Let's Talk: Postpartum Depression | Podcast

Nikki Lively: Hi everyone! My name is Nikki Lively and I'm the Clinical Director of the Transitions to Parenthood Program at The Family Institute. We are a team of psychotherapists specializing in reproductive mental health and provide therapy and support to women, men, infants, couples and families in this important life transition. Today I'll be talking to Kristina Cowan, journalist and author of the book, When Postpartum Packs a Punch: Fighting Back and Finding Joy. In this wonderful book, Kristina shares her own experience with a perinatal mood and anxiety disorder, and the aftermath of a traumatic birthing experience, and the experience of other women and men who struggled in different ways in the postpartum period.

First, I want to thank you personally for the contributions that your book makes to normalizing postpartum experiences, and how soothing this is for new parents to know they aren't alone. They are reading that others have struggled too. May is Maternal Mental Health Awareness Month, and your book is an important contribution I think to shifting expectations for new parents, and building awareness of what they need. I think it also helps establish perinatal mental health in particular as a public health issue that deserves action and advocacy. So, thank you so much for writing it. 1:15

You start the book by sharing your own story of developing a perinatal mood and anxiety disorder following the traumatic birth of your first child. I wonder what it was like to revisit this experience for the book, and what parts of your experience stands out to now, looking back on it today?

Kristina Cowan: Sure. So, first what it was like to revisit. I would say cathartic and healing. I know those terms are used a lot, but it really was healing to go back sort of into the weeds as I was writing. And writing makes you do that naturally. It makes you explore things deeper. I also learned a lot while I was doing that. So, I would say the two big things were that it was healing, and it was a learning adventure for me. So for example, what did I learn that I didn't already know? In chapter two, I take a look at what trauma taught me. So I think there's a section in there called, "What Trauma Taught Me." I think that's the sub-head. And I had to think about that. What did trauma teach me? And I had to lay out my thoughts, and write them down, and then I brought all of my writing to a critique group on Saturdays. So, I had a group of fellow writers who would read everything in my manuscript. And they would read my first pass at whatever it was and say, "hmm, do you really mean that?," "maybe you could revise that," etc. So I would take their revisions in mind, go back and edit the piece, and then bring it back to them. And that process of writing, critiquing, revising really got at the truth for me. 2:43 And the truth, sort of, explored the right way, and what I really mean to say.

Sometimes you'll write things down, and there's stuff in the way. And the critiquing really cuts out the weeds of that. And then your second point, what stands out? I had to think about that for a while, but now when I look back, despite whatever I felt then, the inadequacy, the pain, the grief, I see now that I was able to love my son well. And that I did care for him well. And I wouldn't say that I knew that I was doing that in the moment. That takes, you know, nine years of perspective. My son is nine now. So I look back and think, wow, I was doing a good job despite everything that happened. And I can say that honestly to myself now and believe that. And so, the lesson there, I think, is that women do better as mothers, as first time mothers, than we think we do. And I don't think we give ourselves enough credit or enough leeway. 3:38

NL: So, another thing that I liked about your book, is that you address birth trauma, which I think is really common, and more so is what you're careful to specify, is it's in the eye of the beholder. Like what's traumatic for one person would not be traumatic for someone else. And I think, even more important, what's routine for a medical professional is still going to be possibly traumatic for the people, you know, the new dads, the new moms in the room, the women going through it. So, I think you give permission for women to really honor what they've experienced and really listen to themselves with your message about birth trauma. And I'm wondering if you have any other thoughts about this or any ideas about how birthing providers could do a better job in serving women, in labor and delivery. 4:28

KC: One thing I would say, is to look at the research by Cheryl Tatano Beck. She is an excellent resource, and I believe she is at the University of Connecticut. So, you know, if you're a care provider, I would look her up and see what she has to say specifically in her reports and in her research. She's an author and a researcher. I think that's what her titles are. So, that's the first thing. Another thought I had about this is that birth trauma is one form of trauma that women can go through. And that means anything that happens during childbirth: an intervention, and unplanned C-section, forceps. I had forceps. And then there's this idea of past trauma. So, if a women was abused, or raped, or abused in childhood. All of that can come back as well, even if she's say, fine. Even in the childbirth is not traumatic, but she was abused in her past, that could come up. So, it's important to know the distinction between those two things.

And then, another thing that I would say personally, that I experienced was, what entered into my experience was loss. So, I had lost my mom when I was 15, and that all came up to the surface when I had my son. I knew it would be around somehow. I knew I would have to confront the issues of my mom not being there. 5:54 I didn't know exactly what that would feel like, but I'm sort of a type A person. And I thought well, I had therapy as a kid, I've dealt with this. I've written about it. And I know, I'm going to be all ready. But you can't be until you go through it. And you know, like any human being, I thought, I have to go through this again. But it really was a good thing to go back and revisit some of the stuff about my mom, and not having her there, and to look at her in a new light. Because now I was looking at her as a mom myself, and I never had that experience before. So, a previous loss can enter into a woman's mental state as well. I don't know that we would define that as trauma. Certainly, it was traumatic for me when I was fifteen to lose my mom. I wouldn't say that it was, I mean I'm not an expert on trauma so I don't know what you would call that. But I certainly think that it's present. So, care providers would do well to know her history. Does she have abuse, or trauma in her past? Did she lose a parent? Did she have a severe loss of any sort? That's important, really important to know because then you can care for her well, knowing her mental state. Any loss is still going to come up to the surface. 7:06

NL: You also talk about just normal, uncomplicated births in your book. This is a quote that I really liked: "Not unlike a soldier in combat, the woman is vulnerable, and faces uncertainties. The stakes are life and death." There's a lot at stake in terms of the mom's health, and the baby's health. And so, it's very scary. Especially when you've never gone through it before. I'm wondering about, for the sake of women, what your sense is about what they need to emotionally prepare before, and during a birth. And what they need, even if everything is uneventful to recover from the experience. 7:46

