Postpartum and Breastfeeding

Office Hours: How To Seek Postpartum Mental Health Support With OBGYN Dr Tracy Shevell

Dr. Tracy Shevell

Office Hours: How To Seek Postpartum Mental Health Support With OBGYN Dr Tracy Shevell

Navigating the journey to motherhood and then accessing recovery support after becoming a parent is often far from easy. Many of us struggle to find the time and access to trusted practitioners.

As part of Needed's mission to empower women with expert knowledge, we are excited to invite you to our virtual "office hours." Today, we are asking questions and advice from one of our valued experts, Dr. Tracy Shevell, MD, an esteemed High Risk OBGYN and Needed Changemaker.

During her 17-year tenure at Stamford Hospital in CT, Dr. Shevell won numerous awards from the American College of Obstetricians and Gynecologists. She has served as the Director of Perinatal Ultrasound, as the Division Director of Maternal Fetal Medicine, and eventually transitioned into her most meaningful role, the Director of Maternal and Fetal Wellness. As a high risk OBGYN with years of experience, in 2021 she launched Blue Moon Perinatal to better be able to address the impact of maternal mental health on pregnancy outcomes on a one-on-one basis. 

Needed: Dr. Tracy, what is your advice to a new mother struggling with her mental health? 

Dr. Tracy: After delivering a baby, about 80% of women experience what's known as the "baby blues" during the first two weeks. This is a completely normal phase characterized by crying, heightened emotions, and mood swings. However, if these feelings persist beyond two weeks, or if you suspect you might have depression, it's crucial to seek help early.

If you haven't seen your doctor until a two-week or six-week visit (depending on whether you had a vaginal delivery or a C-section), you should be screened for postpartum depression and anxiety using a questionnaire. If you test positive, your provider will typically give you a referral, but often these referrals can have long wait times.

If you feel like you're struggling, one of the best steps you can take is to find support, such as a new mommy group or a support group. Engaging with others can help you gauge your level of symptoms and provide a sense of community. Additionally, don't hesitate to proactively seek help, especially with the increased availability of mental health assistance online due to COVID-19. Apps like BetterHelp can connect you with local mental health professionals.
If that doesn’t lead to results, there's an organization called Postpartum Support International dedicated exclusively to maternal mental health. They are a valuable resource that can help you find local support and connect you with someone to talk to.

Needed: What's Normal and What's Not When it Comes To Postpartum Mental Health?

Dr. Tracy: If you are struggling postpartum, it's important to recognize some normal emotions. You may not be getting enough sleep, which will make you tired. Hormonal changes can cause your mood to shift frequently. However, there are signs that indicate you should seek help: if you're exhausted and absolutely cannot sleep; if you find no pleasure in anything, including caring for your baby, even when someone else cares for your baby to give you a break; if you have no appetite and find yourself unable to eat; and lastly, if you have any thoughts of harming yourself or your baby that you can't get out of your head and are considering acting on.

Read more about everything you need to know in our Postpartum Guide.

Needed: Can you explain a little more about the types of mental health disorders that women can experience in the postpartum period?

Postpartum mood and anxiety disorders (PMADs) can include conditions like postpartum depression, postpartum anxiety, and postpartum psychosis, among others. Hormonal shifts are a significant trigger for mental health issues that may not have been apparent before pregnancy. These disorders encompass a spectrum of symptoms, and it's important to address a common concern many women have postpartum: fearing they have conditions they don't actually have.

Occasionally, horrifying stories appear in the news about women who were so distraught that they harmed their children or themselves. I want to highlight something very common: one feature of the "baby blues" and postpartum anxiety is intrusive thoughts. Many women, due to exhaustion, sleep deprivation, and stress, have images of dropping their babies down the stairs or accidentally hurting them while swaddling for example, that plague them.

These intrusive thoughts, almost like dark fantasies, are not indicative of postpartum psychosis. They are very normal and happen to many women. The difference is that in postpartum psychosis, women are essentially commanded by a voice they hear, telling them that harming the baby is the right thing to do. In contrast, intrusive thoughts in postpartum anxiety are not thoughts a woman thinks should be acted upon. It's crucial to understand this distinction because many women worry they have postpartum psychosis when, in fact, they are experiencing normal intrusive thoughts, which can occur throughout motherhood.

Needed: What should I do if I feel I'm struggling but not being heard by my provider?

Dr. Tracy: Your OBGYN can help refer you to a mental health professional. However, I want to be realistic. While this all sounds ideal, we know that a postpartum visit to the OBGYN's office can sometimes feel rushed. You might be aware that there are many other many other people waiting, and I can promise you your OBGYN wants to spend more time with you than they actually have. Typically, though, they will have a host of resources available. If they don't have the time to go over them with you, feel free to ask to speak at greater length with a nurse manager, nurse practitioner, or even a quick check-in with a care coordinator if the office has one. Always think about the person one step beyond your doctor who can review all the varied resources and referrals available to you. You should never leave with just a loose “phone number” referral. Simply being told you need to talk to a mental health care provider isn't enough, because then it's not giving you the ability to make that happen and it's not the reality of life.

If you think you need help, the likelihood is overwhelmingly high that you do. In fact, more women need help than they even admit to themselves. If you can't get the response you need from your doctor, your best backup option is to talk to the pediatrician caring for your baby, whom you see frequently. When postpartum mental health screening first became common, such as in Connecticut, pediatricians were often responsible for screening, not obstetricians. This might seem unusual because pediatricians are there for your baby, and you've had a relationship with your OBGYN for nine months. However, the frequency of visits and face-to-face encounters with pediatricians makes them an incredibly valuable resource. Even though they are not primarily responsible for screening anymore, they can still provide you with other resources. 

*If you are struggling with your mental health please seek urgent support from your provider. Or you can call the The National Maternal Mental Health Hotline. Call or text 1-833-TLC-MAMA (1-833-852-6262).


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Dr. Tracy Shevell, MD

Tracy is a High Risk OBGYN who has pivoted from direct hospital care to serving as a guide to help fix our broken system. Mothers and families are more disconnected from ever and their doctors are equally as frustrated. With 20 years of clinical experience, she created Blue Moon Perinatal as a navigational and support service to help women self educate, learn how to empower themselves medically and how to get the best care they can. It is her hope that this can be used to mend the disconnect of the current challenges women face in their childbearing years, from preconception to the postpartum period.