Kayla: Welcome back to the Designer Practice Podcast and I'm your host Kayla Das.
In today's episode, Jessica Bacon, Registered Social Worker and Psychotherapist, will explain what therapists need to know about perinatal mental health in 2025.
Hi, Jessica. Welcome to the show. I'm so glad to have you here today.
Jessica: Of course. Thank you so much for having me. And I'm just happy to be here.
Kayla: Jessica, before we dive in, please introduce yourself, where you're from. Tell us a little bit about your own practice journey, specifically as it relates to perinatal mental health.
Jessica: Yeah, so as you said, my name is Jessica Bacon, registered social worker and psychotherapist. I'm in Hamilton, Ontario, Canada. Kind of right in between Toronto and Niagara Falls.
And yeah, I currently own, run my own practice. I did start my career, like many social workers do, in the public sector across some different organizations. And early on, I always had it in my head that I wanted to focus on something with parents, with moms. What I later learned to know was called perinatal care. I don't think I knew at the time what that was exactly.
So I initially thought that would look like being a social worker in a hospital and something like a labor and delivery ward.. When I did pursue that and did get offered such a position, I actually had two young children of myself at the time. I was working in outpatient mental health, so that's like a bit of a more flexible schedule, and I just couldn't see myself at that stage where I was in my life with my kids, being essentially in inpatient role. Really long hours, pretty unpredictable shifts. So I had to say no to that, which was like so uncomfortable because that's what I felt I'd been working towards my whole career.
And then eventually just turned my focus. Okay. I can't do that. You know, what do I really want? And that's how I really started my private practice journey, got some more training and education about perinatal mental health. And here I am.
There is a personal story as to why I do this work, which is often the case, at least in this field. As I said, I have two kids. And with my first, I did have some pretty significant experience with postpartum anxiety. And what I now can understand, like with the training and education I've received since was probably postpartum OCD. And yeah, I had a little of it with my second and first year, but with more knowledge and better access to treatment, it was certainly milder.
I say this just because, you know, a lot of the clients, at least in my private practice, who are typically parents, they want to work with somebody who is a parent themselves often. It is a pretty typical question I'll get from my consultation calls. And for the ones who are struggling postpartum, if appropriate, they do appreciate hearing that I've gone through that as well, and know what it means to struggle and eventually thrive in parenting. Although by no means am I perfect every day.
So yeah, that's just a little bit about me and how I ended up where I am today.
Kayla: Thank you so much for sharing your story. As therapists, we all have our own stories that bring us to, where we are and who we work with. As therapists, we can help people, even if we haven't been through that same experience, but sometimes our clients do feel more connected, especially in certain circumstances like this, like, have you experienced this? Because I can tell you from someone who only went through it once, it is something that I could have never imagined. Like, it's just totally different, right?
Jessica: Yeah, you just, you do all the planning and preparation and research you can, and you really don't know until you're there.
Kayla: 100%. So, from a clinical perspective, why does perinatal mental health matter?
Jessica: Yeah, so perinatal mental health has always mattered. And in my opinion, it's never mattered more. Before the pandemic, if we want to look at statistics, the statistics that a woman could face-- so we used to call it postpartum depression, of course, knowing some women experience anxiety. The term now it's an umbrella term, like a catch all is perinatal mood and anxiety disorder, PMAD for short, so you might hear me say that just wanted to give it like a little bit of context. So, it could be depression, anxiety, it could be OCD, trauma, something else.
Yeah, so before the pandemic, those stats were about one in four that a woman could experience a PMAD. Since the pandemic, those statistics are a lot closer to one in three. And it is the number one complication of childbirth above and beyond anything physical a woman may encounter. And that can be like a really surprising thing for people to hear, because I think in our prep, when we're pregnant or planning to be pregnant, we do tend to focus so much on the physical, like getting the nursery ready, having a good stash of freezer meals, maybe. We don't always think about like that and that's the one that's going to be most likely. Although, we absolutely hope it won't be
Beyond the statistics that matters because mom’s matter. And if left untreated, it can lead to things like chronic depression, impact her ability to care for her child, and really rob her of what she was probably hoping and expecting would be a joyous time in her life.
