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Postpartum Depression, Anxiety or Burnout? When to Ask for Help · Life After Birth by Her Health Room

• 0:00
  you love your baby, but maybe you're feeling anxious, and motherhood just feels way harder than you expected.
• 0:05
  I want you to know that you're not alone You see things online, you're wondering if it's depression, anxiety, or even just burnout.
• 0:11
  Today I'm joined by a counselling psychologist, Dr.
• 0:14
  Orin, who works in the perinatal space, both in the NHS and privately, to discuss what it feels like, to go through that transition, whether it's in pregnancy or the postpartum period What the difference between normal adjustment, needing help, or having an actual diagnosis of depression or anxiety.
• 0:31
  In this conversation, you're gonna learn what red flags you need to watch out for, and how it's normal to both find motherhood hard, find it annoying but also to love it at the same time.
• 0:40
  So stick around and I hope you enjoy the conversation
• 0:43
  Remi Mogekwu: thank you very much for being on the podcast, first of all.
• 0:46
  Remi Mogekwu: My first question to you is when a mother comes to you, often they won't know if they're depressed, anxious, burnt out, or just in a normal transition phase.
• 0:56
  Remi Mogekwu: How do you tend to tease that out?
• 0:58
  Orinayo: Yeah, I tease it out in terms of, severity, duration, and I guess also just keeping in mind some kind of typical symptoms of depression, versus feeling low.
• 1:08
  Orinayo: We're all capable of feeling low.
• 1:09
  Orinayo: It doesn't mean that you're depressed necessarily or have clinical, depression.
• 1:13
  Orinayo: So that's normally what I would do, and I guess it's a spectrum really, isn't it?
• 1:17
  Orinayo: So it's like, how much is this impairing somebody's functioning?
• 1:21
  Orinayo: Like, how dark does it feel in their mind, in their heart?
• 1:24
  Orinayo: Does this feel like this is hard, but I feel like I can cope, I feel supported?
• 1:28
  Orinayo: Or does this feel somebody's like slowly sinking into the depths of despair, and everything feels really bleak and really difficult and they can't see any kind of light or anything good around them?
• 1:39
  Orinayo: But yeah, I would say it's normally severity and how long it's been going on for how I would begin to tease that out.
• 1:44
  Orinayo: Yeah
• 1:45
  Remi Mogekwu: And where do you reckon they need to be in their journey for them to notice this?
• 1:49
  Remi Mogekwu: Could it happen at any time, or is it, a specific time that you tend to see it?
• 1:53
  Orinayo: It can happen at any time.
• 1:54
  Orinayo: I think you see it a lot after you've had the baby.
• 1:56
  Orinayo: And just thinking about in my private work and also working in NHS postnatal service we do see a large proportion of people who have had their baby and then feel like, oh they will say,"Oh, I had postnatal depression," or,"I think I have postnatal depression." But it can happen at any point, to be honest, because somebody might already have long-standing difficulties with depression before they even became pregnant in the first place.
• 2:17
  Orinayo: So it might just be that it gets worse, or they feel like it's reoccurring, or there's something around being pregnant, or that time that kind of triggers, re-triggers them, so they have a bit of a but yeah, it can happen at any time.
• 2:27
  Orinayo: I think there's a bit of a that it's mostly postnatal, but I've seen lots of moms who have been depressed during their pregnancy as well.
• 2:36
  Orinayo: So I think it's important to just keep an eye out in general to see how somebody is, doing.
• 2:43
  Orinayo: But I think maybe once the baby's here, it can be more apparent because there's a lot more stress on that person looking after a baby.
• 2:52
  Orinayo: So I think sometimes maybe what is depression may not always be picked up because I guess their life has changed.
• 2:58
  Orinayo: Life changes quite drastically for a lot of people, so I think that their capacity levels are different, and any vulnerabilities show up more
• 3:07
  Remi Mogekwu: Yeah, I think that makes sense.
• 3:08
  Remi Mogekwu: And obviously they're not sleeping as well.
• 3:10
  Remi Mogekwu: They might have issues with their relationship, their health, the, the birth itself.
• 3:15
  Remi Mogekwu: And I know you mentioned depression, but I've read somewhere that postnatal anxiety is almost as common as postnatal depression.
• 3:20
  Remi Mogekwu: It's just not spoken about as commonly.
• 3:23
  Remi Mogekwu: Would you say that you see that as well?
• 3:24
  Orinayo: Yeah, I would see that.
• 3:25
  Orinayo: I think there's research to back that up as well, that actually they co-occur just as much as each other, but there's more of a spotlight thrown on depression.
• 3:33
  Orinayo: And I think sometimes people say depressed, but they mean-- but they're also anxious as well in like there's a mixture of anxiety and depression in that.
• 3:40
  Orinayo: But it might be that the depressive symptoms seem to be more obvious to them or more-- to seem to be more problematic for them than maybe the anxiety, like if it's normalized, or I'm a bit of a worrier, I just worry about things anyway.
• 3:50
  Orinayo: So it's really about how people perceive their own and the perceived, like the symptoms or the, the experiences that they're having.
• 4:00
  Orinayo: But I would say anxiety's really common.
• 4:03
  Orinayo: Really common, especially during pregnancy.
• 4:05
  Remi Mogekwu: Is the treatment for both of them the same?
• 4:07
  Orinayo: I think the important thing is about how the person and the therapist that they're working with formulates what the issue is about, why they're feeling anxious, why they're feeling depressed, what it means, what, what aspects of their symptoms bother them the most versus o- versus other symptoms, what's actually causing more of a problem.
• 4:27
  Orinayo: so I think there's lots of different approaches.
• 4:28
  Orinayo: I'm trained integratively, so I wouldn't just strictly use CBT.
• 4:31
  Orinayo: I think it's more about what's your formulation of why this person is presenting in this way.
• 4:35
  Orinayo: It might be to do with childhood stuff.
