Prenatal Anxiety and Depression

Pregnancy is supposed to be a happy time, but that joy can easily be overshadowed by prenatal anxiety and depression. How do you know if you're developing these conditions during your pregnancy? What are the main risk factors or warning signs? And how can you get the support you need to overcome it?

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Episode Transcript

Preggie Pals
Prenatal Anxiety and Depression

Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.

[Theme Music]

Gretchen Mallios: Pregnancy is supposed to be a happy time. But sometimes that joy can be overshadowed by feelings of anxiety and depression. But with all the chemical and physical changes to your body how do you know if you’re experiencing these issue? And what options do you have for overcoming them? I’m Gretchen Mallios, a licensed clinical social worker here in San Diego, and this is Preggie Pals episode 59.

[Theme Music/Intro]

Sunny Gault: Welcome to Preggie Pals, broadcasting from the Birth Education Center of San Diego. Preggie Pals is your weekly online, on-the-go support group for expecting parents and those hoping to become pregnant. I’m your host, Sunny Gault. Have you joined our Preggie Pals Club? Our members get all of our archived episodes, bonus content after each new show, plus special giveaways and discounts. And we’ve got a lot of great discounts right now, so make sure you sign up as soon as you can. You will also get a free subscription to Pregnancy Magazine. You can see our website for more information. And thanks to everyone who is listening to this episode through our awesome Preggie Pals apps. They are available in the Apple and Android marketplace. I don’t know about you, ladies, but this is the way I listen to the episodes, because as a mother I am always on the go, I’m waiting at my OB appointment, I’m waiting for an elevator – there’s always great times to listen to this content – or maybe just I’m trying to drown out the sound of my toddler. Either way there’s lots of great ways to listen to our show. If you want to download our apps they are absolutely free. Visit our website for more information.

Ok. So let’s meet our panelists joining us today. We’ve got a full house today. I love it. I love it when we have lots of people here in the studio. For me, you guys know me, I’m the host of the show. I am pregnant for my third baby now. Still in the first trimester. My due date is kind of still to be determined. I’m just going to say December, because I can’t figure it out yet. Baby gender – we don’t know yet. I have two little boys already – Sayer and Urban. Sayer is almost three, he’ll be three in July, and Urban just turned one. So we have a full house, a lot of little kids. We’re just going on the boom-boom-boom plan. Get them all done. Crazy circus anyway, so just keep them coming. Type of birth – this one’s going to be a Cesarean. My last baby was a Cesarean because my first baby was a vaginal birth that caused a lot of complications. But I’m ok with that, I’ve kind of gotten over the whole Cesarean thing and have learned to just embrace the baby, not necessarily the birth process. So that’s my story. Kristy is a new panelist here on the show. She is also one of our new bloggers. So, Kristy, tell us a little bit about yourself.

Kristy Iris: Yeah. My name is Kristy Iris. I’m 41. I’m pregnant with my first baby, which is a girl and I’m due Labor Day – she already has a sense of humor (laughs).

Sunny Gault: I love that.

Kristy Iris: And I’m planning a natural birth at the birth center UCSD.

Sunny Gault: Nice. Well congratulations!

Kristy Iris: Thanks.

Sunny Gault: Ok, Annie.

Annie Laird: My name is Annie. I am 34. I’m pregnant with my third baby. I would say girl, but I was totally wrong with number two, I said it was a boy and it ended up being a girl. SO we’re Team Green, you know, I don’t really care, although I do have all the little girl clothes because my number two daughter is about to turn one in a month and then I have an almost 8-year-old daughter as well.

Sunny Gault: Alright. Stephanie, tell us a little bit about yourself.

Stephanie Saalfeld: I am Stephanie. I am 30. I’m a stay-at-home mom and producer of Preggie Pals. I have a baby girl, She is about 5 months old. Her name is Savanna and we had an unplanned C-section hospital birth.

Sunny Gault: Alrighty. Well ladies thank you so much for joining us today.

[Theme Music]
[Featured Segment: The Best Pregnancy Apps. Alert ID Helps Keep Families Safe!]

