Dr. Deena Blanchard shares her story on postpartum anxiety. A pediatrician, Dr. Blanchard shares her story to show that postpartum anxiety “can happen to anyone” and that “there’s no shame in having a postpartum mood disorder.”
“Postpartum Anxiety and Making Change” – with Deena Blanchard
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Dr. Fox: Welcome to “High-Risk Birth Stories,” brought to you by the creators of the “Healthful Woman” podcast. I’m your host, Dr. Nathan Fox. “High-Risk Birth Stories” is a podcast designed to give you, the listener, a window into life-changing experiences of pregnancy, fertility, and childbirth. All right. We’re here with Deena Blanchard. Thank you so much for coming on the podcast. It’s great to have you.
Dr. Blanchard: Welcome. Thank you.
Dr. Fox: The podcast we’re doing today is one of our newer formats where we’re going to be discussing high-risk birth stories. And the thought about this and the goal is not specifically to discuss a condition or a diagnosis or a complication related to pregnancy but just to let women talk about their own story, right? Whether it’s fertility, whether it’s pregnancy, whether it’s the birth, whether it’s postpartum, and there’s so much to learn from these stories, obviously, just on a human level, on a medical level, and any sort of, like, you know, life level. And I just have found that these stories are amazing. And Deena, thank you so much for coming on and agreeing to tell your story.
Dr. Blanchard: You’re so welcome, and thank you so much for having me. And I agree with you that the narrative of stories is so important, and actually, it’s such an important part of kind of going through many medical processes, and it’s the connection, the human connection that you have with other people who have been through sort of similar or slightly similar things, and you don’t feel alone and like you’re the only one who’s done this. I think that is really powerful, and I’m really excited to be a part of this.
Dr. Fox: Right. Now, obviously, you yourself are a physician. So, you are Dr. Deena Blanchard, pediatrician at Premier Pediatrics in New York. You have a medical background, and we’re going to be discussing things related to medicine, obviously, but the fact that you’re a doctor on one level has nothing to do with your story, and on another level, it does because it influenced your own practice in medicine, which I think is another fascinating aspect of this.
Dr. Blanchard: I completely agree. And I also think there’s this sort of idea that it’s like, oh, well, you’re a doctor that wouldn’t happen to you. And then part of being able to share with the families in my practice and new moms and new dads is this can happen to anyone. This happened to me. There’s no shame in having a postpartum mood disorder. And I think it sort of takes the edge off almost when I say that because it becomes like, okay, I’m not living on high. I mean, I don’t practice like that in general but, like, I think there’s so much stigma still, though we’ve made tremendous growth even since…you know. I had children. But I think there’s a lot of stigma around mental illness, particularly in the postpartum period where many new parents feel that they should feel like everything is kind of, like, to joke that like rainbows, lollipops, and sunshine. And if you don’t and you’re not Insta-perfect or Facebook-perfect or whatever social media is these days, you kind of, like, start to doubt yourself as a parent, which is a terrible feeling. And no parent should feel that way. So, creating a space in which that can be talked about and removing the kind of fantasy of what life should look like after you have a baby, to me, is one of the most important things right now.
Dr. Fox: A hundred percent agree. So, let’s sort of set the stage. We’re going to be discussing at least at first this is the birth of your second child, AJ, correct?
Dr. Blanchard: Yes.
Dr. Fox: So, tell us at that point in time, you know, during that pregnancy, the year is 2010, correct?
Dr. Blanchard: Mm-hmm.
Dr. Fox: Right. So, the year is 2010. Tell us just, in general, at that time, who are you? Where are you in life? Where do you live? What’s your family like? What are you doing? Just so we understand who you are coming into pregnancy.