• 4:37
  Orinayo: It might be to do with past trauma.
• 4:39
  Orinayo: It might to do with some relationship issues that are happening currently or it might be that there's a lot of life stresses that's putting pressure on them, so actually they don't have as many resources as they might have done.
• 4:48
  Orinayo: And obviously, when we're depleted or our resources are low, we're more susceptible to struggle with our mental health.
• 4:53
  Orinayo: So it's more about understanding first and foremost what is the story around this person's anxiety or this depression, and then you would go and say,"Okay, I think CBT would be good," or compassion focused therapy or...
• 5:03
  Orinayo: there's so many different modalities, but I predominantly like to work integratively because I think makes sense.
• 5:08
  Orinayo: You can pull things from different things that kind of resonate with people.
• 5:10
  Remi Mogekwu: so it was Maternal Mental Health Week recently
• 5:13
  Orinayo: a week in May.
• 5:14
  Orinayo: Yeah.
• 5:14
  Remi Mogekwu: So I saw lots of things around depression and anxiety, and I've had two kids of my own, and I'm very open with the fact that I struggled postpartum.
• 5:21
  Remi Mogekwu: I can't figure out if it required a, a diagnostic label, but I do think there are so many women between normal transition and coping and a full-blown diagnosis like anxiety or depression.
• 5:35
  Remi Mogekwu: And do you find that when women are caught in that middle bit, they often, number one, don't know where to go and often maybe don't get the help they need?
• 5:43
  Remi Mogekwu: So given that you work both privately and in the NHS how do you speak to those women that don't quite meet the threshold
• 5:49
  Orinayo: yeah, a, a lot of people do diagnostic labels that's part of their story.
• 5:52
  Orinayo: But in the type of service I work in, I don't think there's a focus on we must diagnose everybody who walks in or anything like that.
• 5:58
  Orinayo: You can get a sense as to what somebody is struggling with, whether you give them an official diagnosis or not.
• 6:03
  Orinayo: So I would say yes, if I...
• 6:04
  Orinayo: I see diagnosis more in terms of that job.
• 6:06
  Orinayo: But in private practice, I guess I would see people who probably do fall more between the, they don't necessarily meet the threshold to be in a perinatal service or an NBU or something like that, but actually they are struggling.
• 6:20
  Orinayo: So they might be people that are, like, high functioning, so they're able to function well, but actually internally they're finding things really difficult.
• 6:27
  Orinayo: And whereas I think in perinatal service, you do get people like that as well who are high functioning as well.
• 6:32
  Orinayo: But I think in terms of the the wraparound care that we offer you're more likely to see people who are really struggling, but also they're not really able to function that well.
• 6:39
  Orinayo: So that's impacting their relationship with their baby or relationship with partner, family members is really difficult, or they're just not really able to show up in the way that they would want to.
• 6:49
  Orinayo: But we would s- we see a whole spectrum of people, and we have different interventions depending on kind of how severe or how much risk there might be in terms of what somebody is struggling with.
• 6:58
  Orinayo: But I do find the people who reach out to me for private work are the people you're describing.
• 7:02
  Remi Mogekwu: Cause obviously the people who come to you have insight and know that they're, there's something wrong or they're not coping.
• 7:10
  Remi Mogekwu: But how would you, speak to someone who doesn't know?
• 7:13
  Remi Mogekwu: Like, how would you tell them that your service is needed when they themselves don't know that what they're going through is not normal?
• 7:21
  Orinayo: Yeah, that's an interesting question.
• 7:22
  Orinayo: How do you cultivate insight with somebody who doesn't Do you mean someone who's is aware that they're struggling but is not seeing it as anything that requires any sort of intervention?
• 7:31
  Orinayo: Is
• 7:31
  Remi Mogekwu: Yeah.
• 7:32
  Remi Mogekwu: Yeah, like they've normalized the struggle and therefore they just don't know to seek help.
• 7:37
  Remi Mogekwu: When I think about gynae conditions where if you're changing a pad every hour, that's not normal.
• 7:42
  Remi Mogekwu: And so that hopefully catches someone who thought it was normal and makes them go and seek help
• 7:47
  Orinayo: Yeah, I think with that it's just through, like conversation if you happen to make, have contact with these people to say"Yes, just because something is common or lots of people experience it, doesn't mean like that has to be the status quo." Obviously, like a lot of the people who I do come across in my NHS job are thinking that no, something's not right, I need some support with it.
• 8:07
  Orinayo: But I would think it's just through kind of conversation and just using my own knowledge, and experience to say that actually that sounds like you're really anxious, and it's like maybe taking over everything.
• 8:17
  Orinayo: Have you considered this, or have you considered that?
• 8:19
  Orinayo: But yeah, I think it's more about understanding, understanding that person's frame of reference as to how do they conceptualize distress and like what that means and what they should put up with and what they shouldn't put up with and when, when...
• 8:31
  Orinayo: Because I think a lot of people are like,"Oh, it has to be really bad I seek help." And whenever I can, if I ever have gone conversations like that with people or wherever I can, I guess on a platform like this, I would say"No, it doesn't." If you're already starting to feel like something doesn't feel right, even if you're intellectualizing it and saying,"Oh loads of people feel like this," it's just or family members are telling you there's nothing special or there's nothing, know, abnormal about what you're going through.
• 8:53
  Orinayo: I went through this as well." It's like just trying to like really listen to yourself.
• 8:58
  Orinayo: And I say like the earlier the better because it's not when it's really bad that you then, you can seek help at that point, of course, but I would always suggest the opposite.
• 9:06
  Orinayo: If you're starting to feel like something is not quite going the right way, then you can seek help.
• 9:10
  Orinayo: Like you're worthy of seeking help before it gets to a really bad point.
• 9:14
  Orinayo: But yeah, it's just people have different frames of reference for understanding the things that they go through and like what they've grown up with, what narratives they've been exposed to and stuff.
