The Agenda with Steve Paikin (Audio) - What Happens to Your Brain During Pregnancy?

Episode Date: September 26, 2024

Although much more awareness is given to postpartum depression, Dawn Kingston's research shows that just as many, if not more women struggle with their mental health during pregnancy. One in four women will deal with mental health problems in the prenatal period, but these issues are still widely misunderstood. Her new book, "Your Brain on Pregnancy" offers more information, screening questions, and treatment options to help guide expecting parents who may be struggling with depression, anxiety, or toxic stress. See omnystudio.com/listener for privacy information.

While there is some understanding of postpartum depression, research shows that just as many, if not more, women struggle with their mental health during pregnancy. One in four women will experience mental health problems in the prenatal period, but this is still widely misunderstood. Dawn Kingston examines that and more in her new book, Your Brain on Pregnancy, a Guide to Understanding and Protecting Your Mental Health During Pregnancy, a Guide to Understanding and Protecting Your Mental Health During Pregnancy and Beyond. She is also an Associate Professor

in the Faculty of Nursing at the University of Calgary, and she joins us on the line from Edmonton, Alberta. Hi, Dawn. Good morning. Thank you for having me. It's so nice to connect. I've had two kids. My kids are preteens, 11 and 13. I've read a lot of pregnancy books, a lot of baby books, and I have to say that your book, in my view, is, if not, one of

the most important books for women to read and their partners to read. Excellent. Thank you so much. What brought you to research the intersection of mental health and pregnancy? Ma'am, it really started in my neonatal days as a neonatal nurse, understanding the risks of prematurity and when I started to do graduate work, I really wanted to think about how can we prevent preterm birth, small babies being born, and I discovered a real link between stress and prematurity. And then as we researched

it more, I realized it's not just stress, it's depression, anxiety, any form of mental health challenge in pregnancy. And it wasn't just prematurity, it was also children's development, emotional well-being, physical development. And so that really led us on a train of discovering what was prenatal mental health about. And then secondly, really understanding that we had a system that wasn't paying any attention to mental health in pregnancy. And that really started our advocacy journey as well. I think there's this idea that when someone becomes pregnant, they are so happy, they're excited. And when you're pregnant, you are told that everything that you do,

everything that you eat, impacts the baby, that if you get stressed out, there's a lot of guilt about, you know, I can't be stressed. And it's really hard to do over the period of nine months, well, actually 10 months, because it's 40 weeks. But you write that there is much more awareness around mental health problems after giving birth, like postpartum depression. So if you are experiencing anything during pregnancy,

sometimes you blame yourself. So why has there been so little focus on mental health problems like during pregnancy when people are pregnant? I think ma'am, it's been an over focus to be honest that started on the postpartum period, which started really I think with postpartum psychosis. You know, it was wonderful to bring awareness to postpartum psychosis, postpartum depression, and there were lots of media and stars that did that for us. But what it did is I think it overshadowed a little bit what happens in the prenatal period. And when we started really studying the data and

looking at our own work, we realized that three out of four women who had postpartum depression had depression or anxiety in pregnancy. And so prenatal mental health problems are actually the biggest risk for postpartum mental health problems. And so it really, it really to us showed a disparity in where the focus was. And so, again, while I think that postpartum depression awareness was a wonderful thing and very needed, I think we just need to now broaden our understanding of the perinatal period in total, pregnancy and postpartum. I want to read a passage from your book. You write, women see healthcare providers during pregnancy

more regularly than almost any other time in their lives. During prenatal visits, women undergo physical exams, ultrasounds, and laboratory tests that screen for physical conditions such as diabetes, high blood pressure, infection, and fetal anomalies. But these are far less common than mental health problems, yet rarely are a few minutes devoted to asking simple screening questions that would identify the most common mental health problems in

pregnancy. You know, when you are pregnant you are tested for diabetes, blood pressure, and you write that those conditions are actually less likely to happen than mental health problems. Why isn't depression tested? You know, it's a North American thing. In the UK and Australia, they have had national screening programs during pregnancy and postpartum for well over a decade. They have good policies, they have a great health care system,

