workers who are trained but also are trusted members of the community they are serving. This trusted relationship allows them to serve as a liaison or link between health and social services and the community. They help to facilitate access to services and increase health knowledge through outreach, education, social support and advocacy. When we have a mom who is struggling to access the resources that are available to her, we use the CHW to bridge that gap.
In addition, Postpartum Support International (PSI) is a great place to start if you are thinking about starting a program in your facility or community. They provide so much guidance and will direct you to other resources as well. PSI also offers many online support groups, including specialized ones for fathers and specific perinatal mood disorders. The U.S. Health and Human Services Department’s Health Resources and Services Administration also launched on May 8, Mother’s Day, the National Maternal Mental Health Hotline: Call1-833-943-5746.
- What sort of trends are you seeing in the support groups you lead?
Our weekly support group at AHSM has been important, especially during the last two years. We went from in-person meetings to Zoom meetings. It looked and felt different than our traditional in-person meetings we were all used to, but it still gave mothers a sense of community and support when they needed it. When we started our support group in 2013, mothers were coming into the group three to six months postpartum. That period seemed to be when most moms were at a point of knowing they needed some help. It is also when many mothers are experiencing weaning from breastfeeding and going back to work after maternity leave. Since the beginning of the pandemic, we have been seeing most of our mothers coming at two to four weeks postpartum. We also have more coming during their pregnancy or at least reaching out about what is available because they are afraid of how much worse it may be after delivery. I believe this is due to an increase in need for postpartum support as well as the increase of education about perinatal mood disorders.
- May is Mental Health Awareness Month as well as Maternal Mental Health Awareness Month. With your decade of experience leading the program at AdventHealth Shawnee Mission, is there anything you would say to moms – or concerned family members – about seeking support?
Being a mom is a tough job but also the most rewarding. We all want to be the best parent we can be, and that begins with taking care of yourself. Think of the instructions we get on an airplane: Adults are supposed to put on their oxygen masks first so that we can then help our children or others. Same with parenting. We must meet our needs to meet the needs of our children and loved ones. Take the time to do that and do not feel guilty. This can include talking to a therapist, taking medication, joining a support group, going to the gym, taking a walk, having lunch with your friend or a night out with your significant other, taking a trip to the store by yourself, etc. Whatever it is, do it and do it often. You will feel better. And to significant others, loved ones, family, and friends, I would say: Make this happen.
- What are the consequences of untreated postpartum depression?
For the mother, it can mean:
- Poor prenatal behaviors – nutrition, prenatal care, substance abuse
- Poor parenting behaviors
- Longer persistence of symptoms
- Increased risk of postpartum depression with subsequent children
- Increased risk of relapse
For the child, it can mean:
- Poor mother-infant attachment – irritable, lethargic
- Language delays
- Behavioral difficulties
- Lower cognitive performance
- Mental health disorders
- Attention problems
- Sleep/feeding/eating disruptions
- What are some myths about postpartum depression that need to be debunked?
- It will go away on its own. It might eventually get better on its own, but it could take years. That is time that you are missing out on feeling good and enjoying your family. When I work with moms who tried to wait it out, they are so devastated about the time they lost with their baby and family.
- Postpartum depression can be prevented. If you have a history of depression or anxiety, or a history of postpartum depression or anxiety, there are things you can do and support you can put into place to help keep it from being as extreme, but you cannot prevent it.
- Postpartum depression means you are a bad parent who does not want your child. I cannot stress enough how false this is. Postpartum depression is an illness caused by chemical imbalances in your brain that you cannot control and other variables in your life that are out of your control. It is not a reflection of your parenting or the love you have for your child.
- It is only postpartum depression if I don’t like my baby. Since that is not the case, then it must not be postpartum depression. Most mothers I see have a great connection with their baby and are afraid that their depression or anxiety will affect that bond. That is why they are seeking help. If you do not feel like yourself, reach out for help.
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