• 9:20
  Orinayo: So I guess it's just introducing a different one
• 9:22
  Remi Mogekwu: and I think also just for the simplicity of people watching or listening we're talking about things about feeling low mood, feeling worthless, not eating, not sleeping, having intrusive thoughts things that you weren't probably experiencing before pregnancy or before the baby.
• 9:38
  Remi Mogekwu: Taking stock of new symptoms and not thinking that it's all just because you've had a baby
• 9:44
  Orinayo: Yeah, exactly.
• 9:45
  Orinayo: Yeah, like there's like some red flags like if all of a sudden you're starting to feel suicidal or having really dark thoughts and you never had them Yeah, absolutely, that's a sign to seek help.
• 9:54
  Orinayo: But I think it's helping people to understand what their warning signs are'cause they may have had some of these experiences maybe in a different context where actually things weren't going okay, but because, like you said, they're in the period or postpartum, they might just attribute it to,"Oh this is just what it means to have a baby." And it's no, actually these are signs that something isn't quite right, so you can seek help if you're experiencing them.
• 10:16
  Orinayo: Like yes, having children and that transition is, it is tough but doesn't have to be like an absolutely horrific experience either.
• 10:24
  Orinayo: It's o- it's like it is possible for it to feel okay at times or feel good at times.
• 10:29
  Orinayo: It's not supposed to be like all doom and gloom.
• 10:32
  Orinayo: Like it doesn't have to be that way even if that's what other people have experienced or they've said about, their own experience.
• 10:38
  Remi Mogekwu: Yeah.
• 10:38
  Remi Mogekwu: And I think that's also really important.
• 10:39
  Remi Mogekwu: So when I had my first, I remember kinda getting on with it, and it probably wasn't until about 18 months that I realized that my mood hadn't returned to normal, that this had been going on for too long.
• 10:50
  Remi Mogekwu: And then I went and got therapy.
• 10:52
  Remi Mogekwu: I, I can't remember what, whether it was counseling or therapy, whatever, but I went and sought that.
• 10:56
  Remi Mogekwu: And then when I saw my sister have a baby, she was just very different, very happy, very bubbly.
• 11:02
  Remi Mogekwu: And I think for me, it was an, it was like a lightning bolt, that you can be postpartum and enjoy it and have your days where things are hard, but on the whole, enjoy it.
• 11:12
  Remi Mogekwu: Whereas my experiences were very much like cloud and fog and not finding the joy within it.
• 11:18
  Remi Mogekwu: So I think that's also really important, that sometimes, especially when you're online, you hear the doom and gloom, and you completely forget that people go through the exact same experience, and they're happy, and they're making friends, and they're going out for coffee.
• 11:30
  Remi Mogekwu: And you might be going through the same motions, but you're not enjoying it, and that can also be a sign
• 11:36
  Orinayo: absolutely.
• 11:37
  Orinayo: I think it can be hard for people to differentiate because it is hard.
• 11:40
  Orinayo: Like it's hard for a lot of people, and it's like, what's the line?
• 11:43
  Orinayo: It's like that ability to discern, actually, yeah, this is hard, but I'm okay, versus this is hard and like I'm really struggling and I'm not okay.
• 11:51
  Orinayo: But I think that kind of like depletion, burnout, like feeling dysregulated all the time can become quite nor- like other people normalize it as well, like
• 12:00
  Remi Mogekwu: Yeah
• 12:01
  Orinayo: social, like you said, social media.
• 12:03
  Orinayo: Like even healthcare professionals can normalize it.
• 12:05
  Orinayo: So it's that's why it's important to really think, to really be able to reflect, to not use other external sources as the or the yardstick for how you should be feeling, but actually trying to tune into yourself, which I know can be hard.
• 12:17
  Orinayo: It's not everybody is, introspective and all of those kinds of things.
• 12:20
  Orinayo: But I do think it's an important thing.
• 12:21
  Orinayo: Otherwise, you can, like you're a passenger in the whole experience, and then one day you wake up and you're like,"I just feel really flat.
• 12:28
  Orinayo: I just feel really devoid of color.
• 12:30
  Orinayo: I feel like I'm not enjoying anything," and it's been like this for months, and you, even though you're only just realizing it.
• 12:37
  Orinayo: And a lot of time can have passed between that time.
• 12:40
  Orinayo: So I think it's yeah, tuning into yourself is is important.
• 12:43
  Remi Mogekwu: How would you recommend that people tune into themselves?
• 12:45
  Remi Mogekwu: That sounds hard as well.
• 12:48
  Orinayo: It, yeah, yeah.
• 12:50
  Orinayo: and whenever I say this, that's what, that's often the response I get that, yeah,
• 12:53
  Remi Mogekwu: How do you tune in?
• 12:54
  Orinayo: I would say just even journaling.
• 12:56
  Orinayo: I'm not saying write pages and pages, like,"Dear diary," 20 pages later.
• 12:59
  Orinayo: I'm not saying that.
• 13:00
  Orinayo: But it's just"How am I feeling today?" What's around inside me today?
• 13:04
  Orinayo: What are the things that keep recurring in my mind?
• 13:06
  Orinayo: Just what, it's just tuning into what's there in your kind of internal space.
• 13:09
  Orinayo: But I think journaling is a good one.
• 13:10
  Orinayo: I know not everybody likes journaling, but I think that can be a really good one to just tune in to for you to start to notice, or even if it's just a few minutes each day just to check in"How's the day been for me?
• 13:20
  Orinayo: Like, how have I actually felt?" Because you're so busy, and you're so much in your, I guess like your drive system all of the time when you're a parent, you've got young children or you've got a baby.
• 13:28
  Orinayo: There's no time to stop to reflect and pause.
• 13:30
  Orinayo: I would say, like, how can you pause?
• 13:32
  Orinayo: It could be just when you go to the just going to the bathroom.
• 13:35
  Orinayo: Maybe that's when you're able to pause, or you have five minutes in the morning before.
