Postpartum Anxiety and OCD: Podcast Episode #159

Kristin chats with Jasmine Emerick about her personal struggles with postpartum anxiety and OCD and her work as a therapist.  Jasmine is the author of The Postpartum Therapist.

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Kristin:  This is Kristin with Ask the Doulas, and I’m joined today by Jasmine Emerick.  Welcome, Jasmine!

Jasmine:  Yes, thank you for having me!  I’m really excited.

Kristin:  So Jasmine is an energetic mother of two.  She’s a devoted wife, daughter, sister, friend, colleague, and family member.  Jasmine’s often described as one of the craziest people you’ll ever meet.  She has a heart of gold and a love for people with a passion to support women especially.  Jasmine has almost ten years of clinical experience as a mental health therapist and is trained in treating perinatal mood and anxiety disorders.  Now, I would love to chat about your book, The Postpartum Therapist, a humorous and honest approach to the postpartum life.

Jasmine:  Yes, so as you kind of shared, you know, as a therapist, I’ve been in the field for almost ten years.  I did my first treating perinatal mood and anxiety disorders back in 2011.  At that time, we just referred to postpartum depression and postpartum mood disorders.  Now the terminology has trained.  And then I took training again back in 2017, I believe it was.  Before having kids, I had been trained in this area, and I was like, I’m good.  I know what to look for.  So I’m going to let myself know if I experience anything, and I’ve worked with patients and blah, blah, blah.  Then I become a mom, and it’s different.

Kristin:  It’s not textbook.

Jasmine:  Yes, it wasn’t textbook.  So I was motivated to write my book when I realized how much I had suffered from postpartum anxiety and OCD, and I can help differentiate the two of those later.  But that was kind of what – when I came out of it, I realized how much I had truly suffered, and I was able to relate to women and moms at a level that I never thought I would experience or understand.  And so it started with me just posting a couple things on Facebook about my experience, and people liked it, and people were reaching out to me and they’re like, we want more.  And then I was like, okay, at nap times, right, I’ll shoot out a post of my thoughts.  And I just could not keep up with it, not at the level that I wanted to.  But then I just basically wrote an outline and said, okay, what would I want to share with people that I experienced that I want other women to know they’re not alone, or even dads, to be honest.  I started with an outline, and it turned from a couple pages to more pages and more pages, and I said, I think I’ve got a book here.  So that’s where we were with it.

Kristin:  I’m so glad you got it out to the world, especially not only your experience clinically, but personally, and sharing the personal struggles you have and how you worked through it.  I would love for you to define the difference between postpartum anxiety, OCD, depression, mania, and some of the other terms related to postpartum mood and anxiety disorders.

Jasmine:  So I’ll start with the two that I can relate to.  Keep in mind there’s a plethora of knowledge out there; people that are much more trained in this area than I am.  I’ll start with my experience.  So in my experience and what I’ve heard from moms and what I’ve researched, the anxiety is more of the worries, the concerns, and maybe even some of the physical symptoms: you know, sweating, heart racing, maybe feeling nauseous, feeling flushed.  It’s just the worries.  In my opinion, what differentiates the anxiety from the OCD is with OCD, you have the worries but then you have the compulsion.  So it’s not just that you just worry; you’re acting on those worries.  For me, if I were to give you an example – well, I’ll save that for later.  We’ll let that juicy detail be later.  One of my fears, right, was accidents.  My biggest consuming thing, or one of them, I should say, was my kids – an accident happening.  An unintentional, right, that was my intrusive thought, was that an unintentional accident would happen.  Most likely, if I allowed them to be in somebody else’s care.  So it could be as much as, like, what if somebody was wearing a sweatshirt with a button, and it came unraveled, the thread did, and that button went in their mouth when they cried, but this person was talking and didn’t see that the button fell from their sweater into my child’s mouth and they choked?  So what do you do?  You don’t allow your kids to be with anyone else unless you’re there, or are you are constantly hawk-eying how somebody’s holding your child or what they’re wearing when they’re holding your child.  So the anxiety, you know, you kind of stop at the worry, but in my opinion with the OCD, you kind of start the behaviors of maybe prevention or avoidance to counteract that worry, if that makes sense.

Kristin:  It does completely.

