Podcast: Postpartum PTSD: What Parents Need to Know

Lauren Sippel, PhD, is the Deputy Director of the Northeast Program Evaluation Center in the Department of Veterans Affairs and an Assistant Professor of Psychiatry at the Geisel School of Medicine at Dartmouth. She co-leads the ADAA PTSD Special Interest Group. Her research focuses on improving the quality and effectiveness of psychotherapies, particularly those for PTSD, using strategies such as medication augmentation and family involvement.

Our host, Gabe Howard, is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author. Gabe is also the host of the “Inside Bipolar” podcast with Dr. Nicole Washington.

Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without. To book Gabe for your next event or learn more about him, please visit gabehoward.com.

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Hey everybody, welcome to the podcast. I’m your host Gabe Howard. Calling into the show today, we have Lauren Sippel, PhD. Dr. Sippel is an assistant professor of psychiatry at the Geisel School of Medicine at Dartmouth and the chair of the Anxiety and Depression Association of America, or ADAA, PTSD Special Interest Group. Dr. Sippel, welcome to the podcast.

Lauren M. Sippel, PhD: Thank you so much for having me, Gabe. I’m thrilled to be here.

Gabe Howard: Well, I am really glad you’re here. Now, before we get started, I want to give a big shout out and thank you to Evernorth Health Services, who provided funding for this episode. But back to our guest. Today’s topic is postpartum post-traumatic stress disorder, or postpartum PTSD. And I want to be very transparent with you that I wasn’t aware that postpartum PTSD even existed. And I imagine if I wasn’t aware, there are many people who could be experiencing symptoms who also aren’t aware. So let’s go ahead and just do a quick rundown of what postpartum PTSD looks like.

Lauren M. Sippel, PhD: Gabe, I’m so glad you asked this. I mean, you are absolutely not alone in being unfamiliar with this phenomenon of postpartum PTSD or post-traumatic stress disorder. This is, like many issues related to reproductive health, a very poorly understood and very likely under-identified phenomenon among women. You know, when people think of PTSD, they appropriately usually think about folks who are experiencing symptoms related to things like sexual assault or military combat, and those are highly likely to lead to PTSD. But when folks think about postpartum PTSD, they think, well, as long as a healthy baby, you know, as long as there’s a healthy baby and a healthy mom at the end, what could be the problem? And really, what is sort of missed in all of that is that there is so much that goes into the birth experience and really the entire perinatal experience, which can mean everything from during pregnancy to the time after delivery. That can actually meet the criteria for PTSD. And so when you think about from a, from a scientific perspective, like what does it mean to experience a trauma? Because that term is thrown around a lot, you know, in our culture it essentially means an experience that included threatened death or serious injury to oneself or witnessing threatened death or injury to someone else.

Lauren M. Sippel, PhD: And there are, again, many, many aspects of the birth experience and the perinatal period that can include threat to the mother and or threat to the child. And so at the end of all of this, it may be that moms who are experiencing postpartum PTSD have the same kinds of PTSD symptoms that you see related to other kinds of traumas. So things like having nightmares having really intense memories of the of the experience, avoiding things that remind them of the experience both inside their minds, like memories and thoughts and feelings, and also stuff outside of them, like people and places and things. And certainly some of the arousal symptoms, as we call them. So trouble sleeping, feeling kind of really amped up. So in many ways, postpartum PTSD looks a lot like your other forms of PTSD, if you will, related to other types of traumas.

Gabe Howard: One of the things that I hear when I interview any researcher, doctor or any sufferer of postpartum psychosis or depression is that they’re not allowed to experience any symptoms as long as the baby is healthy. There’s this idea that mom did her job by bringing life into the world, and now it’s no longer about her. And any attention that she draws to herself is attention that she’s drawing away from the baby. So my very specific question, and the reason that I gave you that little bit of background, is, is it the same for postpartum PTSD that, you know, mothers are suffering, but they can’t get any help because if they ask for help, they’re being bad moms.

Lauren M. Sippel, PhD: I think that’s entirely possible. And I and well, I’m sure I know that it’s true for many folks. And I think there’s a lot of stigma, right, to acknowledging that in this postpartum period when you have a healthy baby. And of course, that doesn’t that isn’t always the outcome, right? Like moms can experience postpartum PTSD. And there has been some type of, you know, objective and legitimate injury or outcome for the baby or the mom, and then people can kind of get it, but they still may not really understand sort of the depth of the experiences.