• 13:39
  Orinayo: But it's actually being quite intentional about it, otherwise you will be on autopilot.
• 13:44
  Orinayo: So I'm not saying it's easy.
• 13:45
  Orinayo: I'm not saying it's easy.
• 13:46
  Orinayo: I acknowledge it's not as, might be easier for me given my profession, but even I find that har- I find that hard, and I struggled with I didn't find I found postpartum difficult when I had my son as well, and I think certain things really impacted me, and I can relate to that sense of, like, where's the joy?
• 14:02
  Orinayo: I just feel really flat.
• 14:03
  Orinayo: Not like I didn't feel like I was depressed, but it was just like something is not, like there's not, there's something that's not feeling how I think it should f- it should feel, but you can't really pinpoint it.
• 14:14
  Orinayo: But I think finding your own way to tune in and check in yourself because otherwise how do you know?
• 14:18
  Orinayo: How do you
• 14:18
  Remi Mogekwu: No, that's true, yeah.
• 14:20
  Remi Mogekwu: 'Cause you will just go on autopilot.
• 14:22
  Orinayo: You will.
• 14:23
  Remi Mogekwu: Yeah
• 14:24
  Orinayo: We, we do.
• 14:24
  Orinayo: It's to survive, like the amount that you have, the demands, the responsibilities, like we need autopilot, but y- ideally you don't wanna live your whole life autopilot because years can go by,
• 14:34
  Remi Mogekwu: And sometimes we think that like, when you go back to work,"Oh, maybe I'll get better then," and then you find that you don't, and then all you've done is compound the stress of motherhood with being at work, and your feelings haven't changed.
• 14:45
  Remi Mogekwu: And I, I would dare say that you could probably go till your child is 10 before you really realize that you've had some unresolved issues around it.
• 14:54
  Remi Mogekwu: And again, that's not necessarily a mental health diagnosis, but it is something that you could have help with either by checking in with journaling.
• 15:02
  Remi Mogekwu: I find journaling hard, but i've adopted a practice over the last 18 months or so just because I was like that.
• 15:08
  Remi Mogekwu: But I wanted to lean that into this phrase that you introduced me to actually, maternal ambivalence, correct me if I'm wrong, but you give yourself permission to feel both things about your journey in the postpartum period and in motherhood.
• 15:20
  Remi Mogekwu: Would you just talk a bit more to that?
• 15:23
  Orinayo: Yeah.
• 15:24
  Orinayo: So how I understand maternal ambivalence is that it's like feeling mixed conflicting emotions about something, to just simplify it.
• 15:33
  Orinayo: So you can feel ambivalent about lots of things.
• 15:35
  Orinayo: You can feel ambivalent about work, you can feel ambivalent about a partner you can feel ambivalent about your family members who you love.
• 15:41
  Orinayo: So it's, I guess it's about allowing there, allowing the space for there to be a spectrum of different experiences and responses to things without feeling like things have to be binary.
• 15:50
  Orinayo: There can be multiple things that are true at the same time, even though those multiple things can feel a bit paradoxical and like they don't line up.
• 15:57
  Orinayo: But I think it's, ambivalence, I found it comforting when I first heard about it because it it creates space for the human experience and the complexity of human experiences and how we feel different things at different points and depending on what's going on with us and all of this stuff.
• 16:10
  Orinayo: And then you bring in a baby into the mix or children into the mix like you've got two children, I've got one.
• 16:17
  Orinayo: And it's just like children are also very, they can be quite triggering in terms of like just the demands, the things they say, the things they do, the things they don't do.
• 16:27
  Orinayo: There's so much going on that you're having to think about and respond to all of the time that is it really realistic to expect that you're gonna have this one perspective, this one feeling about your children continuously?
• 16:39
  Orinayo: And I think the thing is that when you don't allow space for it, because the thing is people do still have negative thoughts or feelings.
• 16:44
  Orinayo: I'm not saying anything like dangerous, I'm not talking about anything dangerous when I say that, but"Oh, this child is really annoying me right now.
• 16:50
  Orinayo: Actually, I don't wanna spend time with my child right now," or, I don't want you to be around me." Like things like that.
• 16:55
  Orinayo: It's not that people don't think them, but if you're pretending that you don't think them and,"Oh, I love my child so much, Why wouldn't I want to spend all the time in the world with them?" Like I said, it, I think it allows you to be more honest Doesn't have to be a thing of guilt and a thing of shame because feeling ambivalence in, especially in, in relationships that have close proximity to you, is normal.
• 17:15
  Orinayo: you think about, do you have ambivalence feelings about your parents sometimes, siblings sometimes, or even close friends.
• 17:21
  Orinayo: It's not it's not it's like not forgetting that there's an overall picture that, yes, I love this person, but actually there's ebbs and flows.
• 17:28
  Orinayo: They're not always I'm not always at their b- at my best.
• 17:31
  Orinayo: And that, and you can have a similar kind of process that happens with a baby.
• 17:34
  Orinayo: Obviously, a baby is a baby, and the babies are, they're visceral.
• 17:37
  Orinayo: They're whe- whatever they're feeling, Like that, at whatever point is what you will see.
• 17:43
  Orinayo: but we also have our responses to that.
• 17:45
  Orinayo: So when you think about it like that, I think there has to be space for ambivalence It allows you to move with what's happening and tune in and lean into,"This is a really joyful moment," and you can take that in.
• 17:58
  Orinayo: But,"This is a really difficult moment," and okay, you're there.
• 18:01
  Orinayo: But then it can shift.
• 18:02
  Orinayo: But when it's like,"I have to feel like this.
• 18:04
  Orinayo: I can't feel anything but joy.
• 18:05
  Orinayo: I can't feel anything but love," I don't believe it's an honest experience of what it means to be a parent, if I'm being honest, or be in close relationship with another human being.
• 18:16
  Remi Mogekwu: I think that's true, but I also think that there's a pressure sometimes on mums to not be honest.