Dr. Blanchard: Absolutely. So, I am 30 years old. This is my second pregnancy. My son, Nathan, I had him really young at 23, and so the difference of being pregnant between 23 and 30 and then later at 35 was a lifetime, but the nice thing I had Nathan in medical school. With AJ, it was different. I wasn’t attending. I was in private practice, and I wasn’t going to have to rush back to work. I had already decided I was going to take four months of maternity leave and then come back slowly. Whereas with Nathan, I was back in anatomy lab two weeks later. So, it was sort of like, to me, like this amazing situation where I was going to get to have, like, a real maternity leave that I hadn’t had before. And honestly, it was my easiest of all three pregnancies. I had the least nausea. I had no other… Like Nathan was premature. And David, I had gestational diabetes with and I also had an antibody problem. And with AJ, it was easy. It was smooth sailing. And I remember actually his birth was also super easy. My sister who’s a few years younger than me hadn’t had kids yet, and I remember her saying, like, “Oh, it’s not such a big deal.” I’m like, “Oh, don’t use this as your scenario because this was not my first.” And let me tell you my third wasn’t like that either. Like, I was supposed to be induced on a Tuesday. Monday, I was talking to my older son’s teacher for parent-teacher conferences. I jumped off, and my water breaks, and within four hours, I have this baby. Three pushes, no tears, and then I go home. It was once I got home that the struggles really started to begin, but the pregnancy actually was…I worked until I was…I gave birth on a Monday. I worked until that Friday. I was tired, but I was able. It was my easiest pregnancy, but the hardest.
Dr. Fox: Right. And you’re living in New York City, right?
Dr. Blanchard: I was living on the Upper West Side. I was working full-time.
Dr. Fox: And how old was Nathan?
Dr. Blanchard: He was about to turn eight. And like I said, I was more tired, like, with Nathan, but before I gave birth I ran five miles. I wasn’t doing that, but I felt good. Like, I didn’t feel exhausted. I didn’t feel like I couldn’t work. I took call till the end. It wasn’t a hard pregnancy. I was married to a different person than I’m married to now, and so I think having a baby and then getting divorced about a year and a half later, a lot of that time in between being in couples therapy certainly didn’t help the situation, but, you know, going into it, it felt like this was my chance. I was going to do this. Like, and such terrible breastfeeding needs and now I’m like, “I’m going to have a…” He was full term. He weighed 7.5 pounds compared to Nathan who was like 5, 11. And I was like, “This is all going to work.” I went in with the expectations that this was going to be like glorious maternity leave. I was going to, like, take walks and go to brunch with my friends and pop the baby on the breast, and it just…I mean, honestly, in hindsight, it’s not advice I would ever give anyone to go into birth with, but it was because, on some level, that’s completely unrealistic, but it just felt like it was my chance to have a totally different experience than having a premature baby in the middle of medical school.
Dr. Fox: Right. Plus, I mean, listen, you’re riding high in a certain sense. I mean, as you said, you’re done with your training. You’re working full-time, you know, and going through, you know, training in medicine is very difficult and it takes a long time. You don’t make any money, and it’s like it’s gruesome. And then you finish, and you’re like, “Okay, I’m here. I have a job. I like what I’m doing. You know, I have a son. We’re living in the city. I’m pregnant. I’m feeling well.” There was no reason not to expect everything to go okay. And one thing I do want to mention is, you know, you mentioned your son, Nathan. Now, for full disclosure, you and I have known each other since you were, like, one years old, since you were a little kid because, you know, growing up in Chicago.
Dr. Blanchard: I think like one and a half. Yes.
Dr. Fox: Yeah. So, our families have known each other for a long time, you know, obviously, I knew you when you were very, very young. And then we obviously knew each other at the time, though not very well because, you know, you were in training. I was, you know, just early in practice. But, as far as I know, Nathan is not named after me.
Dr. Blanchard: He is not.
Dr. Fox: Okay. Just full disclosure.
Dr. Blanchard: As amazing of an OB-GYN as you are, he is not named after you. But full disclosure, when I was pregnant with AJ, I was like, “Don’t put me…” and with David, actually, I’m like I had all my ultrasounds at Carnegie and then I was followed pretty closely. With David, it was a more high-risk pregnancy. And I remember being like, “I can’t see Dr. Fox.”
Dr. Fox: I always say that…
Dr. Blanchard: And so I was getting abdominal ultrasound. I’m like, “No doctor Fox.”
Dr. Fox: Yeah. No, I’ve always said that…yeah.
