Gayle MacBride Of Veritas Psychology Partners: 5 Things Everyone Should Know About Postpartum Depression

An Interview With Jake Frankel

Breast is sometimes best — I’m a big believer in breastfeeding and frankly for many of us it releases the chemical oxytocin which is a “love chemical”. There can come a time when breastfeeding causes more harm than it provides good. Allowing ourselves to be flexible and sometimes “just good enough” goes a long way to parent and baby happiness. Oxytocin is a chemical that is released during breastfeeding and can be essential to coping with the stress of parenting an infant. This special chemical can increase bonding between mother and baby. Societally we have come to expect, sometimes demand, or even shame, a birthing parent into trying to breastfeed and infant. For some parents a lactation consultant or coach can prove to be essential. Even with this kind of intervention and support some individuals experience significant distress with breastfeeding, milk production, etc. Sometimes it is best for parent and baby to switch to another method of feeding, decrease the feeding stressors, and focus on other wins.

Postpartum depression affects millions of women worldwide, yet it remains a topic that is often misunderstood and stigmatized. Through this series, we aim to shed light on the various aspects of postpartum depression, including its symptoms, causes, treatment options, and the impact it has on individuals and families. As part of this series, we had the pleasure of interviewing Gayle MacBride, PhD, LP.

Gayle MacBride, Ph.D., LP, is a licensed clinical psychologist with over twenty years of experience that ranges from working at a state hospital, the Department of Veterans Affairs, teaching graduate psychology classes, working in a large primary care setting, and recently co-founding a telehealth private practice: Veritas Psychology Partners. Dr. MacBride offers a straightforward, honest approach to working on the things that keep us up at night, which include insomnia, trauma, anxiety, parenting, relationship issues, and work stressors. In addition to all the above, she is a wife and a boy-mom of two teens.

Thank you so much for joining us in this interview series. Before we begin, our readers would love to “get to know you” a bit better. Can you tell us a little about yourself?

I fell in love with psychology in high school; attended Eastern Michigan University and completed a doctoral degree at the University of Toledo. Along the way I got married to a wonderful guy who agreed to get dragged around the country as I finished grad school, then internship/fellowship, and getting my first psychologist position. Having children also gave way to great personal growth and learning. Despite having completed 21st grade, being a parent has taught me more, humbled me more. Becoming a mom has connected me to a special group of people that call themselves “parents” and joining this group has brought me a great deal of connection and validation. As I navigated infancy with my first child, I marveled at how our species has done this for millennia and yet it felt like I was inventing the process and experiencing it for the first time. It also meant that I had to come to terms with Baby Blues and hormonal shifts. I’m forever grateful to the friends that sat on the phone with me while I lived in another state, about 12 hours away. They let me cry and sometimes say things that were not rational (like the belief that I’d let my baby down because he had diaper rash — yup, not rational as I look at it now, but then, it felt like reality).

It’s this experience and sense of belonging that sparked a passion in me to focus on supporting other new parents as they navigate the post-partum period. I’m past that time of my life but empathizing with my clients as they take on this journey brings me back to my own joys and struggles. This is a period that is equal parts beautiful and terrifying!

These days my husband and I are raising two teen-aged children. The sleepless nights are mostly a memory. Now we enjoy traveling together. I love that these guys are growing up with distinct personalities and interests, but I must admit there are those days that I miss those babies!

Ok, thank you for that. Let’s now jump to the primary focus of our interview, about postpartum depression. Let’s start with a basic definition so that all of us are on the same page. Can you please tell us what postpartum depression is?

One of the things I love about psychology, is how there is always a clear description, definition, or outline to work with; but life is often more complicated than that. Ultimately, as a clinician, I have to go with the Diagnostic and Statistical Manual Fifth Edition — Text Revision’s (DSM-5-TR or DSM) definition, which outlines postpartum depression as a depressive episode that occurs during pregnancy or in the four weeks following delivery. But I also tend to be a bit broader and more flexible when working with this in my office because people don’t usually fit into neat boxes, with textbook presentations. The DSM 5 calls postpartum depression, “major depressive disorder, with peripartum (or around the time of birth) onset.”

