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"Tully," Postpartum Depression, And Reassurance For Mothers
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On SDPB Radio, we're talking this hour about #HowToRaiseAHuman, NPR's cross-platform coverage on what parenting books might not tell you.

On In the Moment, we featured a conversation about postpartum depression and postpartum mental health. Many women are speaking out online about the new film "Tully," written by Diablo Cody. They say the movie is marketed as a feel-good look at the joys and absurdities of motherhood, when in fact it's a more serious exploration of the trials of postpartum mental health. Karla Harmon is a Certified Social Worker at Sanford Health. This conversation has been edited for web use, to listen to it in its entirety click here.

Lori: Welcome back to In The Moment, I'm Lori Walsh. We're talking this hour about how to raise a human. Use that hashtag to connect with NPR's cross platform coverage on what parenting books might not tell you. Now we move into a conversation about post partum depression, and post partum mental health. Many women are speaking out online about the new film Tully. It was written by Diablo Cody. They say the movie is marketed as a feel good look at the joys and absurdities of motherhood, when it fact it's a more serious look at the trials of post partum mental health. Karla Harmon is a certified social worker at Sanford Health, and we are going to talk with her today, but we want you to be part of this conversation.

How did you get into this mental health and motherhood field? Tell me a little bit about your work.

Karla: Oh, it was really an unplanned adventure. Sanford had a psych hospital and when that closed I went over to the medical hospital as a mental health counselor. There were about three of us, and once we got over there we were all assigned different kinds of floors, and things to take care of. And I was assigned post partum, and the birth place, and NICU, and high risk obese. At one point in time women who had a history of depression or anxiety were then triggered so that they were at least glimpsed at, or had an opportunity to ask questions with a mental health provider before they left the hospital.

And now since then, for the last six years I've worked in the Sanford Women's clinics, which include all the OBGYN clinics.

Lori: One of the first questions I'm sure you get asked about a million different topics is, is this normal? Is this a normal thing I'm going through? Or is it something that should be a red flag? Is that something you hear a lot of where people just want to know is this how it's supposed to be?

Karla: I do. And there's going to be some emotional response to having a baby. I can just tell you that anybody who says, "Oh, really. Nothing happened." Really I just think is not self aware, or they slept through, or were wide awake during the whole thing. There's going to be some type of emotional reaction. And part of that is because of the brain chemistry that changes after you have a baby you know? And then what happens after that brain chemistry changes really chemistry goes back, or returns to its normal baseline.

Lori: What do you need to know about yourself during pregnancy? Or even before pregnancy? During childbirth? To set yourself and your baby, your family up for managing that post partum time? Do you look into family history?

Karla: It's always good to know family history for many things with mental health, because brain chemistry's as genetic as your eye color. It's just like any other genetic thing. You would want to know what your propensity was. For women even like menopause and how your maternal relatives handled menopause. You want to know that, because there's often times some genetic linkage. It's not a bad idea to get a little bit more information. Mostly you want to know if you've had a history of depression or anxiety, or if you've had little episodes that you really haven't treated, that you've kind of noticed for cycles of time.

I seem to be pretty driven. I seem to be pretty ... My brain is very busy. I talk about busy brain, rather than anxiety. Because, busy brain kind of ... Anxiety people think of as turning around, or biting your lip, or those kinds of things, but anxiety's more about a cognitive function where your brain just doesn't stop. It just keeps going to the next thing, and it projects years ahead, decades ahead. How am I going to handle that?

And a lot of very successful, successful people have busy brains. It's not any cause for stigma, or this might be a terrible thing, but it is good to know once you have a baby because chemistry change is going to affect ... Your busy brain is going to be affected by that.

Lori: I remember calling my father and crying and saying, "She's going to go to kindergarten someday and I'm going to be sad." And he said, "You know she's four days old honey. Not there yet." And I was, my busy brain was way ahead. I had already plotted out every day of her life, and I knew that, that was going to be a hard day and I was living it in anticipation.

Karla: Well your right though, kindergarten was a hard day wasn't it?

Lori: It was a hard day. I was not wrong about it.

Karla: You were correct.

Lori: When do you know it's a problem?

Karla: Well, and that's a wonderful question because it can ... Like I said, there's a continuum. Women usually notice in the first two to three weeks after having a baby, that they often times experience tearfulness for absolutely no reason you know? A leaf flew and it was beautiful, or I walked outside and I smelled really good stuff and it was wonderful. And tears can be promoted from that.

And that's mostly what people define as the blues, and about 80% of all women experience that, and it's a combination of hormonal activity, post partum, and then sleep deprivation. Very few women who have a new baby get very much sleep.