Dr. Blanchard: I’m like, “I’ve known him since I was a child.”
Dr. Fox: Right. The people that I know get divided into two groups, half of them are like, “I only want to see Fox,” and the other half is, “I want to see anybody but Fox.” And it’s just then interesting how that gets broken up. It’s fascinating, you know, whether you know your gynecologist or not. It’s a whole other podcast. Let’s put it that way.
Dr. Blanchard: Well, my primary gynecologist who’s seen you guys for scans and high-risk stuff is a good friend, but she’s a woman, so it felt okay. Like, it just didn’t feel the same.
Dr. Fox: So, here we are. So, you had AJ, you know. As you said, the pregnancy went well. You’re feeling great. Physically, he was okay. At the birth, emotional everything is well. As you said, you were expecting to have this four months of, you know, maternity leave and it’s going to go really well and you’re going to be at all the cafes in Upper West Side or whatever it is just, you know, nursing all over the place. And so, what happened? Tell us the story at that point.
Dr. Blanchard: Right away, I really struggled with breastfeeding and it was extremely painful for me, but I was, I think, actually irrationally committed to not letting AJ have any formula, and it was really a very irrational belief, and I kept breastfeeding through the pain. So, like that was…and I kept feeling like a huge failure. Like with Nathan, I remember thinking…Okay, he’s premature. And I also, honestly, was a first-year medical student. Here I am, pediatrician, done with training, giving advice, blah, blah, blah, and I can’t do it myself. And I was working as lactation consultant and I was doing everything. And, you know, it hurt for a long time, like about 10 weeks, and then eventually, it just came together. But I think that beginning was definitely a strike against me. I also, at first, didn’t have any help because I hadn’t had any help, but when you’re 23, you don’t need as much sleep. And I’m a person who needs sleep. So, I was exhausted. I was overwhelmed. I was up with this baby who was like killing me, and then he was colicky. And so, it was just like one thing after the next. But, you know, of course, “Hindsight is 20/20,” but at the time, I started obsessing about the colic. So, Nathan was very colicky and difficult also. He did have reflux and a milk protein allergy that didn’t get picked up until much later, so he was a more difficult child in that way. But, at this point, this was information I had. So, I started to cut things out of my…I cut milk out of my diet. I put AJ on reflux medicine, and then he was still colicky, and I was, like, really obsessive to the point where even though as a physician, I knew that he was fine. He was growing. Everything was fine. I could not, as a mother, relax and calm down about it. I couldn’t listen to myself, to my partners who were my friends.
I went to see a pediatric GI and still I couldn’t take…like I ended up restricting my diet so much. And, actually, I mean, it turns out he did have a milk protein issue, but he wasn’t able to tolerate dairy, but he could have tolerated all these other things that I wasn’t eating. And so, I basically restricted my diet so much, and ultimately, with time, he became a better breastfeeder and he outgrew his colic and it sort of actually was a little easier maybe for about 2 to 3 weeks, somewhere around 11, 12 weeks, and then I realized I had to go back to work, and I started having panic attacks. I was debilitated. The idea of going back to work. I couldn’t sleep. I couldn’t breathe. My heart was pounding, and I knew that they were panic attacks. Like, I knew it was okay, and I was like, “I’m having panic.” And I was like, “I need to go see somebody because I can’t go back to work like this,” and I remember the day I saw Dr. Gammer, who is my psychiatrist, and I was sitting there. I’m telling him everything, and he goes, “Deena, you have postpartum anxiety.” And it was like the clouds had parted and like a light bulb turned on or like the light turned on and I was like, “Yes, of course, that’s what I have.” So, like, you know, I couldn’t even treat myself in the same respect I was giving to my patients.
Dr. Fox: Right. And also you had the insight to know, and that’s more than most people would have, right? Most people, you know, they wouldn’t have any clue of what’s going on and they may think the panic attacks are heart attacks or whatever. Who knows what they think they’re having? And you had a great amount of insight and still, it wasn’t what you thought you had.