they have trained their midwives, nurses, physicians to do screening. So there has been a call for screening in North America, in the US and Canada, but we haven't lifted it off the ground. And I think in some ways, it's because there isn't a central way of doing that. And that's in part why we have put screening tools in the book, and why we put them also on our website, which has free resources, hopeformentalhealth.com. But we really, this is a North American blockage in some ways, why we don't screen women. I think the other piece of it is there is this feeling

by healthcare providers that this is awkward. It's a difficult conversation. Women don't want this, but actually our research shows that well over 98% of women want to be screened for emotional health. And then the other piece of it is, what do you do when you open Pandora's box and you discover that you have a patient who has a mental health challenge? Our North American system isn't all that well set up to address mental health problems in the perinatal period.

Again, it's also why in our book we wanted to really focus on self-management because actually it is the place most women want to start. You mentioned Pandora's box and I think a lot of if you're pregnant you're looking for this information and if you don't find it because we still live in a society that says that when you're pregnant it's're looking for this information. And if you don't find it, because we still live in a society that says that when you're pregnant, it's the best time of your life. You're supposed to be happy. But if you're feeling any kind of emotions opposite that,

you internalize them. But what other gaps did you identify in the health care system in terms of mental health care during pregnancy? Yeah, our team is going to phrase it. So women don't tell and providers don't ask. Again, if you have routine screening as part of a well woman's checkup, as part of one of the 13 prenatal visits, then you don't have to rely on a particular physician asking questions

or a woman having to bring it up. Most women will not bring up mental health challenges. However, again, in our work, the vast majority of women have identified, if a provider asks me how I'm doing, I would tell them honestly. You do say in the book that the most important thing to keep in mind is that if we don't acknowledge there is a mental health issue, that's the thing that's going to cause long-term damage.

I want to talk to you more about that. But what are some of the factors that would make someone more likely to experience mental health problems during pregnancy? Yes, I'm so glad you asked about those, Nam, because without those, women feel like this is a random thing. You know, postpartum depression, that's the impression we have. And I think it will carry on over into prenatal mental health problems if we're not really clear.

The four biggest risk factors that lead a woman to have a mental health challenge at any point in her life, not having enough social support, so not having friends that love and care and nurturing relationships, having high partner conflict. We're not talking about a single argument, we're talking about a constant tension and fighting in a close relationship with a partner. Having high stress, you know, we've known that for 30 years, that high stress can cause challenges in unborn animals, unborn babies. And then finally, really having a previous mental health problem. And that's an important point because we are starting to put a picture together in our research team

that says it's not postpartum depression or anxiety, prenatal depression, anxiety. It really is about what's happening across a woman's life. So the book focuses in pregnancy, but the more we uncover this work, the more we see long-term struggle as brain and nervous system dysregulation that probably started way before pregnancy

and has existed across a woman's life. Is that what you would call intergenerational trauma? In part, intergenerational trauma is more about, you know, something being passed down from grandma to the mother to the baby. And that can happen when it comes to mental health problems. And there can be genetic tags that can be sort of added on to our DNA and that we're born with. We think we're born with a clean slate of DNA,

but we're not. And mental health problems are one of the things that can add a little tag. Now that tag is impermanent. It can be taken off by good support and nurturing and all of the good things that lead to good mental health can take those tags off. But you have to acknowledge that there's a there it's there, right? Yeah, you have to be

intentional. Yeah. There's a joke around when you're pregnant, you know, you're eating all the foods, you are going through the mood swings. But on the serious side, how can you tell the difference between someone who could just be experiencing mood swings versus something that's really serious mental health-wise during pregnancy? Right. I think that's where the screening tools can really help because then we're not having