Jasmine:  Then when you get into the depression, you know, people kind of think of depression as feeling sad or feeling depressed, and that can be true for a lot of moms.  You know, a lot of moms will say it’s not what they thought.  You know, they’re not happy; they’re not connecting with their baby.  Some are suicidal.  You know, some don’t want to live.  Some maybe regret the decision of having a baby.  But I’ve also talked to moms that it wasn’t your stereotypical depression symptoms.  It was the loss of self, the loss of the lives that they had before they had their baby.  It was grieving the loss of social interaction, of attending things.  Maybe they’re the first in their group to have kids, so they’re staying out as late as everybody else.  Maybe they’re not attending everything that people in their friend group are.  And so it’s kind of that loss of self, loss of connection with others that brings on that depression.  And then you also have the kind of bipolar, and I forget the stats.  It’s in my book.  I apologize.  But the number of women that end up being diagnosed with bipolar for the first time during the postpartum period.  Bipolar can be kind of tricky and confusing because it kind of mimics the symptoms of depression, but it can also kind of mimic just plain adjustment things, as well as anxiety.  So your bipolar is going to kind of be the changes in mood, which any mom listening or any woman is going to be like, check.  In my experience, again, I want to give that disclaimer, it’s going to be to a level that causes probably distress, discomfort, and potentially, you know, maybe the risk-taking behaviors.  Your stereotypical bipolar might be overspending to the point where it impacts you paying your bills or risky behavior such as speeding or racing when you’re driving or, you know, for some people I’ve talked to, they would go on dates out of state without ever meeting somebody and did it spur of the moment.  Some risk-taking behaviors.  Bipolar postpartum can be kind of that changes in mood that causes probably more distress and things that might be a little bit more risky that you’re doing, maybe not paying as much attention to details, et cetera.  That’s what I would say for that.  I’ll be honest, I haven’t personally experience bipolar postpartum personally, and I also haven’t seen a lot of it when I’ve worked with people, so I don’t want to speak too much on that just because I feel like I haven’t witnessed it enough, if that’s fair to say.  And then as a final diagnosis – well, there’s two more.  The other one that we hear about and that gets a lot of media attention is the psychosis that, yes, can happen.  So the psychosis that can happen postpartum is kind of what you see on the media where it is true.  You know, parents feeling like somebody else is in control of their thoughts, or maybe a higher power wants their children or, you know, sacrificing things for a belief and whatnot.  So that can happen.  It’s pretty rare, and media hypes it up.  But it is a real thing that can happen postpartum.  And then you also have postpartum PTSD.  That’s posttraumatic stress disorder that is specific to the postpartum experience.  So you see this with women that might have a traumatic labor and delivery.  Complications happen, and some people are like, okay, what’s the difference between being anxious about that experience and it being PTSD?  You’re going to notice nightmares.  You’re going to notice fear or avoidance of the place where maybe the incident happened.  You might notice reliving it or reseeing it in your thoughts.  So that’s kind of what might differentiate a PTSD experience from anxiety, would be a traumatic experience to the point where maybe death was likely to occur, harm, you know, significant harm was likely to occur to yourself or someone that you care for.

Kristin:  Thank you for giving us a lot of these definitions because it can be confusing.  You also mentioned the husband and partner’s role.  So they can also experience postpartum depression or anxiety and so on?

Jasmine:  Yes, so this is where I get kind of nerdly excited, if I can say that.  So a lot of people don’t realize that any partner – so dads, it can be – and I have a podcast, as well, so I’ve interviewed an adoptive mother – any person providing direct care to the infant can experience a postpartum mood disorder, which a lot of people have historically thought would only happen to the mom because they thought it’s only hormonal changes that must bring this.  True, there are hormonal changes, but there’s a lot of adjustment for everybody involved.  So yeah, dads, I always include dads or other partners or same sex couples; adoptive parents, foster parents, grandparents at times or other family members that are kind of co-parenting with whoever that person is.  Anyone has a likelihood and a chance of having a postpartum mood disorder if they provide the direct care for that infant.

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Kristin:  Obviously, sleep deprivation for anyone caring for the infant can just bring that out even more.

