Maternal Mental Health and Returning to Work with Dr. Emily Guarnotta EP 158

Depression, anxiety, and autoimmune symptoms after birth is not how it’s supposed to be. There is a much better way, and I’m here to show you how to do just that. Hey, my friend, I’m Maranda Bower, a mother to four kids and a biology student turned scientist obsessed with changing the world through postpartum care. Join us as we talk to mothers and the providers who serve them and getting evidence-based information that actually supports the mind, body, and soul in the years after birth.

Hey everyone, welcome to the podcast. Today’s guest is Dr. Emily Guarnotta, licensed clinical psychologist and certified perinatal mental health specialist. We are discussing New moms returning to work and the mental health concerns that are presented.

She is the co-founder of Phoenix Health, which is an online therapy practice that specializes in treating maternal mental health conditions like postpartum depression and anxiety, and she’s also a mother herself.

Maranda Bower: 1:01

Dr Emily understands the challenges that motherhood can bring as a passionate supporter of parents’ rights through every step of the journey.

She’s here today to really speak on the experience of returning back to work after maternity leave, which is such a huge conversation, because in today’s society we don’t usually have much of a choice.

Two working parents are almost necessary to survive these days, and our healthcare system is pushing people to go back to work very quickly.

We don’t have great healthcare standards for mothers and it’s kind of a mess.

So I’m so glad you’re here to have this conversation with us today.

What got you into this world and how have you become so passionate about this? 

Emily Guarnotta: 2:25

I work with a lot of mothers who are going through this transition and who are feeling like they’re having to go through this transition back to work way sooner than they feel ready for.

I’ve also personally experienced what that’s like.

I can empathize with how difficult that transition is, especially when it feels like it’s something that you have to do before you’re ready to. So that’s given me this drive to want to talk more about how we can support parents who have to go back to work.

Maranda Bower: 2:55

I would love to go deeper into this conversation.

What is the typical experience of returning to work after maternity leave like for moms? 

Emily Guarnotta: 3:10

It’s definitely a unique experience.

For a lot of people it’s very stressful.

Many people feel like they have to go back to work before they feel ready.

I don’t think we have any stats on when the average, what the average length of maternity leave is like because there’s such wide variability in it.

I usually see moms having to go back around 12 weeks or so and that’s pretty consistent with my own experience.

At 12 weeks you’re just kind of figuring out the newborn schedule. Maybe you’re getting a little bit more sleep. You’re just kind of feeling like you’re getting the hang of things and then all of a sudden it’s like boom, there’s another transition.

Now you have to figure out how to do all this while working outside the home. It’s pretty stressful for a lot of people.

Maranda Bower: 4:08

Yeah, yeah, and I think that’s a really common thing.

12 weeks, if somebody is breastfeeding, is also when major shifts are changing within the milk and breastfeeding production.

I think a lot of women feel like at that particular time, if they’re breastfeeding, that all of a sudden they are not making enough, or whatever the case may be, because letdown feels differently.

The way that their bodies are producing is a little bit different. Babies are taking more as well, and so you have this stressful period of kind of a new phase in breastfeeding, and so if you add that on top of it, it can be quite a whirlwind.

We know that when women return to work, breastfeeding rates drop significantly because there are so many challenges with that on top of it and that impacts the way a mother feels about who she is as a mother, especially if she’s tied that into breastfeeding, or her identity as a whole.

Would you agree with that? Is that something that you are seeing in your practice as well?

Emily Guarnotta: 5:24

Absolutely. Yeah, I mean, even with all the legislation in place around breastfeeding and moms in the workplace, it’s still very difficult to be able to ensure that you’re pumping every two to three hours and you’re producing enough.

And especially if you’re an anxious type A mom like I tend to be, you want to do everything perfectly and it’s really hard.

You’re trying to be the best when it comes to providing food for your child, plus the best in the workplace, plus be present when you’re back at home.

It’s almost impossible to do 100% in each of those different places.

Maranda Bower: 6:10

That’s so true.

How can experiencing postpartum depression or any other maternal mental health condition affect a mother’s transition back to work as well?

Emily Guarnotta: 6:22

Experiencing postpartum depression or postpartum anxiety or OCD or any maternal mental health condition can definitely make it a lot more stressful to go back to work.

A lot of the symptoms of these conditions involve difficulty concentrating.

If you’re feeling very anxious, it’s going to be hard to stay focused in the workplace.