Sunny Gault: Alright. Before we get started with today’s show we are going to talk about a new app. This is called Alert ID. I have been in touch with the creators of this product. I’ve actually interviewed the mom who created that. I love products that are created by moms, I just feel like they’re more authentic. And a mom named Kelly created this. Unfortunately, she had a situation. She das three kids and they went to an amusement park and became lost from her and her husband for several hours. And you can imagine, as a mom, in a big place like an amusement park you’re freaking out if you can’t find your kinds and you’re thinking some has taken them, where are they, and luckily she was able to get her kids back. They were unharmed. But after that she and her husband put their heads together and thought “How do we make sure that other parents don’t have to go through this? What can we create, what can we do to help parents?” And Alert ID is the app that has developed out of this tragic experience that turned out to be ok for them. It’s a great resource for new parents.
Basically what it is is a way for you to get alerts about things that are happening in your community. I want to kind of talk to our panelists here in the studio who have had a chance to look at this app. Tell me what you guys think about the app? The big thing is would you recommend this to another parent and why? So Kristy, let’s start with you.

Kristy Iris: I tried both the app on my phone and on my computer and I thought it was great that I could look up and find the sex offenders in my neighborhood. And it took me to the website and I could find the pictures, which… my baby is not born yet, but I can imagine just knowing, even being able to show them the pictures of like “If you see this person stay away. Run, scream…” And I thought that was great.

The only downside to it was that it seems like… especially on the website when it popped out alerts of things that happened like a month ago, like traffic incidents… And I didn’t spend enough time on it to figure out how to turn that off, but it was kind of… a little more “alertive” than I needed to know, that there was a hit and run back a month and a half ago.

Sunny Gault: Right.

Kristy Iris: That’s all. But overall I liked also that there’s the family wallet on it, that you can put your kids and your family in it, even your pets. And it says that if somebody becomes lost you can send their profiles immediately to the authorities and to neighbors. That’s cool.

Sunny Gault: Yeah. Well and the big thing with that, too… for example in Kelly’s situation when her kids were lost, she made the suggestion if you’re going to an amusement park, if you’re going to a big mall or something like that, where you could get separated from your children, again you use this portion of the app called My Family Wallet. You enter in all your kids’ information prior. But before you go into the mall, before you go into the amusement park, you take a quick picture of your kid. So they see a photo from that day, a photo of what they were wearing exactly when they went missing, because that’s how a lot of times law enforcement tracks how to find your kid. You literally press a button and it goes out to the resources that need to be notified. And with missing children that is the biggest thing – how quickly can we get your children back, because the longer it takes, the more likely the results are not going to be in your favor basically. What do you think, Stephanie?

Stephanie Saalfeld: Ok. So I was looking at it last night and I’m like “Oh, there’s a sex offender right down the street.” So, you know, I just opened it up and I’m looking at it and I’m looking at this picture and I’m like “Oh my god. I drove by that guy, I saw that guy outside of his house today.” And I remember as I was driving by looking at him and going “he kind of looks like a creepy person”. Well, apparently he really is, because he is a convicted rapist. Like, note to self. And that’s where I usually go for walks. And so I might be changing my walk route.

Sunny Gault: Yes, so it’s not necessarily just to protect your kids, but even to protect yourself.

Stephanie Saalfeld: Yeah. And it was like rape by force… I was like “well, ok then”.
Sunny Gault: One thing that I would say… I love the functionality of it, they keep coming up with different partnerships and they partner directly with these law enforcement companies and these weather services and stuff. So again, they aren’t filtering the information for you, which I love. But they are constantly adding new resources and they’re trying to get it more focused, so it is as local as possible, so you really can tell what’s happening in your community. So I love that idea, it’s great for neighborhood watches, because you can create groups on this and if something weird is going on in your neighborhood you can take a photo, a video of something and send it to everyone in your neighborhood watch, so “watch out for this guy!” So it’s a great way to use it as well. One thing I would say though is that you are storing some personal information in this app, so it’s probably a good idea, if you don’t already have it, to have a password on your phone, so just in case your phone becomes lost. I would hate for somebody to get your phone, to go to this app and see all the personal information about your child. That is the one thing that I would say, you know. But that’s a safety thing with any kind of app you have on your phone, so… If you guys want to check this out you can go to We have a special page there and you can sign up for the app and it’s a free app that you just download through the iTunes marketplace. I really like this app. What do you guys think, would you guys recommend this to a friend, to another parent?