A major depressive episode is diagnosed when the individual is experiencing depressed mood or loss of interest or pleasure for two weeks or more, while also having several additional symptoms such as significant changes in weight or appetite, either sleeping more or less nearly every day, feeling like you are moving more slowly than usual or the opposite, being restless and fidgety, fatigue, feelings of worthlessness or excessive guilt, problems with concentration, and thoughts of want to no longer be alive. Many are surprised to hear that half of postpartum major depressive episodes begin before delivery. Since some of these symptoms are also the experience of most parents who have a newborn, it can get a little tricky differentiate between typical experiences and postpartum depression. While the DSM distinguished between depression and “baby blues”, in practicality they are often treated similarly. Many, including myself, see postpartum depression as any depressive episode in the first year after childbirth. Another concern that is sometimes overlooked is the anxiety that can accompany postpartum depression. In my clinical practice this can be absolutely tied to the perinatal and can and should be treated in similar ways.

Can you discuss some common misconceptions about postpartum depression and why they are harmful?

• It’s just the Baby Blues — This invalidates the mood shift that comes with pregnancy and birth. It diminishes it to “just hormonal” and minimizes the importance of getting treatment. It suggests that mood will naturally improve a few weeks after the baby is born. This can result in the birthing parent delaying treatment that can be critical for both that parent and the baby. All of this said, Baby Blues is a “thing”, and it can be an appropriate label, but should be applied correctly and not assumed. Let a professional help you figure out the difference.
• It starts right after birth — at least half of the time perinatal depression begins before delivery or months after childbirth. Many clinicians consider postpartum depression to occur anytime in the first year after birth. This is a big window of time in which postpartum depression can set in. Not recognizing how large this window of time can be can also lead to dismissal of symptoms or delays in treatment.
• It goes away on its own — postpartum or peripartum depression is a treatable medical condition. Let me say that again, it’s a treatable medical condition that should not be ignored. If you simply try to cheer someone up or talk them out of it this can result in delays of medically necessary treatment. Such delay can disrupt the parent’s ability to care adequately for their infant and may disrupt bonding and attachment time.
• It can’t be Postpartum Depression, if you are not crying all the time — While some may cry outwardly others may present more numb, irritable, or angry. Some find it a challenge to cope with even minor stressors, stay in bed all day, find they have little interest in their new baby. Other parents may lose appetite or experience significant sleep disruptions or other similar symptoms.
• Postpartum depression only affects the parent who gave birth — in families who have experienced childbirth together, a non-birthing parent may also experience postpartum depression. While this won’t be the same kind of (likely biologically based) depression that a birthing parent experiences, it is considered a form of postpartum depression. The likelihood of the non-birthing parent experiencing depression increases if the birthing partner is also experiencing depression.
• This could have been prevented — While we can take steps when postpartum depression is a known risk, these measures do not always work to prevent depression. Known risk factors, include a history of depression, or postpartum depression. Knowing these risk factors doesn’t mean you will have depression and it doesn’t mean that you didn’t do something right if you don’t have those risk factors and you end up developing a depressive episode associated with childbirth. The best thing you can do if you know you have risk factors for developing postpartum depression is to have a mental health professional ready to help. Often birthing parents have a “birth plan” that outlines for medical professionals how they want their birth to go, maybe consider a similar plan for after baby arrives.
• Postpartum depression means you want to hurt your baby — In postpartum depression the biggest risk is usually to the mother and not the infant. When thoughts of harm to the baby are present it is most likely postpartum psychosis. This disorder is rare and very different from postpartum depression. Due to this misconception and misunderstanding many birthing parents are worried about sharing their depression symptoms with their provider for fear of judgment or even having their baby taken away. This misconception is understandable given the lack of accurate portrayals of postpartum depression in the media who tend to show only the most extreme cases of postpartum mental health crises.
• You’re a bad parent — This is blatantly false. Postpartum depression is caused by internal imbalances, including chemicals, hormones, as well as other psychosocial factors. The feelings of failure as well as the negative self-talk are a result of that depression and not a reflection of your ability to parent. Furthermore, it does not mean that you love your baby any less than a parent without depression.