Once you look at that, it makes sense that you would be very emotional, but usually sadness, or depression, or those emotions. Don't go along with the tears, it's just tearfulness for absolutely no reason. I think the people who notice it best are the people who are nearest to the women who cries unexpectedly because they'll say, "What's wrong?" And, "I don't know what's wrong. If I knew what's wrong I'd tell you." Because, it is absolutely groundless. It just comes out of nowhere.

Lori: A Facebook friend who posted that she's crying at a Metallica song I think it was, or whatever random ... You know, that has that sense of randomness.

Karla: Yes.

Lori: Where Metallica doesn't usually make you cry.

Karla: It might. It might, or it may make you cry for other reasons not just because it's beautiful. Yeah, it just comes out of nowhere. And that's really, really normal. And usually people don't really react to that to much because it starts getting better pretty quickly, and I always tell women, "Get one nights sleep." If you can sleep for four to five hours continuously, and I know that's a hard thing to do if you're breastfeeding, or your babies up, or you don't have enough help, but if you can get some rest, then it's much better to evaluate your mood after that rest.

It really makes a huge difference. But as far as the clinical piece, the depression and anxiety, and typically that's what I call it. Depression, anxiety, post partum because people will only usually have that kind of response if they had a proclivity to depression or anxiety. It usually starts having more symptoms after that first two or three weeks. What people mostly notice is moody, irritability, a sense of being overwhelmed. And then the overwhelmness goes into irritability, or a change. Not usually somebody who can usually bear a lot. All of a sudden a milk bottle spilled and they're just ready to yell at anyone, and that's what most women report to me is, "I just want to scream."

And then the busy brain part is a little bit more tricky because we all have safety thoughts after children, "Oh, I hope this doesn't happen. Oh I hope that doesn't happen."

The anxious part of your brain will then have this whole scenario of, "What if it did happen? And what if this is what it looked like? And it probably is going to happen." And. it can really make women very, very nervous just to have these thoughts. They feel like there's something wrong with them, and it's just a thought. It's a thought that has juice behind it, because you just had a baby.

And those are the scary ones that get people. They don't want to report them, they feel it says something about themselves as a mother. And those are the ones my heart goes out for, in fact I will volunteer, "Oh, do you ever feel like, I'm washing my baby. My baby's so sweet. Oh my baby's a little slippery. Oh I hope my hand doesn't slip. What if it slips? What if my baby's head goes under the water? What if I put my other hand over it? What if I drown my baby?" Not an untypical thought.

Knives, driving with your child. All of those things can induce these horrible, horrible thoughts. And they're just thoughts.

Lori: I used to dream. What about dreams? I used to dream that she was frozen in ice, and I left her behind and I had to ... I would always dream about losing her, kind of. Forgetting her. Dreams about anxiety, dreams about being a bad mother. Is that fairly normal that people would sort of take that into their restless sleep?

Karla: Yes. Your brain is so much more active during your sleep time. It goes through all your memory. Dreams are always metaphors too. I mean, with a new baby and dreaming that you left it behind. You can always do a little Google search and find out what your brain is trying to figure out.

Lori: Yeah. Yeah when I woke up there was a fear of just not ... Forgetting you know? You hear stories, forgot your kid in a car seat. And you left them there, and I was just afraid. Could that possibly happen to me.

Karla: Yep. You took a thought, a fear and then you drove it out to. A little story going on in your brain. And then you woke up. Yeah

Lori: I'm a creative thinker.

Karla: That's a very good point because really creative people ... I've found a lot of women who like to watch horror stories after having a baby, really come up with some very, very difficult kinds of thoughts. But again, they're just thoughts. They're not going to act on them. I have not seen the movie (Tully). Talking about post partum psychosis, but I would always warn people because I did work at the hospital when the lady drove her baby's into the lake in Texas and killed them, and I looked at these poor women up on the birth place. Looking up and going, "Is that going to happen to me?"

Psychosis is very, very rare. I wouldn't want anyone to think because they had a bad thought that, that meant they were psychotic.

Lori: Right. I want to talk a little bit about this movie because I have seen it and you haven't, but I mostly want to tell you what happened when I went to see the movie, what happened after the movie. Some friends of mine on Facebook were talking about the marketing, how it kind of looks in the commercial or in the trailer like it's a funny, feel good movie. And there are great comic moments. Diablo Cody is a great writer. But after the movie there were two women sitting in front of me who were new mothers, and there was an older women she was 77. And she came up, and I'm not going to spoil the movie, but there was a twist at the end. And the older woman approached the two younger women and said, "What I think happened just happened at the end of this movie?" And the younger women said, "Yes." And they said, "We're new moms, we thought this was a fun night out. This is not what we expected."

And they were kind of upset. The older women started talking about her own post partum depression, psychosis, suicide attempts. And I remember looking at her thinking, "She needs a counselor right now." I mean she's in crisis, and she's coming up to strangers.

Karla: She was probably having some kind of flashbacks.

Lori: Some kind of trigger, or flashbacks sort of thing.