There's impacts on kids. One fact that has always stood out to me from my earlier training is that the number one lack of school readiness in children is maternal depression. I'm sure paternal depression as well, but typically the mom is the primary caregiver. And when I think back to my public sector days, and I did work for a period of time in outpatient children's mental health, I could really see the impact a mother's mental health had on the child. And how the story could actually often be traced back to those early years, even if I was working with a teenager.
Other things that can happen could lead to friction in the couple’s relationship or other important adult relationships due to the burden of PMAD places on caregiving, as well as that multi-generational impact, given how we know that trauma can be passed through generations.
Kayla: You know, it's interesting because people don't really talk about the mental health aspects of pregnancy and postpartum. And when it is talked about, it's often kind of downplayed by calling it the baby blues. It's just something you experience. Do you have any thoughts about that working in the field and just navigating other clients’ experiences.
Jessica: Yeah, so it's definitely important as a therapist or anybody working with this population to distinguish between a PMAD and the commonly known baby blues. The baby blues are very predictable, it is considered a normal part of postpartum.
They often begin around day three and peak by day 14, so very connected to those hormones adjusting and things like just getting used to a new way of life, a new person, certainly the lack of sleep. So yeah, we know it's a normal part of postpartum and in fact it would be very rare for me as a therapist to even screen a new mom prior to day 14 unless there was something very unusual happening.
So, these symptoms. Well, certainly they can be upsetting. So like women will often call me, I can't stop crying. So yeah, it is upsetting and they should be mild. They'll resolve with things like good food, a bit of rest. Hopefully there is some support and people are telling the mom what a good job she's doing. So that's what we know of the baby blues. And yeah, it's just normal.
Kayla: That's a good distinction.
Jessica: Yeah. And I have these conversations with my prenatal clients when I'm working with them just to kind of prep them a little bit. And then, yeah, if I am getting those phone calls from a mom, whether I've worked with her before or somebody who has a new inquiry. I spend a lot of time explaining that.
And assuming they have all those things that they need, maybe it's four weeks postpartum, they do tend to be feeling a lot better, a lot more like themselves. .
Kayla: So, what are some of the symptoms that therapists should watch out for when working with clients who are either pregnant or had recently had a baby?
Jessica: Yeah, so this is interesting because it does relate to how a PMAD is often missed or overlooked or even dismissed because those symptoms overlap with what we do see in the later stages of pregnancy or early parenthood, such as like feeling pretty tired, maybe crying more than usual.
Generally, though, I can offer like a bit of a list for what to look out for, particularly for a therapist, if this isn't their specialty. Things like confusion and disorientation. That's one of the hallmarks. Inability to sleep, even if someone else is on child care duty. So, the mom doesn't have to worry about baby. Baby's fed, cared for, and they can't sleep. Feeling unbearably anxious, particularly around the health and safety of the baby.
Feeling hopeless, trouble concentrating, quite sad. Quite tearful, intrusive thoughts is a big one that I talk about that comes up a lot. A sense from the mom that she just feels like she's going through the motions. Feeling inadequate as a mom. Fear of being left alone with the baby. Feeling emotionally detached from baby, so something with bonding and even suicidal ideation.
Kayla: Is there any differences between, say, quote unquote, the baby blues versus postpartum depression or anxiety, with respect to the symptoms?
Jessica: Yeah, like, baby blues symptoms certainly that tearfulness, feeling more irritable, being able to cry at the drop of a hat. And again, around that day 14ish, we should start to see some improvement, particularly if the mother is being supported by someone, hopefully more than one person ideally. You know, that expression, it takes a village, it really does, especially in those early weeks and months.
Kayla: Definitely. So, as a therapist, how can we screen or assess for perinatal symptoms?
Jessica: Yeah, so this is where it's really invaluable to spend time checking in with a new parent, about how they're feeling, coping, because we know early detection is really ideal.