Can you explain the role of hormonal changes in postpartum depression, and how does this influence treatment approaches?

Post-childbirth is a time of significant hormonal changes, including disruptions in estrogen levels. This suggests that depression that begins right after childbirth may need to be treated somewhat differently than postpartum depression that begins several months after childbirth. In fact, this may suggest that these are slightly different depressive experiences. For some birthing parents, postpartum depression may be treated with a course of medications and/or hormones. For other birthing parents, depressive episodes that occur after four months and before one year after childbirth, a combination of medications and talk therapy may be most effective. In my clinical practice one of the first things that I assess is the sleeping schedule for all caretakers and evaluate their perception of their social supports. These are often things that we can do quite quickly to decrease depression symptoms and increase a birthing parent’s sense of normalcy. If you think about the symptoms I talked about before, how many of them could be resolved or improved with some quality sleep? With sleep and social supports in place I try to spend a lot of time normalizing what they are feeling and assuring clients that there are a lot of “right ways” to raise a baby and take care of a person after the birthing process. We try to use culture and available resources to decide what is right for each person, not necessarily what they read in a pregnancy books or “hacks” their friends swear by.

How does postpartum depression impact the bonding between a mother and her baby, and what interventions are available to address this?

Postpartum depression can cause serious disruptions in bonding between parent and baby. This depressive period can cause the parent to misperceive infant behavior. A birthing parent may misjudge or over-interpret baby’s signs colored by their depression or they might miss cues and signs because of their withdrawal. For example, a depressed parent may struggle to see the baby’s milestones and increase socializing behaviors or view baby’s cries as dissatisfaction instead of asking for food and telling the parent they need a diaper change. Depressed parents tend to internalize the cry to mean that aren’t doing enough or good enough when in fact, this is your baby finding its voice and learning how to communicate. Depression can also distort the perception of time, which may delay a parent’s ability to react in a timely way to baby’s needs. Feeding your baby can be a wonderful time to get some skin-to-skin contact between parent and baby. A lack of interest might result in a parent decline to or stop breastfeeding. You may see a depressed parent struggle with engaging in nurturing behaviors, such as cuddling and making eye contact. This can affect the child’s developmental trajectory including a sense of security and trust, babies need to learn that when they cry a caretaker will come to help them. Early identification and intervention are key to a good outcome for parent and baby.

Interventions are going to include a range of options depending on what is best for the parents, the baby, and what is available in the community. Cognitive Behavioral Therapy (CBT) and interpersonal therapy (IT) are typical places to start when it comes to talk therapy. It may be also helpful to introduce family/couples therapy to address the major life change that has just occurred. The parent may discuss medications, including hormones with their prescribing provider. They may benefit from support groups and parenting programs. There are in home visit options that allows professionals and trained volunteers intervene right in your own home. Finally, self-care, making sure the birthing parent is taking time for sleep, eating, physical activity, and even basic hygiene go a long way to intervening with postpartum depression. I can tell you how much it means to be able to take a shower without the baby strapped in a car seat, in the bathroom with you.

What are some of the best ways to treat postpartum depression?

Interventions always start with early detection and least intrusive intervention options. Some parents will be responsive to medication and social supports. Others benefit from setting realistic expectations for themselves, including rest, recovery, and sleeping time.

Cognitive Behavioral Therapy (CBT) is a useful approach that identifies negative thought patterns and beliefs that may be developing from, contributing to, and sustaining the postpartum depression. Helping birthing parents develop more realistic and accurate thoughts as well as healthier coping mechanisms has been shown to be quite useful. CBT also emphasizes behavioral activation and helps birthing parents develop a plan to engage in activities that can promote positive mood and well-being. This can often give a natural chemical boost or lift, such as the endorphins that come with a period of being physically active.

Interpersonal Therapy (IPT) is another therapy approach that attempts to help the birthing parent work on interpersonal relationships and social supports. Its aim is to improve communication skills, address any relationship conflicts, or problems that are arising from the transition to parenthood that may be contributing to depressive symptoms and improve the parent-baby relationship.