KC: The first thing I would say is a new mom needs to have at least one source of unconditional love, and that can be hard to come by. We often think, well who loves us unconditionally? Well, our parents usually. And it usually is our moms. So, it might not be your mom who is that one source, but you do need someone to give you that affirmation, and that unconditional love. And it could be an aunt. It could be a friend. It could be your spouse. Okay? But one person. Another thing that I think this does fall on the partner or spouse, is to have a very defined sense of partnership. I know as the mom, and I've talked to my other mom friends, no matter what, the mom needs to feel like she has a partner because the mom who has the baby is, she's just going to feel like she's more responsible. No matter what. You're going to feel like, okay yes, there's another parent, but I had the baby. I'm responsible. I need to feed it. If something goes wrong it's my fault. 8:43 I still feel that way and my kids are nine and six. I think, if they need something I have to be there first. However, you can have a real strong partnership and feel less alone because I think we tend to isolate ourselves as moms, and we can also feel isolated. So I think it's very important that the spouse be very supportive, and extend that, and make it well known to the mom. I'm in this with you and I may not be having the baby, but I'm your partner and we are in this together. 9:12

NL: So you say in your book, "treatment and time stitched my frayed ends, but I was fundamentally changed. Parts of me are stronger. Parts of me are still broken and messy. That's long been true, but motherhood forced me to admit it." What would you like women to know about the opportunity that comes with motherhood to revisit some of these places. 9:30

KC: So, I would say, first it is an opportunity. And it is an opportunity to open them and to heal them. And you might think, I mentioned this before, that you've healed all of your wounds. And I thought, you know, I saw a therapist. My parents divorced when I was eight, and then they had joint custody. So, they split my time. So, I started seeing a therapist then. And then when I was 15 my mom died from breast cancer. And so, I kept seeing that therapist from the time I was eight, until I was 18. So about a decade. And that really helped me. And I thought as an adult looking back, I was in therapy for ten years. I've healed all that. I'm fine. I'm good. I was 34 when I had my son. And you're very different at 18 compared to a 34 year-old women who's had her first child. It was an opportunity for me to heal things that I didn't really know needed to be healed. Childbirth was that pivot point. And I think we need pivots like that, whether it's childbirth or something else. But I can say that I have, having kids probably healed me more than anything. 10:35

NL: I also love that your book addresses postpartum fathers. What was the most surprising or interesting thing that you learned from the fathers that you interviewed, and if you noticed anything different in terms of themes, and their stories versus the women that you interviewed? 10:55

KC: I had an idea to include dads in a back section, maybe with back material for them, and as I did the research and reporting I had people say, you need to do a chapter for men. Men are different. They are just different, and you need to write something. So, I thought I really should. And as I started doing the research there were plenty of things that surprised me and that I found were incredibly interesting. Dads can be just as vulnerable as moms. And we don't like to think that. Men are strong, and they save everything, and they protect and provide. And I think we still have those notions, but their brains are just as delicate. When I was doing the chapter on OCD, Dr. Jonathan Abramowitz said to me, when he did his research to discover how prevalent intrusive images are he found that almost 100% of all new parents, moms and dads, get intrusive images. So it doesn't have to be just the mom. 11:47

NL: I'm curious, just going back to your book now, what do you hope, or most hope that people will take away after reading your book?

KC: Sure. It's just that word you used, hope. That was my goal in writing this book. When I was going through postpartum depression I thought, I want a book to read, and I couldn't find the book that I wanted. I found a blog and I found plenty of clinical resources, and this is what postpartum depression is. It is clinically defined as x, y, z. But what was most helpful to me was when I was sharing with my friends and then said, oh I had this, or this happened to me, or I think I had postpartum depression but I never sought help. Those stories made me feel normal because I thought, oh, and you're fine, and your child is fine. And everything is going good with you now. So maybe there's hope for me. I wanted that hope. And I thought, if I'm going to give back to people through my writing, I've got to provide that hope that I got. 12:43

NL: Any final thoughts you'd like to share with women and families just about the transition to parenthood?

KC: Find one person that you trust. You don't have to broadcast what you're going through on Facebook or to 25 people that you have varying levels of trust for. One person that you trust implicitly. It might not be your mom. It might not be a family member. It might not be your spouse or partner. It might be your coworker, or a friend, or a therapist, or your OB, or your pediatrician, but find one person. And I think that's the door that you walk through to start getting well. Because if your trust them, they are going to have your best interest at heart, and they are going to say, okay well, let's get you help. And they'll get you help. And to find that one person you go back to your instincts, and your instincts will tell you if they are the right person. When I was going through it, I shared with my husband, and my mother-in-law was with us by the time I started to not feel so good. So I told her. And then my cousin. And between the three of them, I felt very supported. And I knew that they weren't going to betray my trust. That's my final thought. 13:46

NL: Well thank you so much for being with us today. For more information on Kristina Cowan, and to buy her book, and to read her great blog, go to www.kristinacowan.com. That's K-r-i-s-t-i-n-a-C-o-w-a-n.com. This podcast is brought to you by The Family Institute at Northwestern University, a nationally recognized leader in the field of behavioral health. We bring together the right partners to support children, adults, couples and families across a lifespan. As researchers, educators and therapists, we work with our partners to see change. If you'd like to request an appointment, please call us at 847-733-4300, ext. 263. You may also visit our website at family-institute.org. And please follow us on Facebook and Twitter for relationship tips and tools, and updates on new podcast episodes. Thanks so much for listening. 14:48