Jasmine:  Yes.  We talk about that in the book.  Just in mental health in general – I don’t only work with postpartum women or perinatal women; I work with all age groups.  Literally, my youngest patient has been a newborn to my oldest being in their 70s so far, with a plethora of diagnoses.  So sleep you will see, whether you’re a parent or anybody else, is one of the biggest factors to your overall mental health.  So when you add in the sleep deprivation – and this is where parents, and I typically just say moms because I’m usually talking to them – they get annoyed.  “Sleep when the baby sleeps,” or “sleep when you can.”  But even when you do that, it doesn’t account for disrupted sleep.  So healthy sleep from what I’ve learned is consistent sleep without waking for, you know, a reasonable amount of time.  So even if these parents are sleeping in three to four hour increments, it doesn’t cover the loss of healthy sleep.  Now, it’s great if you can sleep, you know, those three to four hours, two to three.  I know when my daughter was born, it was one to two for a long time.  But there’s still going to be a deficit there, and that is going to impact functioning.  It’s going to impact your mental health.  And so that’s a huge factor that when I’m working with parents to see how can you get sleep, but also understanding that it might be really unrealistic for them to get good and healthy sleep, at least initially in the postpartum phase, and I personally experienced hallucinations after the birth of my second daughter because our one daughter wasn’t sleeping well through the night, and then we had a newborn that had some acid reflux issues and had to, you know, sleep upright, but she was waking up frequently.  So between two kids not sleeping well, that’s severe sleep deprivation to the point where I did start to hallucinate.  It was one week where I had just seen whatever, you know, black images or, like, stars that weren’t there, and it wasn’t from being dizzy.  I was like, okay.  I’ve got to get this sleep under control.  In my book, I tell you what I did to get sleep, which is something that I never thought I would do, but I ended up co-sleeping because it was the only way my acid reflux daughter would sleep for longer periods of time was upright on my arm, and it was something I was terrified to do.  As someone who was experiencing postpartum anxiety, and my fear of accidents, you know, this was against what I wanted to do, not from a judgy, like, you shouldn’t co-sleep, but just from my own well-being of having a conscience of being able to sleep would be like, don’t co-sleep.  You’ll feel better, you know.  You’re not putting your kid at risk.  But unfortunately, that was how I was able to regain sleep, so I did research, and there’s a lot of – you know, there’s websites out there if you feel like I did, like co-sleeping might be the best option for your family right now.  So that’s how I ended up.  I just had to make that choice of, okay, I truly need sleep.  This is to a point where it’s not okay, and for me, that was the best way that I could get it at that time.

Kristin:  And it sounds like you wouldn’t have felt comfortable even with an expert postpartum doula coming into your home due to some of the fears or, like, the buttons or caregivers having an accident and so on.  We do work with a lot of sleep-deprived families with day and overnight support, and that certainly helps, even with daytime stretches of sleep.

Jasmine:  I think to be honest – and if I look at now, I would say, heck, yeah, I want a doula.  Help me out.  I want all the help I can get.  I think if I were to think about then, the biggest barrier would have been lack of knowledge, more or less.  So as long as I was present – well, and this is what you’ll have to educate me on.  As long as I was present and I could micromanage, I did okay.  But yes, I guess you’re right; if a doula were to have been, like, go get some sleep, I have the baby.  I probably would have been like, no, that’s okay.  Let’s watch TV together.  You’ll energize me socially, and that will be fine.

Kristin:  And we do that.  I mean, every day can be very different.  Sometimes it’s newborn care.  Other times it’s mothering the mother and really focusing on their emotional needs or companionship when the partner or husband is away, and then we do light housekeeping and meal preparation during the healing phase or honestly any time, and sibling care.  So for some of our clients who didn’t want anyone else to hold their baby, we were still able to be helpful.

Jasmine:  Then I think all moms need a doula, or all families need a doula, absolutely.  Because those things are essential.  They really are.  I’m laughing about it, but it’s essential.  And if you look at other cultures, that’s what happens, right?  That’s where we get the phrase it takes a village because if you look at village societies, that’s what would happen.  You would have several women around, and I can say women because historically it was.  You would have several women around to help with all those, meal prepping or physical care if there was injury, helping with the home.  So the mother was being taken care of.  And we just don’t see that as much in our society with families moving away and people being more independent, and we’ve lost that for our moms, and now we’re wondering, why do these moms feel like it’s so hard or they feel so alone?  Well, a lot of them don’t even have grandparents in the picture if people have moved away or sisters, close friends.  We’re kind of losing that community aspect of the postpartum experience and expecting moms to get that – you know, take care of all their own needs independently now, and then they’re asking themselves, why can’t I do this?  Well, we didn’t used to.  We didn’t used to have to do this all by ourselves.