Dr. Blanchard: I think because I was so unwell I couldn’t even begin to think about what I had, and then when he said it, it made sense and I was like, “Of course, that’s what I have.” The other thing is I always thought about postpartum depression. I didn’t really think a lot about postpartum anxiety until he pointed it out to me. And, I mean, I had never really…I hadn’t been seeing this. I mean, when my parents divorced, I went to therapy for a little while afterwards, but I wasn’t in regular therapeutic care. You know, I was living my life, dealing with everything, and this really shook me to my core because it was unexpected. And then being able to kind of hear it and look back, I was like, “Wow,” you know, that glorious maternity leave until I started having panic attacks turned out to be like the worst three and a half months of my life, in some ways. It was a really dark time, and I never had any intrusive thoughts or thoughts of hurting myself or the baby, but I was miserable and I wasn’t eating and I didn’t really want to see people. I was just really unhappy, and I also was hyper-focused on the baby. So, like even when AJ was asleep, I couldn’t really sleep myself because I would start to, like, have what I would describe as circular thinking, which I think is something that’s very important to point out in postpartum mood disorders, particularly anxiety is that you often find yourself…and like I’ll start to say it. Like, if I have a patient that the mom or dad is going through something, I start to say, “Do you find yourself being like I can’t fall asleep because what if the baby needs to breastfeed, but I don’t want to pump because if I pump and then this and this and…” There’s just this constant circular, anticipatory anxiety around I find typically they’re feeding or sleep with the baby.
And sometimes I’m sure in your experience, it’s more related to maternal health. In my mind and the experience I have with, as a pediatrician, it often presents itself as this kind of circular anxiety regarding the child’s health, which is a large part of postpartum anxiety or OCD or postpartum depression, and understanding that there’s kind of different ways for it to present I think was something I didn’t even really completely understand as a pediatrician at that time. I didn’t really feel sad. I wasn’t crying. I was just…I felt like I was in somebody else’s skin, like I was not myself, and I couldn’t really describe it outside of like…and I thought like, “Okay, I’m a new mom. I’m tired, my breastfeeding habits.” Like, I just kept making excuses for it in my head as opposed to doing something about it.
Dr. Fox: At the time, or even around then in hindsight, was anyone in your life who you were close with, did any of them notice this, that there was something unusual going on? You obviously know you didn’t feel well, but you didn’t piece it together, but can you look back and say, “Oh, yeah, my friend or my cousin or my mother or someone said, you know, ‘There’s something going on,’ and I didn’t believe them?”
Dr. Blanchard: Yeah.
Dr. Fox: Who may have noticed that?
Dr. Blanchard: There was only one person who said something to me at the time, and she actually wasn’t a close friend.
Dr. Fox: That must have been pleasant.
Dr. Blanchard: I should have taken her more seriously, actually. It’s like she said it very kindly and I was just like, “No, no, no, I’m just tired.” I actually didn’t feel bad about myself because I don’t see mental health as a stigma and I didn’t at that time either. I just was… It was actually like a relief to have been diagnosed with the anxiety because it was like, “Oh, okay, this makes sense. Like, this is why I don’t feel like myself,” you know. And as opposed to just I suck as a mom or I suck at being a mom which was sort of what I kept telling myself, and being a perfectionistic deck, you know, type A medical student kind of person, my tendency was to self-blame. And I kept thinking…I remember thinking like, “Well, if I just try harder,” which again is like a circular pattern, “then I’ll be better at being a mom, and if I just this, I’ll be better at this. And if I just…” There was always one more thing I just had to do. And then having the diagnosis really took that with sense of relief in that, like, it wasn’t my fault. Like, it wasn’t about me, you know. There was something else going on, but, you know, then there are people who once I got, you know, diagnosed and I was more open about it, which took me some time, but there were people in my circle that I was more open to who were like, “Oh, everyone knew that you had like…” you know.