There's so much stigma though. Still, that can be such a barrier, which is why I think screening should actually just be universal, regardless of a mom's history with mental health or how you currently perceive she's doing. The message women internalize and why they often don't speak up until later. Is, well, if I was a good mom, I wouldn't be feeling this way, which is simply not true. We often hear that message, like, are you loving every minute? You should love every minute. It goes by so fast. And for somebody who's really struggling, whether they have a PMAD or not, you know, if they don't feel that way, they feel like they really don't belong, like something's really off with them. And if nobody really is offering that screening where's the opportunity going to arise?
Yeah, so, once we've sort of passed that baby blues period. That is a really good time to check in and maybe even screen. There is a screening tool commonly used by a variety of healthcare workers in this space. It's called the Edinburgh Postnatal Depression Screen. If somebody is going to use it, like it's really great to use it around two weeks postpartum up to about four months postpartum. Although we know that PMADS do happen kind of any time within that first year.
And it gives a score. It's not diagnostic. But it is helpful if a mom is scoring a bit on the higher end of it. And maybe she's been thinking whether or not to take medication. She sees that higher score and it might be something that kind of tips the balance and helps her feel more confident to try something like that. In my practice, I'll often use it around two weeks, six weeks, and maybe even six months, depending on how things are going.
And, yeah, just really important to know that no two moms are the same, and that just proper, ideally, early assessment is necessary to ensure a good outcome.
Kayla: What does treatment look like, and what could be the outcomes if it's left untreated?
Jessica: Yeah, I'll start with the outcomes if left untreated. As I mentioned before, it could lead to chronic depression in the mom, that impact on the child's development, so socially, their mental health, it does increase the likelihood that a child will struggle in their mental health later on. Those impacts on adult relationships, including the couple's partnership. And it can also lead to a higher likelihood of recurrence in subsequent pregnancies if it wasn't treated that initial time.
Treatment is varied, as it is with all mental health conditions. The more evidence-based treatments, though, suggest ones like cognitive behavioral therapy and interpersonal psychotherapy are a good place to start. In my practice, I also find spending the right amount of time on psychoeducation, and self-compassion work is also really important to dismantle some of those myths of what it means to be a good mom. And that in order to care for our children, we must care for ourselves, which includes being kinder to ourselves. Moms are so hard on themselves. That's internal messages they've received, or you know, been telling themselves for often years, and then the external ones about what does it mean to be a good mom. And it's often like, be selfless. Don't put yourself first, look after everybody else, and then you can look after yourself. Kind of messaging.
And we know that a child's happiness and well-being is directly connected to the happiness and well-being of the mother, if she is the primary caregiver. And that's not always the popular message that's put out there. So, I will often spend time talking about that maybe even providing some research for people who are interested in that. And really starting to take steps on, okay, what can that look like? Like what's realistic for you right now? Let's say if you're eight weeks postpartum, you're probably not going to be going out for two or three hours. Maybe. And it's not required either. So, we could get really concrete, Okay, you can't go out for that amount of time. What could you do in 15 minutes as a starting point?
And if there's been trauma, whether through the pregnancy and delivery, birth trauma, I see quite a bit of as well. And sometimes that's the reason people are coming to see me. Something like internal family systems or EMDR are also options.
I obviously work with a lot of moms and also speak from experience that there's just nothing like having a child to really open up what we've gone through in childhood, even if we had like pretty stable childhoods, there's always kind of something. And I just like to say instead of seeing it as a negative, and we see it as an opportunity to learn more about ourselves and grow so something like the parts work from internal family systems could be a good option to start making some of those connections and offer some healing.
I often get asked how many times should I come to therapy? There's no one answer and I will like to offer a ballpark to people. So, again, depending on the severity of symptoms, it can be anywhere from six to 12 sessions, sometimes a bit less and sometimes more, and all of that's okay.
Kayla: I love all of that. And, you mentioned what it means to be a good mom. And I've spoken to a lot of moms in my own communities, and that is whether it's an internal dialogue or whether it's an external dialogue or expectations, that is probably one of the hardest parts about navigating being a new mom, is everyone has their own expectations of what a quote unquote good mom is. But then there's also that internal dialogue of this is how I need to show up, but it's not necessarily how I can show up.