Another form of treatment is called Dyadic Therapy. This focusing on treatment the parent and the infant together. This intervention attempts to understand the family system and help parents meet baby’s physical and emotional needs. It teaches parents to attune to their infant’s internal world, including their experience of security and an infant’s belief that someone will when they are in distress.

In addition to individual therapy options there are options that include education, group programs, peer led support, and home visiting interventions.

Based on your experience and research, can you please share “5 Things Everyone Should Know About Postpartum Depression?”

1 . First and foremost, postpartum depression is treatable and does not mean that your baby is going to be “scarred forever”. I probably offered this advice first because it was what I wanted to hear in the throes of my “diaper rash” melt down that I talked about earlier. It was so helpful to remember that this instance wasn’t going to forever change the course of my baby’s well-being (and 15 years later, I can promise you, it didn’t have any significant impact on him at all). In the throes of postpartum depression, it can be hard to see that what you’re going through has a name, a treatment, and won’t last forever. Remember, the prevalence rate of this condition is relatively high. Many parents are dealing with the same thing. Parents can experience an irrational worry that because they had this type of depression, they irreversibly harmed their child because, when this is rarely ever the case. Early detection and intervention can improve the relationship quite quickly. Remember, babies are resilient.

2 . If you think you might have or develop postpartum depression, seek out a therapist or trusted medical professional to make sure you are properly supported during the perinatal period. I am always pleased when a client comes to me and shares that they wish to get pregnant or are already pregnant, and not experiencing depression, but want to engage in prophylactic therapy with someone who can follow them on their pregnancy and childbirth journey. Typically, these are parents that I will see for the duration of the pregnancy and for as long after as needed (often three to six months post childbirth). Knowing that you have a risk factor like previous depression or even anxiety may be an indicator that you want to begin working with a mental health professional a little sooner than not. Getting ahead of any possible symptoms of depression is often empowering and helps reduce any delays in obtaining necessary treatment.

3 . Breast is sometimes best — I’m a big believer in breastfeeding and frankly for many of us it releases the chemical oxytocin which is a “love chemical”. There can come a time when breastfeeding causes more harm than it provides good. Allowing ourselves to be flexible and sometimes “just good enough” goes a long way to parent and baby happiness. Oxytocin is a chemical that is released during breastfeeding and can be essential to coping with the stress of parenting an infant. This special chemical can increase bonding between mother and baby. Societally we have come to expect, sometimes demand, or even shame, a birthing parent into trying to breastfeed and infant. For some parents a lactation consultant or coach can prove to be essential. Even with this kind of intervention and support some individuals experience significant distress with breastfeeding, milk production, etc. Sometimes it is best for parent and baby to switch to another method of feeding, decrease the feeding stressors, and focus on other wins.

4 . Sleep when you can get sleep — In my opinion and experience “sleep when baby sleeps” can be a pie in the sky ideal. This adage can be impractical to nearly impossible for some, if not many. Many of my clients report that they are not able to sleep during the day (“I’m just not a napper”). They feel compelled to do other things, like shower or even feed themselves while the baby is sleeping. If it’s a second baby and you have another toddler at home, sleeping when the infant is sleeping is not reasonable because you have another one little one to look after. More importantly, make a good workable plan for each partner to get some quality sleep each night, even if it’s a five-hour stretch and a two-hour snooze later. It may not be as much as you wish, but having a plan and some support to get adequate sleep most nights can vastly improve your ability to cope with the stressors of becoming a parent.

5 . There’s no training for this — if you consider the world’s most difficult professions such as, astronauts, firefighters, military personnel, etcetera, none of these people are expected to do their jobs without significant amounts of time spent in training and simulation. In some cases, this training lasts years and includes hours upon hours of simulated practice. One of the biggest stressors in life is becoming a parent. I would also argue it is one of the most important jobs we can hold. If the above is true we also need to recognize that we are relatively ill prepared and ill trained to do this job without stumbling and getting a few things wrong. Give yourself some grace, the training for this job was limited. No fighter pilot ever got the job by reading the instruction manuals alone. Remember good enough is enough.