All: Yeah, absolutely. Thumbs up.

Sunny Gault: Awesome.

[Theme Music]

Sunny Gault: We hear a lot about the baby blues and postpartum depression, but did you know that you can also experience prenatal anxiety and depression? Joining us today on the show is Gretchen Mallios, a licensed clinical social worker who also serves on the board for the Postpartum Health Alliance here in San Diego. Gretchen, welcome to Preggie Pals.

Gretchen Mallios: Thanks, it’s great to be here.

Sunny Gault: So how common is prenatal anxiety and depression in women?

Gretchen Mallios: Well the rates of anxiety are less measured and less screened. It’s not as commonly observed. Although we’re hoping to increase awareness; I think we’re moving in a good direction about that because they’re recognizing with further research that the incidents of depression and anxiety postpartum are very parallel or similar to those prenatally. So what they have right now in research shows that somewhere between 5 to 16% of the women will experience anxiety prenatally. The rates for depression are 10 to 20% prenatally. And postpartum is anywhere from 10 to 20%, depending on the measure that you look at.

One of the things that’s important to recognize though is that a lot of women – and I have this experience in my practice – a lot of women experience some level of distress and they won’t necessarily register and be screened on that level if they did a clinical screening where their symptoms don’t meet certain criteria. But it doesn’t mean that they’re not experiencing some symptoms, some distress, some sense of just not quite feeling like themselves. So it’s not just about meeting that criteria and hitting positive on that screening tool. It’s also about checking in with yourself or your partner about how they’re feeling overall.

Sunny Gault: Yeah. Let’s check in with our panelists here. Ladies, did you experience prenatal anxiety or depression in any of your pregnancies? Kristy, what do you think?

Kristy Iris: I did. I thought it was depression at one point. I looked up the symptoms and it was like “Oh, they’re all the same. It seems it’s just pregnancy symptoms.”

Sunny Gault: That’s a tough thing. Especially if you’re pregnant the first time. It’s… how do you know whether it’s just pregnancy stuff going on versus something more serious, right?

Kristy Iris: Right. And then I also wasn’t getting… I’m still not getting a good night’s sleep. So the next night I think I had three hours of sleep fully that night. And then the next night I had five hours of sleep and I woke up and I felt like so much better and I was like “Oh that might have just been fatigue.”

Sunny Gault: Right.

Kristy Iris: …instead of depression. And I also have a thyroid condition, so in the first trimester we were constantly adjusting… I had to adjust the medication a lot. I mean twice the normal of what I take pre-pregnancy. So having a thyroid that’s out of whack causes a lot of depression as well at times.

Sunny Gault: So I guess this is a question for Gretchen then: how do we know the difference between just pregnancy symptoms and what’s real anxiety and depression?

Gretchen Mallios: Yeah, that’s a great question and I was appreciating what Kristy has to share, because that comment about sleep is a classic example of the whole spectrum of the types of things we experience during depression or anxiety and during pregnancy and how they cross over. So the thing that I would recommend and I think what we try and educate people on is: if you’re having a bad day or two or the symptoms are fleeting or periodic then that’s maybe part of just sort of the hardship and the transition of pregnancy and postpartum period. The changes in hormones, the changes in responsibilities and pressures that you can have on you and the changes in things that you’re thinking about now that you have a family – there’s a whole different range of things that are now on your radar that you didn’t previously have to cope with or make sense of, right? Responsibility for another life, managing your family, growing family, changing schedules.
When it starts to inhibit how much you participate in. When it starts to really dominate your thoughts and you are not relating to your life, your friends, your social circles in the same way. When your life starts to become narrower. When you’re not able to sleep, when you’re not able to enjoy things and you’re finding that this is going on day in and day out. Or if you were checking back on yourself a few months back, where are you now compared to where you were a few months ago: are you still yourself? I think that’s a pretty good sign if the answer is no. It’s a pretty good sign that you deserve some support. That’s how I like to look at it.