• 18:21
  Remi Mogekwu: If you are honest to someone and say,"I really don't enjoy motherhood," or,"I find it really hard, but I love my kids, I wouldn't trade them," I think that makes a lot of people feel uncomfortable because they don't know what to do with it.
• 18:35
  Remi Mogekwu: Because the story we've been sold is that you become a mum, you're this lovey-dovey, super maternal, and then if that's not you or it doesn't feel like you, who can you genuinely be honest with?
• 18:48
  Remi Mogekwu: And I guess there's also a spectrum, going back to what you said earlier.
• 18:52
  Remi Mogekwu: Say someone felt like that all the time, would you say that they probably had some issues that they needed to speak through?
• 18:59
  Remi Mogekwu: Or would you say that was still okay within the realms of normality?
• 19:03
  Orinayo: I would say if they felt like that all the time, I would say it's worth speaking to someone and seeking help because, it's normal, but you maybe don't wanna feel like that all the time, understandably.
• 19:14
  Orinayo: It doesn't have to turn into this"Oh, there's something really wrong with me," like something really abnormal is going on.
• 19:21
  Orinayo: It's always about the understanding.
• 19:22
  Orinayo: If somebody's feeling like that all the time, what is contributing to the fact that they feel like that all the time?
• 19:26
  Orinayo: That might be their own expectations.
• 19:28
  Orinayo: That might be other people's expectations of them.
• 19:30
  Orinayo: That might be that there's certain challenges with the chi- with the child that they have that mean that it puts them under a significant amount of pressure.
• 19:35
  Orinayo: So it's like understanding what that means.
• 19:38
  Orinayo: I think, yes, from the perspective of you want to live a good quality of life and have good quality relationships with your children, and it's, life is not just about surviving and getting by.
• 19:47
  Orinayo: You want to live a flourishing life.
• 19:49
  Orinayo: You want to feel like you're living a life that's rich and meaningful and feels good to you.
• 19:54
  Orinayo: So from that perspective, yes, if you're feeling like that all the time, it could be that you need, it is something diagnostic, me- not diagnostic going on that needs to be diagnosed, whether it's like trauma-related, for example.
• 20:03
  Orinayo: But again, could be trauma-related for one person, and for another person it could be about perfectionism.
• 20:08
  Orinayo: So- Which one
• 20:09
  Remi Mogekwu: Yeah
• 20:09
  Orinayo: know.
• 20:10
  Orinayo: We need to understand it.
• 20:11
  Orinayo: And I think it's more about trying to understand what is going on before it gets as this or that, and it's like what's actually going on for that person that this is their current experience of parenting or motherhood?
• 20:21
  Orinayo: And sometimes it is something serious going on.
• 20:24
  Orinayo: I guess if you think on like more severe is it like veering into like psychosis or something like Know, or is someone, like, having s- their traum- like PTSD symptoms are so significant that they just can't cope.
• 20:34
  Orinayo: So I'm not saying, oh, it's ne- it's never any of that, but it's like opening up the space to explore what is actually going on with this person.
• 20:40
  Orinayo: So it's again, it goes back to this isn't how I want things to be.
• 20:44
  Orinayo: You have the right and you're entitled to try to change that.
• 20:46
  Orinayo: And even if you feel ambivalent and you feel like,"Oh, I wanna feel more joy, I wanna feel like..." Again, you can seek help for that, but it's not from the perspective of, because I shouldn't feel ambivalent, but it's I feel all of these things, but I want more of this and ideally less of that.
• 21:00
  Orinayo: But it's not that the bits that are bad aren't allowed.
• 21:02
  Orinayo: They're allowed, but it might just be the balance of things you want to shift, and you're allowed to improve your life and improve your relationships and improve how you feel.
• 21:10
  Orinayo: So I think it's more about coming from a place of understanding and compassion versus I should not be feeling this way, I have to get rid of it.
• 21:18
  Orinayo: Because whatever, whenever we start having those types of thoughts and feelings about things, it doesn't actually make those things go away.
• 21:23
  Orinayo: They often intensify That we feel shameful about or we can't be honest about.
• 21:27
  Orinayo: We feel then we have almost have to start lying to other people about pretending like something isn't going on.
• 21:32
  Orinayo: And the thing is that has an impact on your nervous system as well, the suppression, the pretending, the masking, and that drains your energy that actually you could use or you would actually need to make the shifts that you would like to and seek support from the people who do understand and who can help you for things to feel better as well.
• 21:48
  Orinayo: But then, you have to think about how people have grown up, what kind
• 21:50
  Remi Mogekwu: Yeah
• 21:51
  Orinayo: messages they've received about different feelings and thoughts and
• 21:54
  Remi Mogekwu: What culture tells them,
• 21:55
  Orinayo: tells them, what they think their faith tells them about how they should feel or those kinds of things play into it.
• 22:02
  Orinayo: So it's really intricate and,
• 22:04
  Remi Mogekwu: Yeah
• 22:05
  Orinayo: s- specific to that person and what-- and their story and their own, their own level of awareness about how those things might be informing what they're experiencing
• 22:14
  Remi Mogekwu: Yeah, so I really do wanna come back to the culture piece and the faith piece, but before we get there, there was something that you said about perfectionism, and I just wanted to see what your experience was.
• 22:25
  Remi Mogekwu: Do you find that people who were working and independent when they have kids, that they find that transition harder and are more likely to experience some of the things that we talk about?
• 22:37
  Remi Mogekwu: And the reason why I ask is I was watching a show, and the woman was a biologist, and she was married to an engineer, and he came home, and the baby was crying, and before the scene played out, I was like,"This woman's not coping," because she was so high-functioning, independent in her life before a child came and messed it all up or created chaos.
• 22:57
  Remi Mogekwu: She's gonna struggle with the transition.
• 22:59
  Remi Mogekwu: But do you find that you see that as well?