These conditions can also affect your sleep, so even if your baby’s sleeping, you might not be getting quality sleep at night.

And then having to go to work the next day and function and feel like you’re at your best can be challenging. So I think it really complicates it.

It makes something that’s already challenging so much more challenging.

Maranda Bower: 7:05

I wonder how much is actually contributing to postpartum depression and anxiety. Just the very fact that we’re being forced back into the workplace, where we feel forced.

We have this huge elephant in the room. Persistent gender wage gaps, workplace discrimination against moms.

We have all of these laws and legislation around protecting breastfeeding and all of those things, but all of this stuff still exists on top of the challenge of financially having to provide as well as doing all the other things, as you said.

So I’m wondering if the opposite is true it’s not just postpartum depression and anxiety and other maternal mental health existing and then we’re having to go back to work, but also going back to work and now having this develop because we’re feeling forced, like we don’t have a choice.

Emily Guarnotta: 8:04

That’s a really good point.

It’s kind of like what came first the chicken or the egg.

Did the postpartum depression come prior and then get exacerbated by that return to work, or you know, or vice versa?

What I see is a lot of moms have a lot of anticipation about anxiety and anticipation about that return to work, so much so that it either can seem like it triggers a condition or exacerbates one that’s already there.

But there’s so much anxiety just tied to how am I going to return to work? How am I going to do this?

I see moms who start talking about this and fearing this from the second they bring their baby home from the hospital. They’re already thinking, you know, in 10 weeks, 12 weeks, how am I going to go back to work when I’m feeling this way?

So it definitely, I agree with you.

I think it definitely contributes to a lot of those symptoms.

Maranda Bower: 9:05

Yeah, yeah, I know my sister-in-law just had a baby not too long ago and she had to return to work and immediately I think it began for her, even in pregnancy. She’s like I don’t even know what I’m going to do.

What am I going to do about childcare?

It was a constant thing on her mind and she, thankfully, is not the one in seven who’s experienced postpartum depression and she’s not experiencing postpartum anxiety, but she did have a lot of anxiety and fear over where is my child going to go, and I’m not ready for that to happen.

Even in pregnancy that was a huge part of her story and thankfully, her baby had his first days at childcare and they went wonderful, it was absolutely amazing.

But she’s like I haven’t pumped before. Like you know, every time I try, I wasn’t able to, and so now the worry and anxiety has kind of shifted from okay, now I have the childcare that I need, which was a huge concern in the very beginning but now how am I going to provide what my baby needs through breastfeeding if I’m not able to pump or do what my body needs, and I was the same way.

I could not pump at all for the life of me, and I know so many people experience that too.

The concern of postpartum depression and anxiety is really on her mind now more than ever, when it wasn’t so before and vice versa, like it’s just something that we’re consistently having to go through and deal with, which is very frustrating right, absolutely.

Emily Guarnotta: 10:50

When I had my first daughter, who’s about to turn six next week. I was preparing to return to work and I realized a couple of weeks before that she, just wasn’t taking bottles.

She would only breastfeed. I tried having a lot of family members give her bottles. We were trying to get her used to it because we knew she was going to be in childcare.

I had so much fear about what’s going to happen when she’s not with me, and is she just going to not consume any breast milk anymore?

Is she not going to be able to take in any nutrients?

And fortunately, it was okay. It did take her a couple of days to adjust to bottles being in childcare, but that was something that I would have never anticipated would have been an issue or a concern.

You can’t even prepare for all of the different factors that contribute to this transition. But that’s great news that the baby’s doing well in childcare. It’s always a relief.

Maranda Bower: 11:54

Yeah, you know, and before doing this and in my previous life I like to tell people because I sometimes feel old but I worked in childcare.

I worked in childcare for a really long time.

I was a single mom and I was able to go to work with my son. That was very important to me and I was so blessed with that opportunity to do that when I was forced to go back to work.

Being a teacher and seeing how truly easy it is for a lot of children to go back into that space has been really helpful for me and I see it.

But I also understand the challenges and frustrations and the fears around that huge step.

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What can mothers do if they are struggling with this transition back to work?

Emily Guarnotta: 13:57

I think one of the most important things is to know that you’re not the only one who’s having a hard time with this.

When you’re in it, it feels like you’re the only person that’s having a hard time going back to work or a hard time postpartum.

Remember that it is a journey.