Rather than this categorical “are you depressed or anxious or not?” It’s more “are you feeling well and robust?” And if you’re not you deserve to go someplace or talk with someone where you can put some of those things outside of you, take a look at them, talk about them and make sense of them. And that process in itself I think tends to really work against this isolation and this inner confusion that we experience which really pulls us away from the very safety net and social circle that would keep us going forward in general. Does that make sense? Is that…?

Kristy Iris: Yeah. Can you define specific symptoms that really would kind of qualify for…?

Gretchen Mallios: Yeah. I think that’s a great question. There are different ways to talk about it. There’s sort of how our manuals describe it so that we kind of code it based on how we’re trained as “therapists” or “doctors” or whatever. And then there’s how women and people talk about it, right? So women tend to describe the symptoms as not feeling like themselves, can’t really concentrate and focus, things are feeling kind of overwhelming and that they’re just not enjoying their pregnancy or their baby period like they thought they were going to. I doesn’t feel quite like what they expected it was going to feel like.

Technically what the symptoms are that we’re listening for when we’re trying to help screen a person or help them recognize how they’re doing is to listen for things like excessive worry. And so what that can sound like for a woman is… I’ll give you an example from my pregnancy period. So I had this theory at some point – and I know that it was working off of a fear – I wasn’t addressing the fear, I was addressing the theory. The theory was that if I had life insurance on my husband nothing would happen to him. And we would have the happy family that I was looking forward to and anticipating. And so at some point, a few months into our pregnancy, that became my task for our family. And I think every person does it differently. Some people might be “I’m going to make our back yard look amazing, because that’s where we’re going to spend all of our time and we’ll be happy there.” Or “I’m going to get a new car that has side airbags.” And all of these things that we do… they’re fine if they’re within reason, because they are an expression of us working against something that we’re worried can happen to this precious thing that’s happening – our life changing and forming a family.

When it starts to take over and it becomes excessive, where you are constantly needing to purchase something new that’s going to guard against something; you are not inviting friends over because they might be sick and then contaminate you and your baby will get sick; when you are not buying certain products because now you are convinced that nothing is safe, I mean everything has this chemical or that… When it takes over and your life becomes smaller and smaller because nothing feels safe, you’re really getting into that realm where you’re not living fully. And I would say in that case anxiety is taking over. It’s dictating your life.

Kristy Iris: How about like physical feelings?

Gretchen Mallios: So… tightness in the chest – sometimes you’ll get sensations of a racing heart, a rapid short breath. Tension, physical aches, and pains – one of the common complaints for women who… there’s a correlation between who are feeling anxiety postpartum, prenatally, and increased complaints of physical symptoms. I work with somebody in a different capacity than the mental health who’s complained a lot about the tension and tightening that she’s feeling as a result of the pregnancy. She’s managing it very well. Someone else might start to interpret that as a sign of something more severe. They might start to really take excessive steps towards against what those symptoms might be related to.
Kristy Iris: For me it was more the physical… tightness in my chest… And do you think that… so you said that if a woman has anxiety or depression pre-prenatally, before she gets pregnant, does it get worse as she becomes pregnant? And even then after she has the baby? Or is it…

Gretchen Mallios: It’s that really annoying answer: it depends. Because there are hormones in pregnancy that actually protect against some of those stress experiences – the oxytocin and relaxin – that we get in order to help prepare the body for pregnancy and motherhood. They actually guard against the stress hormones and the stress response system that we have. But then you add on all the life changes and the stressors that can overwhelm a person if they think about all of them and their thought pattern tends to be worry-related… then those two things start working against each other. One of the stringer predictors of prenatal and postpartum anxiety would be a past history of anxiety or family history of anxiety. You know I’ve qualified myself as more of a worrier than depressor; we have certain traits, we have an emotional health Achilles’ heel I would say. And it doesn’t mean that we’re destined for certain things, but it means that we have to then watch that and prepare against it. We have to talk to our partner and say “Now you know I tend to be the worrier. So am I being crazy here or is this reasonable?” And you talk to your partner or your family members, whoever you trust who can say “You’re going crazy” or “No, that’s pretty good. That’s a good one to worry about.”