At that point, people kept saying postpartum depression because no one really knew what postpartum anxiety was. But, like, basically, everyone knew you weren’t well, and I’m like, “Why didn’t anyone say anything?” And then this one person who was my…I mean, she’s still, she and I share a best friend. And I remember sitting at my friend’s dining room table and her saying to me, “I got to tell you, Deena, like, with all respect, like, I don’t think you’re doing great. Like, maybe you want to talk to somebody,” and I was like, “No, I’m just really tired. Like, I’m totally fine.” She’s like, “You look really thin,” because I really was barely eating, you know. And I’m like, “No, it’s just because I’m on this restricted diet for breastfeeding.” I mean, I just sort of, like, excused it mostly I think because if you’re not well, it’s hard to, one, have insight in that way, and two, it’s sort of, like I said, it wasn’t in my mind what typical depression looked like. I just sort of felt like if I were doing better at this, like if I were better at not getting sleep, if I were better at X, Y, and Z, like, then all this would go away. And so, it didn’t really occur to me that, like, this wasn’t my fault and that there was a way to treat it until it got really bad.
Dr. Fox: Once you ultimately were diagnosed, and you said you had that aha moment, and for you, you did not feel a stigma about the diagnosis about mental health, which is again, that is great. I would say that’s probably unique. I think a lot of women would feel stigma, unfortunately, but what about those around you? Did you feel stigma from the outside, you know, people who you worked with or people who you knew? Did you sense that or did you feel it or was like even overt?
Dr. Blanchard: I mean, I think at first, I just felt so much relief and I haven’t really talked about it, and my psychiatrist told me that he wanted me to go on Zoloft. I was like, “I don’t need Zoloft. I’m just going to start coming for therapy,” and he’s like, “I think you need both. So do me a favor, try it. If you don’t start to feel better in two to three weeks at all, if you’re seeing no improvement between now and therapy, we can always taper you off of that.” And, I mean, being a logical person, I’m a medical person, I’m like, “Okay, that makes sense.” I’m like, “I’m willing to do that.” I got lucky also seeing someone who, I mean, he’s not a reproductive psychiatrist, but he understood a lot about pharmacology and I was very concerned about breastfeeding and he’s like, “Zoloft is a big molecule. It really barely gets in the breast milk. There are studies. It’s safe. It’s more dangerous for your baby for you to continue feeling like this.” And I was like, “All right.” Like that made sense to me as a logical rational physician, and it felt like I really can’t tolerate the way I’m feeling anymore, so I might as well.
And I have to say, like, even though it takes time for, you know, Zoloft, which is SSRI serotonin reuptake inhibitor, a selective search on a reuptake inhibitor, it does take the irritability off quickly, and the irritability was a big issue for me. Like, I think that experience of kind of like crawling out of my skin in hindsight when I think about it and as I’m talking about it, I was irritable. Like, everything bothered me, you know. Like, I was just very touchy, which is not my general temperament. Like, I’m a pretty laid back, like stuff-doesn’t-really-get-to-me person. And that lifted actually relatively quickly, and I was able to actually go back to work. And initially, I didn’t actually tell anyone at work, and then people kept saying, “Wow, you seem so chilled.” Like, you know, “You seem so relaxed.” Like, I mean, even, probably prior then to my baseline, I was more relaxed because I was now in weekly therapy and I was exploring, like, other interpersonal relationships that I was having issues with that like, of course, cause you stress, but unless you’re working on yourself, you don’t know about it, and I do think the medication actually allowed me to make a lot more progress within my individualized therapy because it did take the edge off. And so, I was able to focus and deal with some uncomfortable feelings as opposed to maybe… But I’m not sure I would have been able to if I wasn’t on medication. I don’t know. I’ll never know, but it does feel that way to me.
And then eventually, I don’t know, at some point, like, probably somewhere when AJ was about six, seven months, I was back to work four days a week as opposed to five, but that was sort of where I had been gearing up to get to, and I was back on becoming a partner track and things were sort of back where they were. I remember, you know, having run into an older colleague and the colleague was like, “How are you doing?” And I was like, “Actually, I’m doing well, though I had a really difficult postpartum period. I had postpartum anxiety. I’m taking Zoloft,” and this older physician said to me, “Oh, I don’t think you should tell that to anybody else. People will question your ability to be a physician.” And there was, at that moment, shame that I hadn’t felt prior. And then I said, “Well, I don’t look at mental health that way, and look, I’m a daughter of a psychologist and a social worker.” So, obviously, like, I mean, I talked about feelings my whole life, you know, but I said, “I don’t really look at mental health that way. That’s not how I see it. I see it, like, the same way I have to wear glasses. Like, my brain is not doing okay right now. This medicine is like glasses for my brain,” but I think I felt an undercurrent of shame and I felt like, okay, I don’t really want to talk about the details of my case, but I want to change something in my practice, and that’s when I approached my partners and said, “Okay, I think we need to start screening for postpartum mood disorders, and I think we need to do it in a really organized, thoughtful way because I think we’re missing people. Like, I missed myself, so we’ve got to be missing people.”