Kristin:  Exactly.  And depending on the culture, it’s caring for the mother in the first 40 days.  In some, it’s six months.  Some even longer.  And you’re right; it’s family members, friends, anyone in the community, focusing on their emotional needs and the household tasks as well as the newborn.  So yeah, that is a very important thing that is lacking in our culture here in the US.

Jasmine:  Yeah, we have a close neighbor from Bangladesh.  I had talked to her one day about the differences and what she was seeing with me versus her own experience, and she’s much older than me, so I’m sure it’s even changed in her country since she’s been here.  But, you know, she was saying that she had two or three people in her home that were paid that helped to do all the meal prepping, to take care of her baby and her other child, to allow her to sleep, to help with the household tasks, to get things done, to do laundry and cleaning.  And I’m like, oh, my goodness, and I just fantasized about it for a minute.  Like, what would that look like here in Zeeland, Michigan for me?  I would love it, but we just don’t see it as much.

Kristin:  No, we don’t.  So what other tips do you have for our listeners and clients about caring for yourself in that postnatal phase or identifying signs of postpartum mood disorders?

Jasmine:  One of my biggest things that I wrote about is in the chapter Slipping Through The Cracks, and what I realized with talking to a bunch of friends – because once I realized I was suffering, I became this open book and talked to as many people as I could that were comfortable and willing to talk and just got some feedback.  What we noticed is many of us had a diagnosis; definitely would have qualified for a diagnosis, but kind of slipped through the cracks.  We kind of went untreated and suffered silently for a long time without even realizing it.  And so one thing that I make sure to let moms know, and I say moms here because they’re typically the ones given the questionnaires, is the questionnaires that you get at your checkups or after you have your baby or even at the pediatrician’s office – don’t count on them to be the determinant of your mental health.  So if we think about the Edinburg or the other depression screening, people kind of think, okay, if I pass these screenings, then I’m good.  Right?  I’m good.  Nothing was picked up.  Well, that’s true because a lot of my symptoms and a lot of the symptoms that I’ve talked to other women that we experience were not things that would have been picked up on your questionnaire.  My close friend who had body dysmorphia and was grieving the loss of her life and independence – those weren’t the questions that you’re asked.  She’s like, well, no, I don’t want to harm my baby.  No, I don’t want to cry.  I’m happy I have my baby.  I’m happy I’m here.  I’m not sad.  I’m not crying.  But she still was really struggling with the changes of her body.  So some people think, okay, if I “passed” this questionnaire, then I should be good, and that’s not true.  How do you feel?  You know, what’s it feel like day to day?  I know for me, a lot of the questions for the anxiety that are brought up in the postpartum questionnaires use the term – what is it – unreasonable worry or something along those lines.  Something that makes it seem like, you know, you shouldn’t be worrying.  Well, that’s going to kind of deter a lot of moms from answering that at times because when you’re a new mom, it feels reasonable to worry.  So when you see questions that say, you know – I forget how it’s phrased, but something about unreasonable worry – those questions didn’t screen for me because in my mind, I have an infant in the winter during flu season, during RSV, so my doctor is telling me I should be worried.  My doctor is telling me not to go in big social places.  And this is before the pandemic, even, so imagine that.  For a lot of these moms, having babies during the pandemic.  A lot of these screenings won’t pop up because we’re told we have to worry.  We leave the visit with a whole page worth of things to make sure you do this in your home and make sure you’ve done this and make sure you baby proof that.  So when you use those words, it can distract the mom from feeling like I should answer this positively or yes because no, I’ve been told I need to worry.  A lot of those questions didn’t ring for me or have a red flag because as a good mom, you worry, right?  You want to make sure your home is ready for a baby and they only have a crib sheet and all these things.  So I tell people, yes, answer the questionnaires, absolutely, because a lot of people do get screened on those positively, and that’s good.  We want that.  But there’s a lot of people that are missed.  How do you feel?  What does your partner say about you?  Is your partner noticing anything?  Allowing your partner; having the conversation before that baby is brought into your home, allowing your partner the freedom to let you know when something’s up and opening up.