Kristy Iris: My husband always thinks I’m going crazy. Because he’s not a worrier at all, so yeah.

Gretchen Mallios: And honestly a certain amount of worry during pregnancy and postpartum is protective, right? I mean our worry function actually is protective. It gets us to put our guard up to watch for things, to make sure we get to those appointments that we were taught are really important. SO a certain degree of worry is actually functional and it’s protective.

Annie Laird: It’s like the mamma bear thing.

Gretchen Mallios: It is. It’s the momma bear. And the thing is we want momma bear to go out and live, not hibernate. That’s what it is.

Annie Laird: Something I did during my last pregnancy that I thought was very helpful. I was diagnosed with depression, which most of my friends would not guess. At all.

Gretchen Mallios: Yeah. It’s very private, very internal.

Annie Laird: Yeah. But I was diagnosed before my… gush how many pregnancies… I’m on my sixth pregnancy, but it’s my third child. So just a lot of anxiety about “Is this one going to last?” I guess it was… before my fifth pregnancy that I was diagnosed with depression.

Gretchen Mallios: How did they come about that? They were asking questions that helped get you diagnosed?

Annie Laird: Well I self-referred to the emergency room. Yeah.

Sunny Gault: So you knew there was a problem.

Annie Laird: Ignore, ignore, ignore… Major emergency! Yeah.

Sunny Gault: Ok.

Annie Laird: So then I was in counseling with a therapist my entire last pregnancy. But anyway. So something helpful that I did, because I am a worrier as well, I was wrapped around the axle about things and my dear husband, how patient he is, I’m like the opposite. I’m not patient, I worry about everything. My labor doula… I wrote a list with hypnobirthing fear releases, a big thing. So I wrote out a list of everything that I was fearful of or worrying about. It was a list of 48 things. And I gave it away to my doula – “this is yours now”.

Gretchen Mallios: Wow that’s great. Yeah.

Annie Laird: … I’m not worrying about this anymore. But just to write it out and to name and to put my finger on… you know… I’m worried about this and this and this… Did some of the come true? Yeah. But I was able to roll with the punches a little bit better.

Gretchen Mallios: Yeah.

Annie Laird: Because there were things in there about hospital transfer and all that and, like I said, I was disappointed, it wasn’t like “Oh my gosh my birth was traumatic and I just can’t deal with this and now it’s all ruined. It’s ruined!”
Gretchen Mallios: And you bring up a really great point, actually another risk factor. A vulnerability for prenatal or postpartum anxiety is past perinatal loss. So possibly a pregnancy that didn’t carry to term or some other kind of perinatal loss or a history of health concerns will definitely ramp up the anxiety, because suddenly you don’t feel as in control. You realize that some of the outcomes aren’t within your control. And it creates some anxiety for some. So that’s an important piece to mention.

Sunny Gault: What are some of the other risk factors, Gretchen, that we should know about?

Gretchen Mallios: So prenatally the strongest risk factor, like I said, is a family history or personal history of anxiety. Postpartum – and this can also happen prenatally, but it’s definitely more the case postpartum – a perfectionistic type expectation of yourself as a mother, as a pregnant woman. “I’m going to do this perfectly.” Well if we try and live perfectly according to all the information we have out there these days, it’s untenable, unsustainable and exhausting. And the reason we aspire I think to some of those perfectionist ideas is that we think it will guarantee us an outcome. It sort of works against fear, like I said, and ensures the kind of family or experience that we’re looking for. But it’s exhausting. And that lends to more of a propensity towards anxiety. Perinatal loss, past perinatal loss, like I said, certain medical conditions that leave one predisposed and vulnerable to anxiety or depression can all contribute to prenatal anxiety.

Sunny Gault: Alright. When we come back we’ll be talking about how to know when outside help is needed. Also: what are your treatment options? We’ll be right back.