Gabe Howard: It’s a very fair point. But of course, if there’s an injury to the baby, then the mom is even less likely to want to get support. I just it really seems like and again, you can tell that I’m both male and have no children, but it really seems like once the baby arrives, nobody cares about mom anymore, including mom.

Lauren M. Sippel, PhD: It is it is a and as a mom, and I’ll try not to obviously reflect too much of my own experiences, but it’ll it’ll pop up here a few times as we’re talking because it’s only I’ve always been interested in post-traumatic stress disorder research and treatments, and I’m well trained in all of this. But becoming a mom has made a lot of this so much more salient to me. And I think that your observation that in that period after the baby is born, the mother’s life is sort of just kind of I mean, even when she’s pregnant, you know, there’s a lot of sort of dismissal of the mom’s experience as long as the baby is okay. And I think that can absolutely be a barrier for the mom seeking treatment. It’s very easy for mom to self-dismiss or other people to dismiss. Mom is just having the baby blues, or you’re just getting used to being a new parent. Oh, everything’s going to be fine. But look, the baby’s healthy. What do you have to worry about? Meanwhile, mom is vigilant for every single sign of a threat to safety. Meanwhile, mom is so afraid to let baby out of her sight that something terrible might happen. Meanwhile, you’re having normal bleeding after delivery, and mom is, you know, freaking out that something is really, really wrong with her. And unexplained bleeding is very common during and after delivery, and yet it can be a sign of something terrible. Or it could be. Absolutely not. And so that, that limit between sort of what is actual threat and what is perceived threat is especially salient when it comes to postpartum PTSD, and I think it’s one of the many things that contributes to women being underdiagnosed, misdiagnosed, kind of dismissed altogether. And you’ll figure it out.

Gabe Howard: There is this general attitude of, oh, you’re figure it out. And you’re right, especially if this is your first child. It is a very confusing time. I’m just wondering, how does a new mother, how does a new parent figure that out? How do they know if they’re just like, yeah, look, I’m not getting a lot of sleep. My body has just been through a medical trauma. I pushed life out of me. Right. This is, you know, that that is a that is a physical trauma. Forget about mental trauma. That’s just a physical trauma. You are healing. Everything in your world has changed. So how can you make the leap from this is just a stressful time and I am therefore stressed to I have postpartum post-traumatic stress disorder.

Lauren M. Sippel, PhD: Absolutely. It’s such a great question. And there are a couple of things to keep in mind. So one, this challenge of kind of like when do you cross from something that is typical and transient to really, really problematic is what we deal with in all domains of mental health, right? When does it go from being sort of a a negative mood to depression? When does it go from, you know, I’ve heard a couple things that maybe were a little hard for me to understand to I’m having a psychotic episode. And when it comes to something like PTSD, among many other disorders, it’s really like when do the symptoms truly interfere with your ability to live your life the way that you want to, right? So is the not sleeping interfering with your ability to interact with your partner to, you know, if you’re if you’re back at work to, to do your job is the inability to sleep not because your baby’s waking up, but because, you know, you’re perseverating or ruminating over concerns about safety in the middle of the night. Right? So it’s also trying to kind of be curious about, like, is there like a very reasonable explanation for what’s going on just from a practical perspective? Or are there things going on for me that maybe are above and beyond your typical I’m adjusting to being a new parent. This can be a really good opportunity to talk with other parents or other loved ones of like, have you noticed a shift? Because I’m feeling really, really different and I’m not feeling like myself and I would love some observation. So again, if there’s if the symptoms are interfering with quality of life or functioning, it’s at least worth a discussion with a healthcare professional or a self-screening online. ADAA actually has a really nice and I can give you the link for this.

Gabe Howard: I’ll drop it right in the show notes.

Lauren M. Sippel, PhD: Oh, fantastic. Yes. So we have an infographic that we created both myself and Dr. Michelle Bovin, who is my co-lead for the PTSD Special Interest group. Based on some of Dr. Boivin’s research, we created an infographic that includes five self-screening questions that help you get a sense of whether you might have PTSD. Now, not postpartum PTSD specifically. But again, from the symptoms perspective, it doesn’t really matter. If you score a three or a four out of five, it’s worth having a conversation with a healthcare professional. And that often means starting with, you know, a primary care doctor or maybe a general counselor or social worker. And then if it looks like what you’re dealing with really is PTSD, then getting specialized care for PTSD, which certainly we could talk more about. But again, I would really just lean into if the symptoms are interfering with your quality of life or the way you function day to day, it is time to get some help.

