Today marks the beginning of World Maternal Mental Health Month. In many countries, as many as 1 in 5 mothers experience some type of perinatal mental health disorder (PMHD). These illnesses frequently go unnoticed and untreated, often with tragic and long-term consequences to mothers, children, and fathers alike.
I sat down with Elizabeth Bretz, a Rockland resident, to talk about this important topic. Liz is a clinical social worker and creative arts therapist who specializes in perinatal mental health. She has a practice in Nyack where she welcomes new, hopeful, and seasoned parents into her office.
Thanks, Liz for talking about this incredibly important topic! Tell me a little bit about yourself and why you love Rockland County.
I have lived here in Rockland for the last 10 years and welcomed all 3 of my children with the support of doulas (I am Team Doula!). When I’m not working, some of my favorite things to do are to collect books that I’m sure I’ll find time to read…someday…go hiking, gardening (much to the appreciation of the Rockland County wildlife), hunt for bugs and snakes with my middle child, watch for shooting stars with my oldest, and hone my sprinting skills chasing after my youngest. While not a replacement for therapy, I firmly believe that a good song and an impromptu dance in your living room can help shift your mood. I love to escape to Disney any chance that I get, but I feel most peaceful when I am near the ocean. My clients probably hear way too many ocean/wave metaphors!
Why did you get into perinatal work?
Two paths converged for me in perinatal work. I have always been fascinated by birth stories and earlier in my career worked with families in community mental health. I could see how both parents and children were impacted long term by the effects of traumatic birth experiences and untreated postpartum depression and anxiety. I wanted to follow the thread back to understand how that began and to see how treating parents sooner might allow for better outcomes for the whole family. On my own personal path, I have had several friends and family members suffer through postpartum mood disorders without help or having major barriers to getting treatment. I also experienced PPA (postpartum anxiety) with my first child and found it challenging to even share how I was feeling, much less to find the right kind of supports. After I recovered, I was committed to pursuing a perinatal specialty so that I could help make this kind of care more accessible. I did my training and certification through Postpartum Support International, and additional training with The Postpartum Stress Center.
What are some things you wish expecting parents knew about mental health in the perinatal period?
First, that they are not at fault for how they’re feeling and nothing that they did “caused” their PMHD (perinatal mental health disorder). PMHD is also really common, with around 1 in 7 parents experiencing perinatal depression or anxiety. Second, that with the right supports and treatment they will be able to recover. How they feel now is not an indication of what kind of parent they are. You are just the right parent for your baby and you are not your symptoms. Lastly, I wish that we’d put as much focus and value on building a support network ahead of baby’s arrival as we do on creating the perfect registry or nursery. I’d love to normalize registering for a doula or therapy sessions instead of onesies!
What are some things to look out for?
Pay attention to changes to your mood. Intrusive, scary or persistent thoughts that won’t go away, not feeling like yourself, and feeling disconnected from your baby, family, or self are all some indicators that you may need to be assessed for PMHD. Remember, even if other people tell you that you “look fine,” don’t dismiss how you feel. Many parents with PMHDs crack jokes, appear pulled together, and continue with business as usual. From the outside view they may look like they’re in control and having no problem adjusting to parenthood. PMHDs can’t be assessed just by looking at someone. Keep speaking up until someone takes what you’re saying seriously. And for supporters of a new parent, if they tell you that they are struggling, believe them and assist them in finding help. That is the most supportive thing that you can do!
Doctors keep telling me it’s just the “baby blues,” so what is the difference?
Baby blues are hormonal changes that can cause anxiety, crying, and restlessness that go away within the first two weeks after giving birth. Key words being TWO weeks. If your symptoms are severe or they persist after that initial two week period, it is not the baby blues. Unfortunately, many parents are told they have the baby blues months after delivery and this can cause more of a delay in getting help. Knowing the difference can help you advocate for yourself or your partner.
Can I really get better from my postpartum depression? What kind of help is out there for me?
You can! This is something that I really emphasize when parents come to my office. With treatment and support you can, and will, get better. I know that when you’re struggling it can feel as though this is the “forever feeling.” Just know that no feeling lasts forever. There are so many ways that parents can find support including therapy, medication, support groups, postpartum doula support, pelvic floor therapy, help with feeding your baby, and acupuncture. I always encourage parents to build their own dream team! These are the providers, groups, and individuals that hold and nurture the parents. I also really love parent/baby activity groups that meet at libraries, in parks, exercise together, and have playdates. A key component of overcoming PMHDs is to decrease isolation and to connect to other parents. For me, something that really was a lifeline was a breastfeeding support group. It was the one appointment I could get out the door for each week. For one hour I got to sit with other moms and feel less alone. I ended up making my first “mom friend” – she was leading a baby-wearing ballet class that I attended. Afterwards we would take our babies for a walk and lunch. Out of a really dark time came one of my most cherished memories of early parenthood.
How do I “get over” my traumatic birth?
So many parents come to therapy with this question. The short answer is you don’t “get over” it. You will need to move “through it” by processing and integrating your experience. I think it’s important to first remember that birth trauma is defined as any physical or emotional distress experienced as a result of childbirth. Birth trauma is individual and one person may experience a birth as traumatic while another birthing person may have a similar birth and not feel distressed. A deciding factor in whether someone feels their birth was traumatic is whether or not they were made to feel safe (physically and/or emotionally) while giving birth. I encourage those who have experienced a traumatic birth to be gentle and compassionate with themselves. Do your best not to blame yourself. Find a supportive person with whom to process your experience. For many, this is a therapist. You might have questions about your birth and need help filling in the blanks with your partner or medical provider. You may need to express feelings like grief and anger. You may also have symptoms that are interfering with your daily functioning (nightmares, flashbacks, physical reactions, persistent thoughts, difficulty thinking about or talking about your birth, trouble bonding with your baby). Your therapist might help you by teaching coping skills to help soothe and settle your nervous system before you feel ready to verbally process your birth. Other treatment can include cognitive behavioral therapy, eye movement desensitization and reprocessing (EMDR), medication management, and exposure therapy. In my practice, we access creative modalities like art, journaling, and even working in a sandtray to help parents create a narrative about their birth. I also work with parents who need to process a past traumatic birth in order to feel ready to have another child. With time and support it is definitely possible to feel differently about your birth.
Any closing thoughts?
I believe that every person deserves that right to a safe birth and postpartum experience and I think there is so much more we can do for families in this country. I hope that my work helps to contribute to healing and uplifting parents.
**This is for educational purposes only and does not replace therapy. If you would like to know more about perinatal mental health and supports check out www.postpartum.net