to guess. We just do a screening tool. It tells us if we score above a certain level, then we're struggling more than average. But in general, we're really concerned about women who... Let's use a situation. Someone's cat dies and sort of a situational thing. I feel kind of crummy, sad, grief, loss, angry, angst, but it doesn't last. Now in the DSM, you know, or kind of our Bible of psychology, it would say six months, but that's a long time in pregnancy. In general, something that goes beyond a situation and lasts for a period of time is where we start to think this is just a little

bit beyond normal, beyond healthy normal. But if someone is experiencing symptoms, how can they tell the difference between depression, anxiety, and toxic stress, or does that matter? Often they come together, and especially in pregnancy, often they come together, and that's actually why it makes it a little bit hard to diagnose. But in general, if, and so, you know, we can actually put that all under brain and nervous dysregulation too. So what does that look like?

Trouble sleeping beyond a physical discomfort, sleeping too much, not sleeping enough, eating too much, not eating enough. A sense of loss of joy, a sense of dread. Not worry about a particular situation, that's more worry, but kind of this anxious dread that something terrible is going to happen, something terrible is happening to me. And where it really tips over into unhealthy is where a person feels immobilized by the situation. You know, that there is no hope, it is inescapable, and it's never going to be different. And that's impacting themselves and the baby.

Yes. I want to take a look at some of the statistics in the book regarding how women feel about reaching out to their healthcare providers for help. Seventy percent are hesitant to talk to prenatal provider about their mental health. That's a big number. Forty-four percent worry about being put on antidepressants. Forty-six percent believe symptoms will just get better on their own. We seem to live during a time where we're having a lot of open discussions about a lot of different topics that might have been taboo 20, 30, 40 years ago, even 10 years ago.

Why is it still so hard for us to talk about mental health challenges? I think, Nan, because it speaks to the very heart of who we are as a person, to our identity, to our sense of competency, to our sense that we are a broken person. And that's where in the book we are really, and our team is really starting to focus on the idea about, isn't it just brain and nervous system dysregulation? We've been jarred. We've been jarred often by circumstances in our lives as children or as adults that we have no control over. But it affects how we see ourselves.

And depression, anxiety, stress are symptoms that are kind of losing out of those experiences that have become embedded in our nervous system. But if we can think about it like that and take it away from the fact that we are broken and wounded and, you know, we're in trouble because of that, it's a very different look at what we're experiencing. Maybe this is just my experience,

but even just talking to some of my friends who've had kids, when you're pregnant, there's a lot of concern about the baby. There are rarely any questions asked about the mom. And even after you have the baby, as soon as the baby is born, it just kind of feels like, OK, here you go. And if you're a first time mom, it's like, oh, gosh, I have to keep this person alive for the, like, what did I do? Do you think there's a little bit of that societal expectation

that you're supposed to know what to do? And maybe it makes it harder for women to talk about the difficulties they have with their mental health during pregnancy? Yeah, that's a really good point. And I think many women who have not been nurtured as children in a loving, nurturing home also feel a bit unable to, or they've lost confidence about whether they'll be able to nurture and love their child as well so I think that plays into it too but I agree and I I think I'm gonna bring in at this point NAMM some of the

research that's been done on on Dan Siegel Dr. Dan Siegel is a big proponent and researcher in the area of interpersonal biology. And it's the idea that we regulate each other. Partners regulate each other. Our nervous systems, we regulate each other. Mothers and children regulate each other. It's why we put babies on a mother's chest after birth, right? We know that it regulates the heart rate and breathing. But there is a bigger picture to this, which is it regulates emotions as well.

And so that really speaks to me about the importance of mothers being emotionally healthy so that they can regulate the emotional well-being of their children as well. Is that Dan Siegel, did he write the book, Zebras Don't Get Ulcers? No, no, that was Robert Sapolsky. I love that name of that. I'm such a big fan of him. I love that. I think one of the things that I found really helpful in your book is that once you identify it, the most important thing is to identify it because then you can actually address what's happening.

