Q & A with a Certified Nurse Midwife about Postpartum Depression

I reached out to The Midwife Center for Birth and Women’s Health with some questions about Postpartum Depression (PPD). One of the midwives, Jatolloa, was kind enough to answer all of my questions!

Jatolloa sees moms throughout their pregnancies as well as for postpartum visits, when screening for PPD is very important. We hope this Q & A sheds some light on what many women encounter and helps create and open conversation about PPD.

What is PPD?

PPD is a mood disorder that affects women in the postpartum (or post-birth) period. It usually peaks in the second month of the postpartum period, but can affect women up to a year after their baby is born.

What are the signs of PPD?

Signs of PPD include but may not be limited to:

• Feeling overwhelmed.
• Not bonding with your baby.
• Feeling nothingness.
• Feeling empty or hopeless.
• Inability to sleep.
• Unable to concentrate.
• Unable to enjoy things you used to.
• Feeling like you can’t take care of your baby.
• Anxiety, OCD, and psychosis.

It is important to differentiate between “baby blues” and postpartum depression. Baby blues usually resolves after the first two weeks of birth, while PPD arises after that time period. During those first two weeks of the postpartum period, the body and brain are readjusting in regard to the hormones circulating during pregnancy. Some women experience symptoms related to these adjustments after that period, which could be considered PPD.

How common is it?

Between 15 to 25 percent of women will have some major depressive episode at some point during the postpartum period. That’s up to one in four women.

Who does it affect?

It affects women of all cultures, ages, incomes, races, and ethnicities.

Are there underlying conditions making some people more likely to experience it?

Strong risk factors may include:

• History of depression.
• Anxiety, depression, and life stressors during pregnancy.
• Low level of social support.
• Postpartum depression in a prior pregnancy.

Additional risk factors may include:

• Family history of depression or PPD.
• Unplanned pregnancy.
• Young maternal age.
• Lower socioeconomic status.
• Financial insecurity.
• History of interpersonal violence/abuse.
• Thyroid dysfunction.

How can someone recognize it?

Become familiar with the signs of PPD. I would note that often women have high expectations of themselves and motherhood and are unable to check in with themselves mentally. That’s why I urge partners and families to familiarize themselves with the symptoms as well so they can encourage loved ones to seek care.

What options are out there for those who experience this?

The first step is realizing it may be affecting you. Next, I would recommend reaching out to a care provider. This could be your prenatal care provider or your primary care physician. They will be able to assess and guide you. We have also seen pediatric providers screening women when they bring their little ones in for their visits. This is great because we only see women until six-weeks postpartum, and as I mentioned before, symptoms of PPD may surface starting at eight weeks.

After that, the provider may recommend reaching out to a therapist. Most providers will have recommendations. But it is important to make a plan. One of the hardest steps is making the phone calls.

After meeting with a mental health provider (such as a therapist or a licensed clinical social worker), it may be decided that medication is recommended, but this is not always the case. It’s all about making a plan that feels right for you and your family.

Some providers, such as midwives or ob-gyns, are able to bridge the gap in certain situations. For example, a woman experienced PPD in her last pregnancy, used a certain medication, and would like to restart. That is a possibility, but always being evaluated to see if it is still the right route to take.

What advice can you give to loved ones?

A: As stated above, knowing the signs of PPD is a start. But what you already have going for you is that you know this mom well. You know what she was like before getting pregnant and during pregnancy, and you will most likely be able to separate new mom challenges and possible depression or anxiety.

The most important item is patience. It is a challenging time for women, even those without a mood disorder, so it may take some time to work through this difficult period.

If there was one thing you could communicate to the community about postpartum depression, what would it be?

A: We need to keep the conversation going. It is a serious condition affecting our moms, which in turn affects our families and communities. Just because we can’t see a mental illness, it should not be less important. Let’s remove the stigma and support the women who keep the world going. And, Moms, you are not alone. You are doing the best you possibly can. We are here for you! We are proud of you!

Jatolloa is currently a staff midwife at The Midwife Center for Birth and Women’s Health (TMC) in the Strip District. She’s knew she wanted to be a midwife since the age of 16. After taking an anatomy class, she became enamored with the birth process and in awe of the ability for a woman to grow a human. From there she thought she wanted to become an ob-gyn but had the opportunity to shadow a midwife. After just one interaction, she knew it was her calling. With midwifery on her mind, she decided to take up nursing at the University of Pittsburgh. After graduation in 2010, she moved back to her hometown of Philadelphia, where she worked as a medical/surgical nurse for three years. During that time, she started her midwifery education at the University of Pennsylvania. When she graduated in December 2014, she had already completed one semester at TMC as a student and was offered a job as a fellow. Now calling Pittsburgh her home, she enjoys reading, practicing yoga, and teaching young women and men about midwifery, reproductive health, and justice.