• 23:01
  Orinayo: Yeah, I think so, yeah.
• 23:02
  Orinayo: There's definitely, like thinking in my NHS job, there's definitely I guess a demographic or group of moms who struggle with yeah, perfectionism, extremely high p- expectations of themselves, very self-critical, or maybe they've always just been able to do things, high achievers, all of this kind of stuff.
• 23:18
  Orinayo: And then like you
• 23:18
  Remi Mogekwu: High achievers, that's the word
• 23:20
  Orinayo: yeah.
• 23:21
  Orinayo: And throw a baby in the mix, obviously, babies are, they just do what
• 23:25
  Remi Mogekwu: Unpredictable.
• 23:26
  Orinayo: They're unpredictable.
• 23:27
  Orinayo: They're unpredictable.
• 23:28
  Orinayo: They don't, they're not, they have no conscious- c- consciousness about, oh, you're doing well or this, they're not giving you that type of feedback, not initially anyway.
• 23:36
  Orinayo: So if you're used to getting that kind of external validation by how you perform and then what you do, and that means my baby doesn't cry too much, or they feed well, or they go to sleep when I put them down for a nap, or, all of these kinds of things that we want to happen because it would make our life easier of course as well.
• 23:51
  Orinayo: But I would say, yeah, I do see- I would say I see it in private practice as well, like
• 23:55
  Remi Mogekwu: Okay
• 23:55
  Orinayo: it can be a struggle.
• 23:57
  Orinayo: It can be a struggle to make that transition especially the society you live in, I think with high, being a high achiever, you're praised.
• 24:03
  Orinayo: You're, it's encouraged to achieve, to perform well, to do to go above and beyond.
• 24:09
  Orinayo: Like all of these things, especially in the work context, it's praised, it's encouraged.
• 24:13
  Orinayo: Nobody's thinking about is this person like behind closed doors burning out?
• 24:18
  Orinayo: Is this good for this person's family relationships?
• 24:20
  Orinayo: Is this impacting this person's marriage?
• 24:22
  Orinayo: Is this, how are they actually showing up for their kids once their work is done and all of this kind of stuff.
• 24:28
  Orinayo: Nobody's thinking about that because that's your business, but what we care about is how...
• 24:31
  Orinayo: I'm not saying every, every workplace is like that, but I mean in
• 24:33
  Remi Mogekwu: Yeah
• 24:34
  Orinayo: that is what is rewarded.
• 24:35
  Orinayo: So I think, yeah, for some of those moms it can be really difficult.
• 24:38
  Orinayo: But that's, but often I think that with high achie- this isn't for everyone.
• 24:41
  Orinayo: Like I, I can't make a sweeping statement, but I'm just thinking about people I've worked with.
• 24:44
  Orinayo: For high achievers, there might be something around like performance, excelling was really important in their family background.
• 24:50
  Orinayo: That's how you got like praise, and approval and acceptance and stuff.
• 24:54
  Orinayo: So there's often a story behind the high achiever.
• 24:56
  Orinayo: I'm not saying it's always like something bad happened in your childhood, but like some of these things are not bad, but they can have, they can send certain messages that make people feel,"I've got to do this," or,"This is how I've got to be in order to achieve that, get that praise or be seen in a positive light." So I think all of that does come in when you have a baby, and people aren't necessarily prepared to feel on the back foot or"I don't know what I'm doing," or, This is
• 25:19
  Remi Mogekwu: This baby's not doing what I want it to do.
• 25:22
  Orinayo: not doing what I want them to do.
• 25:24
  Remi Mogekwu: Yeah.
• 25:25
  Remi Mogekwu: No, for sure.
• 25:26
  Orinayo: don't.
• 25:27
  Remi Mogekwu: Yeah
• 25:27
  Orinayo: But it's, yeah.
• 25:28
  Orinayo: So it's you know- Yeah.
• 25:29
  Orinayo: It can, you have to relinquish control to an extent, and it is, I'm laughing about it, but it's har- it is hard and it can be really frustrating.
• 25:35
  Remi Mogekwu: Yeah.
• 25:36
  Orinayo: Yeah.
• 25:36
  Remi Mogekwu: I'd, I've definitely been there, and I remember even when I was in therapy myself she would say just it's not bad'cause it's obviously gotten you to where you are in life, but it just no longer serves you.
• 25:47
  Remi Mogekwu: That
• 25:47
  Orinayo: Exactly
• 25:48
  Remi Mogekwu: of thr- keep going, you can power through, blah, blah, blah, it's not a bad thing.
• 25:52
  Remi Mogekwu: It's just not helpful as a mother, and it's just a really hard thing to drop when you have a newborn, and you're like,"No, the book tells me that you need to sleep or eat every three hours," and this baby wants to eat every hour, and you're like,"What have I done wrong?" But yeah, so I really want us to touch on culture, faith, and Black women specifically, and how you find they interact or not with mental health services.
• 26:16
  Remi Mogekwu: Do they present late?
• 26:17
  Remi Mogekwu: Do they present at all?
• 26:19
  Remi Mogekwu: And what w- what you think might be happening in our subculture that prevents us from seeking help on time
• 26:26
  Orinayo: That's a big question.
• 26:28
  Orinayo: Okay,
• 26:29
  Remi Mogekwu: Like a whole hour episode.
• 26:31
  Remi Mogekwu: But
• 26:31
  Orinayo: basically so I mean-- Oh, I think it's so nuanced.
• 26:34
  Orinayo: I think...
• 26:35
  Orinayo: I'm just trying to pull together thinking about people I see in private practice.
• 26:38
  Orinayo: So as I do, I have seen quite a lot of Black mums in my private practice.
• 26:40
  Orinayo: I've intentionally tried to see Black mums.
• 26:42
  Orinayo: What I'm thinking, I think we do present in mental health services, and we do present seeking help, but I think there's difficulties in terms of, look, there's-- yeah, some people may not have had very good experiences.