Gabe Howard: Dr. Sippel, I imagine that the people listening to this podcast fall into one of two categories. They suspect that they themselves might have postpartum PTSD, or they suspect that a loved one might have postpartum PTSD. I want to talk to the people who suspect that a loved one has postpartum PTSD, and specifically, I imagine that they’ve already raised some concerns with them like, hey, are you feeling okay? How are you doing? Are you handling this okay? And chances are that person has been like, yeah, I’m fine. Focus on the baby. Yeah. I’m fine. Focus on the baby. What should the person who is concerned that somebody might be suffering from postpartum PTSD? What should they be on the lookout for and what should they do?

Break

Gabe Howard: Hi, listeners. Your host, Gabe Howard here. And I want to let you know about a fantastic free resource I recently learned about. If you or someone you know is struggling, or even just wants to learn more about mental health, check out the Anxiety and Depression Association of America’s website at ADAA.org. The ADAA has tons of free resources and even a Find Your Therapist tool to help you find support close to home. Their website again is ADAA.org. That’s ADAA.org.

Gabe Howard: And we’re back, reminding you that funding for this episode was provided by Evernorth Health Services, and that we’ve been discussing postpartum PTSD with Dr. Lauren M. Sippel.

Lauren M. Sippel, PhD: Yeah, this is this is really hard. It’s hard to see someone you care about suffering. Especially if it seems like they’re not doing anything about it. It can be pretty maddening and puts you in a position of feeling helpless. What I would say to be on the lookout for are, again, you know, the kinds of behaviors and, and, you know, things that people say and do that are just out of character that seem troubled. If it feels troubling to you, you know, you hear your loved ones say like, oh, I just don’t know if I want to go on. That, that’s worth a question of, hey, I hear what you’re saying. And actually, I’m worried about you. Can we talk about how things are going and, and so I can give you an opportunity to talk, or so I can hear. If there’s a way that I can be helpful to you. You know, essentially what I would say is to be on the lookout for anything that, again, seems kind of out of character is a pretty dramatic change. And then in terms of what to do as non-judgmentally in as non-controlling and non-confrontational manner as possible, express concern, express care, express openness.

Lauren M. Sippel, PhD: Hey, I’ve been noticing this. Are you willing to have a conversation with me about how you’re doing? I wonder if you’d be open to thinking about talking to someone professional. Hey, I know how much you love our child, and it seems like you’re having trouble connecting with her as much as as you might want to. I wonder if we can talk more about this, right? Nonjudgmental. Non-confrontational. Non-controlling. But in a way that expresses care. And then keep in mind, the more you push, the more people will often dig their heels in. All right. So, be persistent, but be gentle. You know, it’s only on TV that these, like, you know, kind of big confrontations really lead people to behavior change. It’s usually like just that moment where they say, okay, I’m ready. I’m ready to do this. I’m ready to talk to you. I’m ready to talk to someone else. I’m ready to go with you to a place where someone can help me, whatever that would look like.

Gabe Howard: So now we’ve got a diagnosis, right? You’ve gone to the doctor, you’ve done the right things. You meet the criteria. You’ve now been diagnosed with postpartum post-traumatic stress disorder. What’s the treatment? What’s the outcome? Are people who are diagnosed with this okay?