[Theme Music]

Sunny Gault: Welcome back! Today we’re discussing prenatal anxiety and depression with our special expert Gretchen Mallios, a licensed clinical social worker. So, Gretchen, so women with prenatal anxiety and depression always need professional help? Or sometimes is this something that can be managed on their own if they recognize the symptoms?

Gretchen Mallios: If they’re recognizing the symptoms and they are taking action to understand what’s going on and they’re intervening early when they’re starting to feel the difference and they read what they need to read or talk to somebody to start learning about what they can do toward against it. In the case of depression: that they are not isolating, that they’re resting and getting the sleep that they need, that they are possibly getting the physical care – maybe it’s massage, maybe it’s some acupuncture – something that really helps them balance their body again. Yoga is very protective against prenatal depression and anxiety. If they’re doing things that help them start to reset that baseline physiologically and emotionally and that works, then that’s great.

When the symptoms start to become very strong it’s really hard to work against it on your own quite honestly. Depression is an ironic illness as far as I’m concerned, because the very things you need to do to get better and work against it are the very things that depression pulls from you. You need to engage and connect with people and talk to people. And you need to organize your life and structure yourself in a way that sort of puts you on a track to take care of yourself. Depression works against that. It isolates you, it interferes with your sleep, it interferes with your appetite and your energy levels, it interferes with your cognitions and your ability to sort of organize mentally. All these skills that you need to engage with in order to start to feel more like yourself are kind of pulled away from you as a result of the depression and the anxiety. So it is important at some point, when it feels strong and your efforts to get on top of it aren’t working, that you don’t be shy, that you engage with something; that you engage with a professional; that you talk to your OB about it; that if you have a past history of using a therapist or counselor or somebody to get support from that you start having that conversation.
Sunny Gault: And then when should you consult with them? I would assume right away after recognizing the symptoms and you realize this is a little beyond your control?

Gretchen Mallios: Yeah. As a therapist I am biased. I think therapy and counseling is a really good thing. I think it doesn’t have to be problem focused in something shameful and something negative. There’s so much more of a transition towards positive psychology right now and solution-oriented psychology and ideally you can find somebody that works with you and speaks your language that’s positively oriented and helps you place the concerns and questions outside of yourself and helps you start to see them for what they are, because when you roll through them privately in your head or you only talk to your partner about that and your partner isn’t skilled in that particular area – unless your partner happens to be a mental health professional – you really limit your ability to just get on top of it and start to feel like yourself. The longer you wait to work with someone, the more of a hold the depression/anxiety risks taking over you.

Sunny Gault: What about women who have experienced this in a previous pregnancy and they have a subsequent pregnancy that they think this could happen again. Would you recommend seeking some sort of help even before those symptoms really manifest themselves to avoid that?

Gretchen Mallios: My prescription for somebody who has a history of it or who is concerned – and I kind of had this experience with a client actually – my prescription would be: start making some calls and find somebody you want to work with. Maybe go in and have one session to explain your fears. And let that person assess you and sort of see how you seem to be. And let them give you feedback: “You seem quite stable and quite clear-minded and on top of this right now. How about we check in or how about you call me if you need? How about I talk to your partner and I help him or her keep an eye out for certain things that will help you know if things are going in a rye?”

Because I don’t think that women during pregnancy or postpartum should be responsible for screening or tracking their own symptoms. I think that is not fair. She has so much to worry about and think about. I think it’s important that we pull in other people in the family system to help be on top of it and monitoring. Because that way she can focus on herself and they can say “we got you covered. We got you. We’re keeping our eye out. You know, you don’t seem like yourself. I noticed you haven’t been sleeping for this last week. And I know you’re sane, it’s fine, but let’s… there’s something going on. If you don’t want to tell me, let’s have you go someplace where you can start talking about what are the thoughts that are rolling through your head that are keeping you from sleeping.”

So I would recommend at least setting up or having somebody in your address book. And maybe you’ve already contacted them. Maybe you just filed in your own head: “this is the person that I plan to go see when things don’t feel right”.
Sunny Gault: Ok, that makes sense. What are our treatment options? Let’s say we decide to seek professional help. I think in our heads, as moms and moms to be, we think, “Oh well I don’t want to get on medication. I’m planning to breastfeed; I want to do everything naturally.” Whatever the case may be. But that’s not necessarily the case, right? There are multiple options.