What are some practical strategies for supporting a partner or loved one experiencing postpartum depression?

First, support and validate their feelings. Saying things like “you should be happy” or setting unrealistic expectations about this being the happiest and most fulfilling time of life can only serve to increase the pressure. These comments may also result in the birthing parent further hiding their feelings or symptoms from you.

Encourage your loved one to engage in self-care. This is a very demanding time for a birthing parent. Their body has not only undergone the necessary changes to grow a small human, but it has also now given birth to that human. This is an incredibly emotional and physical task. Now that the tiny human has been brought into the world (presumably successfully), there are more demands because that little human cannot survive without its parent. It is critical to make sure the birthing parent is getting good sleep, a refreshing shower, time to eat a meal that isn’t a few bites here and there, and some alone time. The latter being important because breastfeeding parents often feel as though their body is not their own anymore and having some alone time, even if it’s just showering without the baby in a car seat on the bathroom floor, can help that parent reconnect with their body.

Help out. Do more than you used to and be flexible about the previously agreed to chores around the home. This might mean that the non-birthing parent takes responsibility for dinner over the next couple of months. You can help the birthing parent by making small decisions and reducing the decision-making mental load.

Set your ego aside. Sometimes birthing parents, especially those who are struggling with depression may say things they would ordinarily not say or mean. They may also have withdrawn, due to the depression, not because you have done something wrong. Not taking it personally can help keep the situation from getting more complicated. This does not mean that if they snap at you or say something inappropriate that you shouldn’t respond at all, just keep your tone even and matter of fact while you give them some grace.

Just be there. Notice when your partner is doing something good or great and comment on it. Ask the birthing parent what they need, including asking what words they need to hear for reassurance and say them often. Be willing to sit in silence and not necessarily “solve” anything, including their mood. Sometimes I tell my clients “You are a good mom” and I can see that those words mean a lot. Another way to “be there” is to not just ask about baby’s wellbeing, but also the parent who gave birth. Often after baby comes into the world, the parent fades into the background.

Keep expectations realistic. The more realistic you are, it will help someone with postpartum depression also keep their expectations in line. I remember this moment after the birth of my first child and I was on the phone talking with my mother-in-law. She asked me how I was doing, and I explained to her how I had “not gotten anything done that day.” I proceeded to recount a list of things that I hadn’t accomplished including, dinner, laundry, house cleaning, you get the picture. She very quietly asked me if I had taken care of her grandson. Had I fed him, held him, put him down for naps, you get the picture. Of course I had. She reminded me then that my full-time job while I’m maternity leave was to be a mother, not a housekeeper, and that’s what I had done that day. It’s been more than 15 years since that phone call. I treasure it to this day.

Find support for you. If your partner has postpartum depression, it’s important that they get treatment right away. However, this can be a very difficult time for the non-birthing parent as well. This parent is also at risk for a form of postpartum depression. So, as you are supporting the birthing parent also make sure that you are getting help for yourself as well.

Last, the above is all extra complicated if you underwent the process of birth but were not able to bring home a healthy baby. Some families experience infant loss and are never able to bring their child home, or that infant is in the NICU, or has significant health concerns at birth that complicate or intensify the above. Regardless of outcome, the birthing parent has still undergone huge hormonal shifts, the physically and emotional process of birth, and on top of it all they may also be trying to process the associated grief. It is important that we keep in mind that postpartum depression will complicate the associated grief and/or anxiety and vice versa.

What are some cultural or societal factors that may contribute to the prevalence and experience of postpartum depression, and how can we address these effectively?

Socioeconomic status — including low income. Increasing the financial demands on an already lower income household can significantly contribute to the experience of postpartum depression. This can range from “how I afford formula” to “I’ve had a C-section and can’t return to a job that is very physical.” Not having the financial resources to sustain oneself during the postpartum period is extremely stressful. Obviously, there are programs in place to help new families, but often these programs are not comprehensive enough and may exclude those who live on the margin of “making it” to poverty.