Lauren M. Sippel, PhD: Gabe, I’m glad you asked that. And let me. I’ll even take a step back to say, you know, to your point about how challenging it can be to get mental health care, to ask for mental health care. Unfortunately, there are many steps in between identifying symptoms in oneself or in a loved one, and getting into the kind of treatment that’s really known to be effective, which I’ll say more about in a moment. But yeah, that first step is telling your primary care doctor telling your OB/GYN, getting a referral for an assessment and an assessment could look as simple as a, as a, as a paper and pencil questionnaire. Those are pretty good at giving us a good sense of someone has PTSD. And your general practitioner may be able to administer that. There’s also a gold standard interview for PTSD that not a lot of people are trained in. But, you know, if you’re in a health setting that offers something called the clinician administered PTSD scale which is published by the Department of Veterans Affairs and is available to providers for free. It is amazing to get like a gold standard assessment that’s often only available in research studies. And it’s not necessarily it’s not necessarily required to have gone through that to then go into a PTSD treatment and benefit from it. Okay. So there can definitely be steps. One should always be asking questions of how do I get where I need to go? How do I get to the social worker, the psychologist, the psychiatrist who knows how to help me? And being really proactive about that once you know you’re ready to start a treatment, really the best treatments are cognitive behavioral therapies that heavy trauma focus. And there are a couple of these called prolonged exposure cognitive processing therapy, eye movement desensitization reprocessing. I always get this one on DMDR, essentially. [Laughter]

Gabe Howard: Yeah. Yeah, yeah. EMDR. I’m very familiar with it. We did a whole episode on it. If

Lauren M. Sippel, PhD: Oh, good.

Gabe Howard: You want to learn more, check it out on the Inside Mental Health podcast. There, I plugged it for you.

Lauren M. Sippel, PhD: Perfect. Thank you, thank you. Isn’t it funny with like.

Gabe Howard: Thank you. Thank you.

Lauren M. Sippel, PhD: The acronyms? All of these are in sort of the cognitive behavioral tradition, which means that they help folks learn and identify and kind of change their thoughts, their feelings, and their behaviors. Right. So if you’re having thoughts like if I let my baby out of my sight, something terrible will will happen that’s going to lead to the feeling of fear and maybe shame if you don’t want to, like, let the baby out the door and then avoidance, right? Well, then we’re not going anywhere, because leaving the house means that now we’re in danger. And so any of those treatments is going to kind of put those thoughts and those feelings under a microscope and help people kind of understand them and consider alternative ways of approaching these kinds of situations. And those treatments have so much research support, certainly for the treatment of PTSD. I’d be lying if I said there are a lot of studies on the treatment of postpartum PTSD in particular, but any good clinician who knows how to conceptualize what a patient is going through in terms of, again, their thoughts, their feelings, their triggers can absolutely treat postpartum PTSD with one of these interventions. And so looking for the terms PE, prolonged exposure, CPT, EMDR and asking providers, are you trained in these? Because it’s my understanding that these are the treatments that have the best chance of helping me.

Lauren M. Sippel, PhD: There are also some select antidepressants that are helpful for PTSD. They don’t tend to work as well in terms of just the effect size. And, you know, one of the challenges of medication versus psychotherapies is that in theory and there’s some evidence to support this. You do a psychotherapy, you learn new skills and new ways of thinking that you carry with you into the future. Whereas with medications, if you stop taking them, some of them basically just stop working. It’s not quite so cut and dry. And I know people who have had their lives changed by antidepressants. And so it’s really worth a discussion with your doctor about pros, cons, time, you know, what are you able and willing to do now that you’re a new parent? Do you want to do psychotherapy? Do you want to try a medication? If you’re also dealing with depressive symptoms, is there something that might help with both? And so there are so many good treatment options. It just it really takes asking good questions, making sure that you’re, that you are getting access to the treatments that have the best chance of helping you and finding a clinician or therapist who you feel comfortable with which can take a little time. But that’s really especially when you talk about sensitive things around trauma and birth trauma or anything in the PTSD in the postpartum PTSD realm.

Gabe Howard: Thank you so much for your time today. We really appreciate it.

Lauren M. Sippel, PhD: It’s been my pleasure. Thank you.

Gabe Howard: You’re very welcome, Dr. Sippel. All right, I want to once again give thanks to Evernorth Health Services for providing the funding for this episode. And, of course, a great big thank you to all of you, our listeners. My name is Gabe Howard, and I’m an award winning public speaker, and I could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon, but you can grab a signed copy with some free show swag or learn more about me just by heading over to my website, gabehoward.com. Wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free and you don’t want to miss a thing. And hey, can you do me a favor? Recommend the show to everybody you know. Share your favorite episodes on social media. Send somebody an email, bring it up in a support group. Send somebody a text message. Hell, use your handheld device and make a phone call because sharing the show with the people you know is how we’re going to grow. I will see everybody next time on Inside Mental Health.

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