Jessica: Yeah, and it's just about being responsive to our children in a way that feels reasonable. Like we don't have to spend all our time with our children to be considered a good parent and that goes back to that connection between mother's well-being and child's well-being. And it's not about did you stay home with your kids, or did you go out of the home to work? It's were you doing what felt like satisfying? Meaningful for you. And it was your choice.
Because a mom who stays home with her kids all the time and doesn't want to that's not going to be great either for a child's wellbeing and development. So it's really about finding like that sweet spot for you as a parent and knowing that that's okay and that idea that's been like well researched as well of good enough parenting versus being perfect. And that supports a child's well-being and development more than perfection ever could.
Kayla: That's a beautiful way to say it. Yeah. And I'm just going to share my own experience. Like I went back cause of course I run my own business as many therapists do. But the judgment that I experienced was definitely hard to navigate. And I assume, that some listeners, whether you take two months, five months, a year, two years, whatever works best for you and your practice.
But typically, as business owners, we don't receive employment insurance, we are getting unpaid time off. And that can be challenging, especially when navigating our friends, our colleagues, our family who can take a year off. Whether you do or don't want to take a longer maternity leave, that expectation from other people that why aren't you taking a year off? A lot of people don't necessarily understand or see some of those pressures that moms in private practice go through.
Jessica: Yeah. And quite often people who are in their own business or their own private practice, you know, it's because they chose to do that. Even though it can be a lot of work, perhaps it's work that hopefully gives them a lot of energy in a way that might be different when working for somebody else. So, it's also thinking about that and what do you want, even if you do have paid maternity leave. What if staying home just isn't for you? And you want to go back at eight months? That is perfectly okay because the fact is if you're not happy and doing what is right for you, it's very unlikely that you're going to be the type of mother or partner or model to your children. So, it's important to think of those factors as well.
Kayla: Amazing. Do you have any additional advice, insights, or tips for listeners who are working with women perinatally?
Jessica: Yeah, so although a lot of those treatment modalities that I mentioned are commonly used for other mental health conditions, so many therapists may be trained in them, the perinatal population is unique.
So, I always recommend that if a therapist wants to better support women in this stage that they find a reputable training to better understand the nuance and the context of this time in a woman's life. It's actually called matrescence, which is interesting, simply the process of becoming a mother.
Similar to how we know the impact adolescence has on youth. In motherhood there are also physical, psychological, and emotional changes you go through after having a child, and it's only really just starting to be explored.
Kayla: That's interesting. Jessica, are you currently accepting clients into your practice?
Jessica: Yes, on a limited basis. I do also have two colleagues who work with me in my practice. They can also support those needing perinatal mental health care. For someone looking for a perinatal therapist, as I said, we're in Ontario, so we can only support people who are in Ontario.
There is a website with a directory run by the Canadian Perinatal Mental Health Trainings. They offer excellent trainings and you can become certified. So, they have a directory where you can search up a provider best suited for you. Not only therapists, but other specialists, such as lactation consultants, pelvic floor physiotherapists, and more.
Kayla: How can listeners reach out to you if they would like to send a referral your way?
Jessica: Yeah, the best place is probably to go to my website, so www.mountainbrowcounseling.com. And on there, there's a contact form. There's lots of buttons to click if somebody wants to book a consult. It's pretty easy to navigate.
Kayla: Fabulous. So, to connect with Jessica, check out mountainbrowcounseling.com.
Or simply scroll down to the show notes and click on the link.
Jessica, thank you so much for joining us on the podcast today to discuss everything we as therapists need to know about perinatal mental health in 2025.
Jessica: Yeah, thank you so much, Kayla. I had a lot of fun and really appreciate you highlighting this important topic.
Thank you everyone for tuning into today's episode and I hope you join me again soon on the Designer Practice Podcast.
Until next time. Bye for now.