As much as we like to jump right into things and feel good on day one, that’s probably not going to happen when you go back to work.

It’s going to be this transitional phase that is going to take time and it might even feel like you’re starting over at work, almost like it’s your first day back in the job, and that’s completely normal.

Leaning on colleagues if you have them that are supportive, can be extremely helpful.

It’s really important to notice the signs.

If you’re struggling and things are not getting better and you’re feeling worse over time, don’t delay getting the help, because the treatment for postpartum anxiety or postpartum depression or just even more general stress is out there.

Many people will want to hold off and say I’ll give it another month, I’ll see how I feel, and then I’ll give it another month, and then it just goes on and on and often gets worse before it gets better.

So I always tell people, as a psychologist, as a therapist, it’s never too early to seek help.

Maranda Bower: 15:36

If this is something that you’re experiencing, the anxiety of, in pregnancy, as my sister-in-law did that is a beautiful time to get help, get some support and help and kind of work through those emotions and fears.

You don’t have to wait until you go through the process of having to go back to work and dealing with all of that stress, because, let’s face it, it’s a lot that’s on our shoulders and it’s not OK that we’re experiencing all of that frustration and anxiety and fear.

Get help, that’s beautiful.

Should a mom share her struggles with her employer or keep it to themselves during this time? 

Emily Guarnotta: 16:31

Yeah, that’s definitely a question that comes up a lot and it’s it’s really tough to answer because I think it kind of depends.

It’s kind of a case-by-case basis and it depends on what your needs are or what you’re looking for.

So if you’re struggling and you’re dealing with a maternal mental health condition like anxiety or depression, and you feel like maybe you need some more time off and you want to explore the Family Medical Leave Act, FMLA, to extend your time, or you need some accommodations at work because of your condition, or you need time off to attend therapy appointments, things like that, you are going to have to disclose that to your employer, to your human resources department, to find out if you’re eligible for some of those things.

If you’re not exploring any of those options and you’re just wondering, should I be open with my boss or with my colleagues about what I’m going through because maybe they’ll be more supportive or helpful?

I think it really depends on how comfortable you feel in your relationship with your colleagues and the workplace culture.

You certainly don’t have to disclose anything that you’re not comfortable with, but if you do work in a supportive environment and you do believe that it’ll be received well, it could be helpful to be honest about that and give people an opportunity to kind of rally around you and support you.

Maranda Bower: 18:03

Do you feel like someone should be extending their maternity leave if they’re struggling with perinatal mood or anxiety disorders?

Emily Guarnotta: 18:14

I think that’s kind of another case-by-case basis.

For some women, it is very helpful to take more time off if they’re able to, just to kind of work through things better, get a better handle on their symptoms, especially if maybe they just started treatment, they just started their medication and they need a little bit more time for those things to start working.

I’ve seen it be very helpful to extend leave, and then there are some cases where women just feel like they’re so in their heads that they need to, they need to keep busy in that way, and that going back to work can be helpful for them.

So it really does depend, but it’s something worth considering if you feel like it would be helpful for you to have a little bit of extra time to work on things before adding another transition to the mix.

Maranda Bower: 19:07

Yeah, so true, so true.

The big takeaway message here is this is a huge conversation and it is a massive transition.

So if you’re feeling this or you know somebody who might be going through this, it’s okay to reach out to them.

It’s okay to reach out for support because you’re not alone.

These are difficult times for many people where we’re feeling like we don’t have a choice.

This is something that we have to do and it does take a toll on our mental and emotional health.

So thank you so much for sharing this.

Where can people reach out and find you, especially if they want to have more of a conversation or ask specific questions for you?

Emily Guarnotta: 19:55

Yeah, well, thank you so much for having me be part of this discussion. You can find me on Instagram at Dr. Emily E-M-I-L-Y underscore G-U-A-R-N-O-T-T-A.

If you want to learn more about my company, Phoenix Health, and our maternal mental health services, you can find us at www.joinphoenixhealth.com

I am so grateful you turned into the Postpartum University podcast. We hope you enjoyed this episode enough to leave us a quick review and, more importantly, I hope more than ever that you take what you’ve learned here, apply it to your own life, and consider joining us in the Postpartum University membership. It’s a private space where mothers and providers learn the real truth and the real tools needed to heal in the years to come and the real tools needed to heal in the years Postpartum. You can learn more at www.postpartumu. That’s the letter U.com. We’ll see you next week.