Gretchen Mallios: Yeah. There are a number of options and up until now most of my language has been around that sort of mild to medium experience where we’re still mentally coherent enough and the symptoms haven’t totally taken over that, we can even engage in some of the options. So if you are staying on top of it and you know something about depression or anxiety or you’ve taken steps to understand exactly what it is and how it’s affecting you then depending on your lifestyle orientation, you have a number of options.

If you already work with an acupuncturist or you like the effect of acupuncture and you feel that it’s something that suits you, that is a non-medicated way to balance your physiology – and depression and anxiety have a physiological quality along with the thought and cognition quality that sort of creates the symptoms. So I consider them by-directional experiences. You can have physical symptoms and that can create a worry or concern and then you suddenly get the thoughts going. And they’re racing on a hamster wheel. Or you can have some thoughts about some things that might happen to you or your baby and suddenly that creates fear and that fear creates that tightness in your chest, that palpitating heart, that shortness of breath. So it can work in two directions.

I like to recommend – and certainly recommend to my clients – acupuncture to sort of get that physiological system regulated down, and getting into a healthy balanced, more easy state, in a supportive state. So that's one option. Like I said before, yoga, and massage, are very protective against depression and anxiety, just because you get into a centered state. There are some practices around that can come up, they can also do some attachment and baby related work in their mindfulness exercises, and yoga, that sort of help you route down into your center, and are very protective against the worrying and the sadness. And then you can step up the chain, you can also look at individual support groups, with people who are specifically trained in this, who really support and understand the spectrum of experiences for women. And then, of course, you can always talk to your doctor about medications, if you have a history of being responsive to medications, and that works for you, there is no judgment in choosing that. If that's what works for you, to feel well and engage in your life in a healthy way, that is good for you. And there is a lot of options that we know are safe for women during pregnancy. If it's necessary for you to feel mentally and emotionally well, then that is important, because you are either suffering and you may think you're grinning and bearing it for your baby, “Well, I won't get treatment, but I'll protect my baby”. There is going to be effects. If you are not well and strong and supported, you are that same person who is raising that baby. You need to be strong and whole, and supported, to be a stronger mom for your baby. We deserve the support.

Annie Laird: And there's a lot to be said about how your mental state effects the baby in utero.

Gretchen Mallios: Yeah, and I don't want to get into the statistics, 'cause I don't want to have moms feel judgemental of themselves, like, “Well, if I had these emotional symptoms, then now I've hurt my baby”. We don't need to add anymore stress. But there are associations. What we do know is that the more emotionally healthy mom is, the more balanced. Like I said, there is a physiological effect to these mental illnesses, so the more well and balanced she is, the healthier the pregnancy. The healthier and later term the birth. The more robust the baby is and easier to transition into motherhood is.
Sunny Gault: What happens if these symptoms go untreated? What if we just keep pushing it aside, like, “I can handle this”, or, “My due date is just around the corner, I just have a couple more weeks”, what happens?

Gretchen Mallios: I worry that it's sort of like somebody running into a war zone with a fractured leg. Or running into a serious competition, like the competition of their life, with a sprain. You're setting yourself up to run into the hardest physical experience you might ever endure. Childbirth and then postpartum period, nursing, the loss of sleep, the physical drain that goes on, it's a wonderful experience, obviously, we all look forward to, but it's taxing. I frequently explain and joke that childbirth, pregnancy, motherhood, parenthood is an endurance sport. My husband was a marathon athlete before we had our daughter, and he is like, “Gush, I thought all those training sessions were for the marathon, but they were for fatherhood”, and he would step in when I was down, and he had the long nights too, and so what happens is that we walk into an already very difficult experience, compromised. So what I find in women is that those first couple of months, most of the time, they've got the energy, they keep going, and they're OK, but after two and three months, they are depleted. And the more they were vulnerable prior to the childbirth, even that much more depleted, that much faster. So if we don't get the treatment, than we have these thought patterns, we have these physiological experiences, we're not making sense of things, we're not able to interpret and see things accurately, and it risks affecting how we experience our motherhood, and some women, when they feel that badly, interpret it as, “I guess I wasn't meant to be a mother, I guess this isn't what I expected, I wonder if I made a mistake”. And she is not at fault for thinking that, these are common thoughts that women who were suffering start to have. And what is the commonality in all that? Judgement. We judge ourselves for how we're feeling, when the reality is that those are the thoughts, that is the depression and the anxiety talking. That is the fatigue of motherhood.