Relationship discord — If the relationship between the birthing parent and the non-birthing parent is tense or stressful it can increase the likelihood of postpartum depression. If your relationship is experiencing this kind of stress, it may be useful to seek talk therapy or mediation to help you navigate what is surely going to create additional complexities, parenting.

Social isolation — The postpartum period can be an incredibly isolating time especially with the concerns of a pandemic, new parents often do not want to take their newborn child into more public spaces or social gatherings for fear that an infant with little to no immune resources may become susceptible to illness. Furthermore, as our population is more mobile around a large nation, we can find that people have moved further away from family and others that social support resources. Interestingly, it is not the actual lack of social support that contributes to postpartum depression. It’s merely the perception of the lack of support. This means you can have those supports available, but if the birthing parent doesn’t feel supported by the system in place, their risk may go up.

Birth related complications — If a birthing parent experiences complications with the infant’s birth and delivery their risk of postpartum depression increases. There are socioeconomic/social factors that influence this. We know that prenatal care is critical to having a relatively uneventful and successful birthing experience. If you are unable to obtain adequate prenatal care due to finances, availability of care, even cultural misgivings about the medical community, there may be an increase for an experience of postpartum depression. Societal education about the importance of prenatal care and parent well-being during the prenatal period can help decrease birth related complications.

Substance abuse — As our nation is undergoing an epidemic of substance use, specifically opiates, we find more and more birthing parents struggling with their own substance use disorders both during the prenatal and post-natal period. Making sure to have adequate supports in place so that birthing parents can remain sober, and they have a perception of adequate social support can help buffer any additional substance use disorder related stressors that would increase depression risk.

Gender preference- Some cultures may prefer a male gendered baby. This perception about a male gendered baby being able to “carry on the family name” or other gender related beliefs about male babies may increase risk of the birthing parent feeling as though they have failed their partner in some way. Making sure to continue to destroy gender-based biases and empowering individuals can help shift societies preference for male children.

Unplanned pregnancy — If a birthing parent was not expecting to become pregnant many of the above stressors compound to create an increased risk of postpartum depression. One of the ways that we can assist the birthing parent with postpartum depression is ensure that all options remain available to that birthing parent. This means making available contraception as well as the ability to choose your path when the pregnant person does not wish to remain pregnant. The availability of these choices varies from state to state. The socioeconomic stressors that occur when a birthing parent delivers an infant when they are not prepared or did not want this baby continue to be a larger burden on our community as a whole. It is also imperative that all sexual partners have adequate education and comfort discussing birth control options at the time of sexual intercourse. The responsibility and availability of birth control methods should be equally offered to anyone involved in a sexual relationship come up regardless of sex or gender.

You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

If I could start a movement that I thought would bring the greatest good to the greatest number of people, it would be about equitable access to nutrition. This would ensure that every person, regardless of socioeconomic status or geography would have access to healthy and nutritious food. This is an effort that would eliminate food deserts, support sustainable agriculture, and make sure that everyone had equal equitable access to healthy food options in and affordable way.

Equitable access to healthy food would require expanding farming efforts to urban gardens where access to healthy food can be limited. It would ensure that all populations had accurate education about nutrition, with a focus on underserved communities. Policymakers would create incentives for stores to offer fresh and healthy foods that support their local farmers and provided this at affordable prices. This advocacy would also extend to how stores managed food waste and make this available to the public in meaningful ways, instead of adding it to landfills. This plan would provide access to appropriate technology that would increase the efficiency of food production and distribution as well as appropriate access to adequate agricultural equipment in underserved communities. Finally, because this is a community wide effort, there would be local, grassroots efforts to give community agency and ownership over their local food sources. For example, what they grow in local gardens and co-ops to ensure that foods being grown we’re recognizable and culturally appropriate.

How can our readers further follow you online?

https://www.veritaspp.com/

https://www.tiktok.com/@drgmacbride

https://www.instagram.com/drgmacbride/

https://www.facebook.com/drgmacbride/

https://www.linkedin.com/in/gayle-wuttke-macbride-80678682/

Our new podcast! https://www.veritaspp.com/podcast

Thank you for the time you spent sharing these fantastic insights. We wish you only continued success in your great work!