• 26:54
  Orinayo: If I'm thinking like maybe their maternity care experience or their birth wasn't good.
• 26:58
  Orinayo: So like you think about this whole journey the person's gone through or like you don't know what their re-reproductive kind of history or journey has been up until that point, interactions with healthcare professionals.
• 27:06
  Orinayo: It all sets the tone for when I guess typically somebody might then end up being referred to a perinatal mental health service or another mental health service, maybe during their pregnance- pregnancy or But I think we do show up we do try to seek help.
• 27:19
  Orinayo: And the research around this does say that if we can get access to mental health support, we do actually use the support and use it well.
• 27:28
  Orinayo: So this, there, this-- which kind of dispels this idea that like we wouldn't really engage or anything like that.
• 27:33
  Orinayo: I think it's about getting in the door.
• 27:35
  Orinayo: But then there's issues like obviously around trust.
• 27:37
  Orinayo: There's like stigma within people's families.
• 27:40
  Orinayo: People also have their own self-internalized stigma as well.
• 27:44
  Orinayo: Like racism is real, like biases are real.
• 27:47
  Orinayo: Like we see them, with everything going on with these reports and stuff that have come out recently, but they're not really telling us anything new that we didn't know.
• 27:56
  Orinayo: So I think there's lots of factors that go into how a Black woman might be showing up, like might be coming, presenting at any point during their kind of perinatal journey.
• 28:07
  Orinayo: Like there's a lot of, I think, load that has been carried by a lot of people.
• 28:10
  Orinayo: I'm
• 28:10
  Remi Mogekwu: Yeah
• 28:11
  Orinayo: everyone, but there's enough people who are carrying that load The differences in what's happening and how people feel that they've been treated and not feeling that they can trust the, trust services and things.
• 28:21
  Orinayo: But I think also, I don't know how good across the board mental health services or NHS services are in terms of partnering with community organizations who might have a better in with some of these communities and things like that.
• 28:35
  Orinayo: And I think there's some that are really good and do that.
• 28:37
  Orinayo: But I think part of the problem is that it's very optional.
• 28:40
  Orinayo: Okay, this trust wants to Cultural competency training or this trust
• 28:44
  Remi Mogekwu: Yeah.
• 28:44
  Remi Mogekwu: This
• 28:45
  Orinayo: org- it's very okay, yeah, it's a great idea, but are we gonna do it?
• 28:48
  Orinayo: Are we not gonna do it?
• 28:49
  Orinayo: So I think Black women are-- There, there are a lot of like barriers that I don't think are of our choosing or our causing Happening in systems.
• 28:57
  Orinayo: And it's when you think of also like the stats around, like we have a lot of the worse outcomes in terms of maternity care outcomes, neonatal outcomes.
• 29:05
  Orinayo: And then, all the statistics and you think it takes a lot of strength and a lot of courage to"No, I'm gonna engage.
• 29:10
  Orinayo: No, I'm gonna push for the need I,
• 29:12
  Remi Mogekwu: Yeah
• 29:13
  Orinayo: need," or,"I'm gonna advocate for myself," because you're, it's like you're climbing uphill really, is
• 29:18
  Remi Mogekwu: yeah
• 29:19
  Orinayo: see it.
• 29:20
  Remi Mogekwu: It's tiring
• 29:21
  Orinayo: the main issue.
• 29:21
  Orinayo: It's tiring.
• 29:22
  Orinayo: It's exhausting.
• 29:24
  Orinayo: It's
• 29:24
  Remi Mogekwu: Yeah.
• 29:25
  Remi Mogekwu: Yeah
• 29:25
  Orinayo: know how you're gonna be perceived.
• 29:26
  Orinayo: You don't know, is this gonna be a safe person?
• 29:28
  Orinayo: Is this gonna be a safe service?
• 29:29
  Orinayo: You don't know.
• 29:29
  Orinayo: You have to take a lot of risks, I think.
• 29:32
  Orinayo: Think those are some of the things that impact But also yes, there's cultural stories about do you seek, where do you seek help?
• 29:39
  Orinayo: You don't go outside to seek help.
• 29:40
  Orinayo: Like obviously not everybody subscribes to that, and not everybody believes, necessarily abides by that.
• 29:44
  Orinayo: But like you, you think if those are all these kind of systemic issues that are happening, and then on top of that you're also in a family or in a culture where they say,"Oh no, don't go out and say this," or,"We keep these things be- with ourselves." So it's like you have to look about the intersect of all the things that are happening that would make it more likely or less likely for
• 30:03
  Remi Mogekwu: Someone to see camera, yeah
• 30:05
  Orinayo: Seek help or to keep pushing through or to feel that they can advocate for themselves.
• 30:09
  Orinayo: And so like it kind of-- I don't know if you've ever come across a social graces model before, but it kinda About like different identities.
• 30:17
  Orinayo: So you think about your race, your ethnicity, your gender, your sexuality how your level of ability, physical ability and all of these kinds of things.
• 30:24
  Orinayo: And if you think some- somebody might be really privileged and gr- you know is well off and, really well educated and able, maybe m- maybe more able to advocate for themselves.
• 30:34
  Orinayo: But if you think somebody who isn't, doesn't have all of these advantages and is also maybe doesn't speak English or, there's so many things.
• 30:40
  Orinayo: So it's like what is, what are the things that are going on for this person that would make it mean that they are able to get what they need versus they're not?
• 30:49
  Remi Mogekwu: I think that's also really important,'cause I don't think Black women as a label is a fair description of all Black women, because there are some Black women who are also really economically advantaged, and there are some who are new migrants to the country.
• 31:02
  Remi Mogekwu: There are some who don't speak the language.
• 31:04
  Remi Mogekwu: There are some who have a fear of services ultimately.
• 31:08
  Remi Mogekwu: So you might see that certain Black women can advocate for themselves, can push through, can get, get the complaints in, can get the help they need.