Sunny Gault: Well, Gretchen, thank you so much for joining us today!

Gretchen Mallios: Thank you, it's great to be here!

Sunny Gault: And for sharing all this great information, we really appreciate it and I know our listeners will too. For more information about our expert, Gretchen, as well as our panelists here in the studio, visit the episode page on our website. This conversation continues for members of our Preggie Pals Club, after the show, we'll talk about different resources available to women who are struggling with prenatal anxiety and depression. To learn more about our club, visit

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[Featured Segment: A Parent’s Babysitting Guide. What Qualifications Are Needed?]

Sunny Gault: We have a question from one of our listeners. This comes from Sandy of Kansas. And Sandy writes, “I am pregnant with twins, I'm not very far along yet, so I'm still nervous and praying they both make it through the first trimester safe and sound, but I'd love some advice in the meantime. Anything different I need to do with my diet, besides ingest more calories? Any special gear for pregnancy and beyond that I need to make sure I have? Any ways to better my chances of no bed rest and any way to help up the baby's cook as long as possible? I'm trying to learn everything I can, and so any advice would be greatly appreciated.”

JonaRose Feinberg: Hi Sandy, this is JonaRose Feinberg, I am an ICLC and mom of twins, and editor of As I am sure you have already learned, there are somethings about expecting twins that are a little bit different from being pregnant one baby at a time. Here are some things to think about in view of your pregnancy. First and most importantly, listen to your body. Some moms find they have to make a lot of lifestyle changes while they are pregnant, and some don't need to change much of anything. Some moms are up and about at their normal activity levels, and some need to limit their activities early on. This depends on so many things. Your previous activity levels, your child condition, and the unique circumstances of your own pregnancy. There is no single set of rules that is right for everyone. Keep track with your own health provider to help you make decisions about your own unique pregnancy. Many nutritionists suggest increasing not only your overall calory intake, but specifically your protein intake while pregnant with multiples. Protein helps your babies' development, and while many moms carry their twins to 37 weeks or more, some moms deliver early. It's important to ensure that your babies are growing well early on. This doesn't mean you should live on milkshakes and yogurts, but you may want to include additional proteins sources in your overall diet. Lots of moms like making smoothies with protein powder because it's an easy way to get a lot of healthy ingredients into one meal. I recommend a book called “When You're Expecting Twins, Triplets or Quads”, by Barbara Luke, for really good explanations of diet and nutrition during a multiple pregnancy. To keep yourself comfortable, I strongly suggest adding some extra pillows to your sleeping arrangement. You may want several pillows, maybe one behind your back and another between your legs, or you may be most comfortable with a long body coat or other maternity pillow to support your growing belly. Many moms also find that they are more comfortable using a belly support band during pregnancy, to help support their growing areas. Sometimes you can have your care provider prescribe a special band, or get one from a maternity specialty store. Pregnancy is a great time to reach out to other moms. Try in your local twins club or reach out to other moms of multiples online. Local groups often have expectant and new moms groups that you can attend now, to get advice from moms who have recently been through the adventure of twin pregnancy. Note that local clubs have different personalities, programs and offerings. If one group is not a great match, you may be able to find another one online that will meet your needs. Again, congratulations on your pregnancy! Take it easy and enjoy this adventure. And come visit me online at for more information and tips.

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Sunny Gault: That wraps up our show for today, we appreciate you listening to Preggie Pals. Don't forget to check out our sister shows, Parent Savers, for parents with newborns, infants and toddlers, and our show The Boob Group, for mothers who breastfeed their babies. This is Preggie Pals, your pregnancy, your way!


This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

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