Karla: Intrusive thoughts.

Lori: It's sort of a serious situation there.

Karla: Psychosis is very ... I mean you know, and typically post partum psychosis comes on very quickly, but it's usually also related to some kind of a history of bipolar disorder that had some psychotic feature to it, or a history of psychosis. And that could also be through schizophrenia, or a schizo affective disorder. Psychosis can happen in many different ways, but there usually is a history of it. And it's very serious. It's very dangerous. And if you went through it, especially as a new mom. I imagine you would remember it for the rest of your life.

Lori: Right. At 77. She was processing this.

Karla: At 77 she probably didn't have much help with that either.

Lori: Right. Very rare. Not something that mothers need to worry about, but what are the tips to sort of say if you do have a more severe history of mental health, you really got to talk to your healthcare providers, and not be afraid to open up about some of the things that ...

Karla: Typically people with bipolar disorder in their history will go to psychiatry throughout their pregnancy, and then look at that post partum.

And it's not impossible to breastfeed while you're still taking a mood stabilizer. I mean you can do all of the normal things, but you know they tend ... People who understand their proclivity's, tend to want to make sure they're taken care of during pregnancy. I mean no matter what they are.

And all I would say, and if I could say it a thousand times I would, is sleep. Even an anxious person who has a incredibly busy brain, who doesn't sleep for days at a time can start seeing things out of the corner of their eye, or they can start thinking people are talking about them, or they're thinking that people are ... They're a bad mom, and they can start developing some kind of, not paranoid thoughts, but self persecution thoughts and then they transfer onto other people and that can just happen with lack of sleep. And that's not psychosis.

Lori: When I post things on Facebook the first thing that happens is there's this ... People talk about shaming. I'm doing this, I'm letting my baby cry it out, and then this mother's shaming me because I'm doing that. I'm nursing, and I'm getting shamed by somebody who went back to work right away. Vice versa. How do we all let ourselves off the hook about being good parents? And what's the impact from a mental health standpoint if we don't? If we're always striving to achieve whatever our idea, or the people around us idea is of being the perfect mom?

Karla: I would say you're probably going to have neurotic children, but other than that. I think probably you know, we grow up always wanting to want the love and acceptance of other people and that's pretty much it. And then when you have a child you're pretty vulnerable because nobody knows how to be a mom, or a dad. And that's not something we actually learned how to do, and it's a trial or error kind of thing.

I think you find the people you trust and listen to them, and the other people kind of understand that they're just saying it because it makes them feel good about themselves. I find most people who are trying to change or alter other people's behaviors simply by their opinions, are just doing it because they want to feel good about themselves. It's about them. I've found the right way so I want everybody to do it the right way. Not too enlightened because everybody has their own way, and most folks know that. I'd say influencing ... Influenced by other people, they just caught you at a vulnerable time after having a baby.

You might just want to take a breath. Talk to the people who you trust, and those are the people maybe you want to listen to. And they'll tell you you're doing a fine job. They'll tell you confidence building things. They'll tell you the things that you will most likely benefit from hearing.

Lori: How important is a partner? Or support from relatives, friends, co-workers, how important is that?

Karla: The three indicators of depression or anxiety post partum is, a personal history of depression or anxiety. A family history of depression or anxiety, or women who perceive they don't have enough help. Or assistance, or support. And note, it's perception. Its not even real or unreal.

One of the things that happens is, women don't want to accept help because we're used to just doing things ourselves, and we're just growing a small human being and that doesn't really ... I mean that shouldn't really take much other time then buying a new wardrobe, or cleaning out your oven.

They tend not to take advantage of the people that are there, and I always try to encourage people, make a list ahead of time. Have people there that can help... they're going to do something for you anyway. You might as well direct what they're doing, because otherwise it's going to be stupid and irritating.

If somebody needs to go to Target. Have them go to Target for you because it takes a lot of energy to go to Target right after you have a baby. If somebody wants to mow the lawn because the baby's daddy wants to be with the baby rather than out mowing the lawn, then have them do that. Have a little list. Don't milk it. You don't want to do it when the child's still 18 years old. Then you've probably abused people.

For the first couple months use folks as well as you can. Most people really do have folks that will help them, but we tend to avoid that. And dad's, or partners, or whatever the situation, if there's somebody in the baby's life that you want them to have a relationship, well you've got to let them spend time with them. That means that you leave the house when they're together so that they can bond their own way. It means you don't helicopter around to make sure they're doing it the correct way. You let them do it their way, and go take some time. Go do something for yourself. Go to Barnes and Noble. Read a book. A magazine. You know, do whatever you want to do.

Lori: Where were you 17 years ago in my life Karla Harmon?

Karla: But these are all very practical things.

Lori: Right, yes.

Karla: And they can be done, but you get into this mindset of, "Oh, I can do this. I can do this." Maybe you don't have to do everything.