Kristin:  So helpful.  They know you better than anyone else, so they can tell the change.

Jasmine:  Right.  And a lot of partners that I’ve talked to – because I told you, I became an open book and I talked to dads and everybody – you know, a lot of partners will say, well, they’re the mom.  This is kind of natural for them.  I just kind of follow their lead.  I guess I was just kind of assuming they would let me know.  Well, for me, even being a therapist, even having the training, I was so blinded by my own mental health that I didn’t see it.  And let me tell you, another big fear that I had as an intrusive thought was somebody abducting my kids.  I was looking out the windows multiple times at night.  My daughter was born in January so there was snow.  I was looking for shoe prints outside our windows.  That is classic anxiety OCD that is completely unrealistic.  Even I, doing those behaviors, it didn’t ring to me.  It was like, no, you have a baby.  This happens.  You’ve heard about it on the news, so it can happen.  You start to justify if you’re really in the thick of it, and you really might miss it yourself, even with the best of intentions.  I didn’t want to go undiagnosed.  I talked to my partner before we had our daughter.  Hey, I have a history of anxiety.  This might really flare up when we have our daughter.  Still, I didn’t catch it.  So I just tell people, how do you feel?  Listen to your partner.  Listen to your friends.  If you can, allow open dialogue because they might see it before you do, and just believe them.  If they’re good-natured people, if they’re people you’ve trusted and you’ve loved, just believe them.  I don’t think they’d have harmful intent.  There are harmful people out there, I’ll give you that.  There’s harmful family members.  But I’m saying if somebody that you love and trust is giving you feedback, then believe.

Kristin:  Yes.  So how can our listeners who live all over the world find help in their area if they are experiencing any perinatal mood disorders, whether it be support groups, online resources, or finding a therapist?  What should they be looking for?

Jasmine:  My go-to site is Postpartum Support International.  I did all my training through them, and that is where I go to refer everybody because they have ways to search for therapists locally.  They have online support groups for people all over the world.  They’re basically, in my opinion, your kind of go-to website to get connected, to get support.  They have a help line.  They have all sorts of resources and are kind of the leaders in this field.  So that’s simply where I would refer people if we’re thinking about just in general, if anybody is listening all over the world, would be to go to Postpartum Support International.

Kristin: Perfect.  And then when searching for a therapist, or if they’re getting a referral from their provider, what sort of specialties should they be looking for?

Jasmine:  For anyone interested, I say to make sure they are trained in postpartum mood disorders or perinatal mood and anxiety disorders.  If you go to that website, they will give you a list of clinicians, many of which can do telehealth now, thank goodness.  From the pandemic, that has been a benefit is allowing access that way.  Anybody that’s been trained through that program, and I believe they’re the only program that can train people, at least right now in the United States, to get that, to say that they’ve been trained.  So if you look, that’s where you’ll get a list of therapists that would meet that specialty and criteria for being trained in postpartum mood disorders or perinatal mood and anxiety disorders.

Kristin:  Perfect.  So Jasmine, how can our listeners connect with you personally as well as your book?

Jasmine:  My book is on Amazon, so you would just go to Amazon and type in The Postpartum Therapist, and then my name, Jasmine Emerick, and it will pop right up.  I do have an email, which is postpartumtherapist@gmail.com.  I’m on Instagram.  This was new for me, so I’m a little bit older in regards to being friendly to Instagram, but I’m learning.  So I started an Instagram that is specific to my book, so that would be another way to connect.  Then I would say if you just want to listen – one thing I did – the reason why I did a podcast was because what I learned is even though we’re all moms and maybe we can attach these labels of “I had postpartum anxiety” or “I had postpartum depression,” many of us experienced it very differently from each other, so I wanted to interview different moms to show that my experience is not representative at all of all of us or even many of us.  We all have our unique experiences.  Another thing is that if you search on iTunes The Postpartum Therapist, I have a podcast that I’ve started where there’s many moms on there that share different backgrounds, different diagnoses, and what they’ve experienced as a way to help connect and kind of fill the gaps and help moms realize they’re not alone, no matter what their symptoms are.

Kristin:  Wonderful.  That’s a great resource for doulas, as well.  Thanks so much for your time, Jasmine.  It was so great to connect with you, and I appreciate all of the important work you’re doing.

Jasmine:  Thank you so much.  I appreciate it.

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