Recognize the red flags of pre, post-partum mental wellness

Hovis discusses warning signs as advocate for rural health

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PRAIRIE DU SAC, Wis. – One in five women either during pregnancy or postpartum will have a diagnosable mental health concern or illness, but 75% will go untreated, according to Elizabeth Maxwell Hovis.
“It doesn’t stop with the mother,” Hovis said. “It actually has a ripple effect through the entire family and will eventually affect the entire community if we don’t recognize it and treat it.”
Hovis spoke at the Farm Well Summit June 22 in Prairie Du Sac.
She is a psychiatrist at the Medical College of Wisconsin who specializes in maternal mental health. Hovis has studied how the variables of a life in agriculture affect rural communities and especially women during the prenatal period and the year following childbirth; this is referred to as the perinatal period.
As mental health becomes more of a priority among the health care community, certain groups have focused on mental wellness in rural communities. Farm Well Wisconsin is one such group that works to give rural communities the tools they need to support its residents.
“Rural America struggles with a lot of mental health concerns, and farming especially can be an incredibly challenging space to be in the community,” Hovis said. “It is isolating, hard work waking up at sunrise and getting done at sunset and burning all of the daylight hours.”
Recognizing a clinical health concern can be difficult during the perinatal period because there are many changes taking place that are considered common during pregnancy and the symptoms are similar to those of depression. Changes in sleep patterns, weight gain, changes in appetite and decreased energy are all interchangeable symptoms.
“When I ask my patients how they are sleeping, most of them laugh at me because they have a newborn,” Hovis said. “They are frustrated that I would even ask this. I don’t blame them for that.”
Hovis said there are certain criteria she considers to be red flags when considering mental health. If a parent is not caring for themselves and not caring for the baby, it is cause for concern. They may also lack in caring for the older siblings or have a hard time doing regular duties.
“They describe it like they are walking through molasses,” Hovis said. “Things that used to be second nature for them become really difficult.”
Another red flag for someone during pregnancy is if they experience a loss of interest in things they enjoy and in the pregnancy itself. It may indicate an unwanted pregnancy which puts them at higher risk for developing postpartum depression.
Weight changes are considered common during pregnancy, but if a patient cannot gain weight like their doctor needs them to in order to sustain a healthy pregnancy, that is a red flag. It is also worrisome if a patient is below their pre-pregnancy weight by their six-week checkup.
While most new parents attest they do not get a lot of sleep with a newborn, there is a problem if a new parent suffers from insomnia. Ideally, they should be able to sleep when the baby is sleeping.
“My goal for pregnant or postpartum women is four hours of uninterrupted sleep in a 24-hour period,” Hovis said. “It’s not an Olympic team goal; you don’t have to get eight hours.”
The other big red flag for Hovis is recurring thoughts of death. This manifests by the patient feeling like a burden or that their family would be better off without them.
“I have so many patients tell me they do not feel up to the task, or they think their children would be better off with a different parent,” Hovis said. “That is never a normal thing. We should never normally be thinking about death.”
Many people have heard of what is referred to as the baby blues. This affects 80% of women to some degree. It is characterized by tearfulness, mood variability and irritability, especially in women with many kids at home. A defining feature is that symptoms tend to go away within two weeks of giving birth.
Hovis said mental illness is treatable. Many times, there are concerns about prescribing medication to a pregnant woman, but Hovis believes there are safe ways to do so. And, furthermore, it is riskier to leave a mental health problem untreated.
“There’s been a lot of data recently showing the negative health supply of babies born to women with untreated depression and untreated anxiety in pregnancy,” Hovis said. “Historically, the medications were linked to things like preterm birth, low birth weight and longer NICU stays. But it’s actually gone to show that untreated depression and anxiety are associated with those exact same things. We’re not comparing risk of medication to no risk. We’re comparing risk to risk.”
Her passion for bringing awareness to perinatal wellness has led Hovis to participate in the Periscope Project. The project was created to fill the gap between screening initiatives and psychiatric treatment services in Wisconsin. It serves as a resource to assist health care providers in treating pregnant or breastfeeding patients.
Hovis said her goal with bringing awareness to these topics is to help rural communities to be better advocates for each other by recognizing the red flags of mental wellness.
“These conversations are only uncomfortable if we perceive it as such,” Hovis said. “If someone gives you a string, pull it.”

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