But if you don't do that, what are the risks if a mother is experiencing these mental health challenges while she's pregnant? Yeah. Yeah. The biggest risk is chronic depression, anxiety or stress. That is not doing anything about it. And I'll go back to that statistic. 44% of women don't want to talk to their doctors because they fear going on antidepressants. And what most women, our research showed, most women don't understand that there are actually lots of ways of dealing with depression, anxiety, and stress that don't involve medication. And so the main issue with not identifying a challenge is yes, not being able to take steps to do something about it. And then the dread that exists, right, when you don't know there's a dread, but when you have the facts, then you're able to kind of draw a line in the sand and you can create a plan and you can go forward.

And with mental health, it's just like in the book I talk about, it's just like diabetes. It's just about managing. You know, you mentioned medication, and there is this kind of, I know when you're pregnant, you shouldn't be taking any medication at all. But sometimes medication is needed, yes? Yeah, it is. And I wouldn't say it's the first thing unless a person has left their symptoms so long that it really is needed to sort of begin the process of getting well. But most women really want to start with something else. They want

to start with some kind of self-management and that's completely reasonable. And then if that isn't helping, go forward and consider medications. And yes, sometimes medications are needed. Yeah. In the book, you describe strategies that people can use to mitigate symptoms when they might be experiencing.

How do you know when these strategies are enough versus when it's time to seek professional help? I put together a bit of a list, sort of five items in the book that women can use questions to ask about, is it time to get help? If you are using strategies and they are helping and your symptoms are lessening and you're feeling better and you're feeling confident about managing your own mental health,

that's the place most women want to be in. But if those are not working, if you're feeling like I'm getting worn out from doing this on my own, if you feel that it would be helpful to have talk with someone who is compassionate, then it is time to get help. And you know, it doesn't have to be an all-in.

You can try a couple of sessions with a professional, and if it's not helpful, you can turn around and go back. We only have a few minutes left. I want to sneak in a couple more questions. We talked a little bit about stigma, but we kind of danced around a little bit around it. What would you say to mothers who don't want to talk about prenatal or postnatal mental illness because they worry others will question their competency as a parent? I would go back and really have them focus on what is it that started this journey. A woman wasn't born broken, she's not broken.

What has happened in her life that has led to this point where she is experiencing these symptoms, that they are symptoms. They are like a cold or a flu. They're like a fever. They tell us that something is going on inside that needs some attention. And so they are red flags and symptoms, much like a fever is a symptom of a virus. And so I would encourage women, I think it's partly education, being able to educate others and say, you know what, it's a symptom. It's not me. It's not that I'm broken. What if they think that they've damaged their child?

Right. You know, there was a... I love this. I'll just share this one study. I love it because it shows how neuroplasticity is the root of our brain health. Our brains change, our nervous systems change. And even if a woman had depression or anxiety or high stress in pregnancy, that does not mean that the baby's future is sealed

and the baby's going to be in trouble going forward. I love this study. It showed that women who had depression, the women who held their babies after they were born, their brains basically healed. And so they measured the amount of time that women held their babies and the women that held their babies more, their babies' brains looked different. And so when we talk about those impermanent changes to the brain,

that's what we're talking about, then holding and nurturing the baby takes those epigenetic tags off. And I love that because it's such a story of hope that the simple things of nurturing a child can reverse these effects. Isn't that a good news story? That's a great news story. I think it makes a lot of women feel much better. In a recent study published in Nature Neuroscience, scientists in California took MRI scans of one woman before she got pregnant until two years postpartum. They found that nearly every part of the brain was affected by pregnancy. This was a review of just one person. But will

studies like this help others learn about the brain and pregnancy in the future? Yes. And in fact, we just got a hundred thousand dollar grant, which is small probably by comparison for what this work requires to start looking at scans of multiple, multiple, multiple women. So we'll be doing that here in Alberta. And our goal really is to create a database of what women's brains look like so that we can really start embracing and improving upon our brain-based treatments.

Dawn, it was really nice to connect with you. Thank you so much for spending time with us. I think this book is going to help so many. It has, it answers questions that a lot of women want to ask, but maybe are too ashamed to ask. So thank you for that. I appreciate your time. Thank you very much for having me on today.