• 31:16
  Remi Mogekwu: But on the other side, you'll see that there'll be some women who can't because of exact same thing that you've just described.
• 31:23
  Remi Mogekwu: And it's not one and all for all Black women, in the same way it's not one and all for all white women or all Asian women.
• 31:29
  Remi Mogekwu: It's just a continuous spectrum.
• 31:31
  Remi Mogekwu: Yeah.
• 31:32
  Remi Mogekwu: And I think that...
• 31:32
  Remi Mogekwu: Yeah, I do think that's a really important point.
• 31:34
  Remi Mogekwu: If I think about people who are, Black British, educated more plugged into the system, they are more likely to seek help.
• 31:41
  Remi Mogekwu: But even myself as a doctor, when I was feeling the way I felt, I didn't go to the GP, because in my head I was like,"You're gonna go to the GP.
• 31:49
  Remi Mogekwu: You might get a referral to perinatal mental health.
• 31:52
  Remi Mogekwu: I could do a self-referral, and I still know it will take a year or a year and a half," because the system itself is not easy to navigate.
• 31:59
  Remi Mogekwu: And so therefore you're just like, whether if you've got the means, you circumvent it.
• 32:04
  Remi Mogekwu: If you don't have the means, you're constantly back and forth, and you still might not get anywhere.
• 32:08
  Remi Mogekwu: And also, picking who you have as your therapist.
• 32:11
  Remi Mogekwu: There's certain people that you probably would feel more comfortable speaking to versus not.
• 32:15
  Remi Mogekwu: And all these things just don't get taken into account,
• 32:17
  Orinayo: yeah, yeah, exactly.
• 32:18
  Orinayo: It's, yeah, it's
• 32:19
  Remi Mogekwu: yeah
• 32:20
  Orinayo: the choice privilege, what you're able to tap into, what you have at your disposal.
• 32:25
  Orinayo: Not everybody has, the same thing.
• 32:28
  Orinayo: The way I like to think about it is more from an intersectional point of view and not just in terms of somebody's different ident- differing identities, but also what is happening in the system?
• 32:36
  Orinayo: What's happening in their family?
• 32:37
  Orinayo: What's their partner saying?
• 32:39
  Orinayo: What is their own relationship to struggling or fight- all of these things culminate together to create a particular outcome, But I System has to do w- a lot of work to do there, but yeah
• 32:49
  Remi Mogekwu: No, completely agree.
• 32:50
  Remi Mogekwu: I just wanna wrap up.
• 32:51
  Remi Mogekwu: So ultimately, if you think about the woman who's just had a baby, maybe they're 6 months old, 12 months old, they're not sleeping, they're constantly on Google trying to figure out what's wrong with them and how they can be better, what would be your parting words for them?
• 33:05
  Orinayo: I think I'd wanna get the message across that it is a bit of a jungle out there to navigate, like, all of these different things postpartum and, all the different things that they're experiencing, but that there are people who understand what they're experiencing and what they're going through who, and who can actually help.
• 33:21
  Orinayo: it might take some time to find those people.
• 33:23
  Orinayo: Like whether that's therapy or, whoever it might be professionally speaking, but not to feel like that they're alone or to lose hope because there are people who understand how to help them get to a place where they feel better in themselves.
• 33:35
  Orinayo: But I think you can feel really hopeless and feel like you're just spinning around in circles.
• 33:40
  Orinayo: So yeah, I think it would be a message about hope.
• 33:41
  Orinayo: Sorry, I'm like not being very concise here.
• 33:43
  Orinayo: It's hard to narrow it down.
• 33:44
  Orinayo: But it would be about not losing hope, that there are people who are really passionate and who really care and who really have a nuanced under- nuanced understanding of like the perinatal journey, perinatal mental health, and how this impacts a person in transition to parenthood.
• 33:57
  Orinayo: And so not to lose hope in finding the help, the support that they need, as they navigate their journey.
• 34:03
  Remi Mogekwu: Perfect.
• 34:03
  Remi Mogekwu: And where could they find you?
• 34:04
  Remi Mogekwu: So say someone's watching and they're like,"You know what?
• 34:08
  Remi Mogekwu: Dr.
• 34:08
  Remi Mogekwu: Orin looks like the person I need to help me," where can they find you?
• 34:12
  Orinayo: They can find me yeah, they can find me on Instagram, but probably sending me an email would probably be best.
• 34:17
  Orinayo: My website which is www.dronobandjo.com.
• 34:21
  Orinayo: So they can find me on there and they send me a message or an email.
• 34:23
  Orinayo: I'm also on Instagram as London Perinatal Wellness- Yeah although I don't use that as much.
• 34:27
  Orinayo: But yeah where you can find me
• 34:29
  Remi Mogekwu: Thank you so much for your time.
• 34:30
  Remi Mogekwu: I think you've helped us.
• 34:31
  Remi Mogekwu: Obviously the perinatal mental health space is huge, and we've literally just touched on certain topics and tried to bring it back to the person who doesn't really know they need help, but, can have something to latch onto.
• 34:43
  Remi Mogekwu: So I hope it has resonated with someone.
• 34:45
  Remi Mogekwu: And if you are out there and you're struggling with motherhood and you want to just feel better, I definitely hope that you will go and seek help.
• 34:55
  Remi Mogekwu: Contact Dr.
• 34:56
  Remi Mogekwu: Orrin as well.
• 34:56
  Remi Mogekwu: I'll list her details down below.
• 34:58
  Remi Mogekwu: But thank you so much for joining me today
• 35:01
  thank you for tuning in to this podcast, Making Room for Pregnancy and Postpartum.
• 35:05
  In this episode we spoke about getting in touch with yourself or checking in with yourself and how journaling's a really good way to do it.
• 35:11
  If journaling's not for you, drop down in the comments something that you've done to feel better or to connect with yourself and hopefully encourage someone who might be going through the exact same thing.
• 35:21
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• 35:24
  Until next time