And I said it kind of…like I think back on the year and a half before, like how many people did I chop up like, you know, their worry over the child to like, maybe, “Oh, they’re just more neurotic or first-time parents?” And like, “That was me,” you know, and I’m like, “Okay, like, you know, no one…” I just felt so committed at that point to, like, the idea that no one should have to suffer for three and a half months in silence. No one should have to continuously, you know, question their ability as a parent and feel horrible about themselves in a silent way, and that we as pediatricians saw parents over and over again and it was an opportunity for us to make a difference, and I started to read more about it and get more involved. And that’s when my practice started doing screening, and then you don’t want to… So, it was initially a two question questionnaire and then we moved up to the Edinburgh, which is a 10 questionnaire initial screen, and we kind of made it a hard stop. Your child could not be seen for a five-week, two-month, four-month, six-month, well-child checkup without filling this out. And then suddenly, you know, and actually I was committed to following it and looking at were we screening? Was it happening when we weren’t? Were there specific doctors that weren’t? Why was it getting missed? And creating sort of a systems approach so that, ultimately…and like, was it being documented? Was the number being documented? Was the approach being documented? And then, you know, sort of I started saying like, “Okay, it’s not enough to just refer. Like, we need to have resources. We can’t say to somebody you have postpartum anxiety. Good luck.”
Dr. Fox: Yeah. That would be bad.
Dr. Blanchard: And so, I mean, it wasn’t like that, of course, you know. Like, we would say, “Here are some people we recommend,” but I felt like we needed more immediate resources. And I had started to build up relationships with people in the field of reproductive psychiatry, psychology because it became, like, a goal of mine to try to change things. Look, I mean, would I like to change the world? Yes, but here I was in a position to make changes within my practice and with so many parents that’s already. Like, you know, if I even picked up one person who hadn’t been picked up before, it felt to me like here I was with this opportunity to make a huge difference. And so, we actually started working with Melissa Paschke who is a postpartum social worker. And we continued to work with her. We could refer to her and she would see our patients in the office, so it was a de-stigmatized process. So, for example, the baby could come in to be weighed or not, or the mom could just come, but it was sort of a safe place [inaudible 00:27:21], in that case. It was a safe space because it was the pediatrician skills and like, you know, it really created…it opened doors I think for a lot of people to feel more open to it, and then we started to devoutly develop more relationships with the Motherhood Center, and, I mean, it came to the point where I had contacts all over the city and put together this list for my partners where they would say, “Mom, we were really worried about,” we could be on the phone with a doctor and figure things out pretty quickly.
And we also really felt strongly about partnering with the OB-GYNs because as you know, we work together professionally anything to the practice. You know, we love being a partnership and I think that what we wanted to say to new parents is, you know, whether it was your 1st, 2nd, or 25th kid, you know, there is a partnership here between your OB-GYN and your pediatrician. And is it okay with you if we speak to your OB-GYN? Because we, as pediatricians, could not prescribe medication for a mother. Yes, we could screen, but we couldn’t diagnose. So, what we were really…you know, but we created kind of, like, you know… We put that out there from the new first visit where people would either sign yes or no. If they had said no during these discussions, I would usually talk about it and most people were very amenable to having, like, their whole treatment team involved. In cases where it wasn’t an emergency where there was just either mild, moderate, or significant feelings where either it was therapy or meds or something that wasn’t emergent, we could get people in with people in this field very quickly, and we would then call the parents to follow up two days later, and we had…I mean, it was something that we tracked, you know, for a long time until we got it right.