My Interview with Dr Marci Nelson, MD, Family Practice/Obstetrics Physician

It’s a universal truth that motherhood isn’t always a steady stream of unicorns, rainbows and warm chocolate chip cookies. And yet, some moms are reluctant to discuss their insecurities, worries and frustrations, fearing that friends, family and society at large will judge them. New moms might hide their struggles with postpartum depression (PPD), thinking, “Isn’t every mom supposed to be a natural at this? What’s wrong with me?”

FACT: not all new moms feel comfortable with parenting—they grow into it. And there’s nothing wrong with that.

Not That Kind of Call Girl features Julia, a twenty-something experiencing PPD. She and her husband, Charlie, are excited for their child to arrive. After the birth, they quickly learn that parenting a newborn isn’t what they expected. Julia’s convinced she’s not cut out to be a mom and feels sure the baby was a mistake! She worries about everything and doesn’t bond with her son. She pines for her “old life,” cries constantly, can’t sleep and wants to run away from home.

Julia, in many ways, is me after our firstborn.

*Marci Nelson, M.D., has been in family medicine for over twenty years. She’s delivered somewhere around two thousand babies! I spoke with Dr. Nelson over the phone in late February 2024.

Q: Why did you get into family medicine and obstetrics?

• My father was an old-school veterinarian, and I worked as a vet technician at his clinic. I loved how Dad developed relationships that lasted years. He did a wide assortment of things, from orthopedic surgery to birthing animals and everything else that comes with a general practice. His profession was partly my inspiration for going into family medicine. I liked obstetrics and pediatrics but didn’t want to get tied to one thing. I got my undergraduate degree in political science from UCLA and decided it wasn’t for me. I got my medical degree at UC San Diego and completed my residency at Swedish Family Medicine in Seattle. I’ve been practicing in this area ever since.

 Q: In your experience, how many new moms develop PPD?

• Up to eighty percent of moms develop mild PPD (aka the baby blues), which can include anxiety, crying, feelings of uselessness and restlessness. These moms generally get through it within a few weeks with the support of family and friends.
• I’d say fifteen percent of the moms I work with develop PP anxiety, which is when a mom’s worry becomes all-consuming. The anxiety can cause irrational fears or excessive stress about events that are unlikely to happen. Examples could be the inability to sleep for fear the baby will stop breathing and being terrified to leave the baby alone, even with someone she trusts.
• The most common is PPD disorder, which occurs in my patient population somewhere around twenty percent of the time. Symptoms may include:
  • Mood: anger, anxiety, guilt, hopelessness, loss of interest or pleasure in activities, mood swings, or panic attacks
  • Whole body: fatigue, loss of appetite, or restlessness
  • Behavioral: crying or irritability
  • Cognitive: lack of concentration or unwanted thoughts
  • Psychological: depression or fear
  • Weight: weight gain or weight loss
  • Also common: insomnia or repeatedly going over thoughts
• Severe PPD happens infrequently, and it’s completely disabling. Mom may feel no bond or connection to her newborn or may be a threat to herself or the baby.
• Delusional PPD is even more rare. Moms in this category suffer from extreme confusion, loss of touch with reality, paranoia, delusions, disorganized thought processes, and hallucinations.

Q: When do you typically notice that a mom is suffering from PPD?

• We do a newborn check-up at two weeks, and our nurses see the baby the day after discharge from the hospital (usually 2-3 days old), so we have some interaction with moms very early on. We do our 6-week postpartum check-up with the mom and then see the baby again at two months and four months old. We do an Edinburgh PPD screening at all those visits, which helps us determine how the mom is doing and if extra support is needed.

 Q: What do you tell moms who are experiencing it?

• You are not crazy and you are not a bad mom.
• You’re doing everything right; it’s just hard.
• Give yourself some grace. It’s an enormous life change.
• Changing hormones contribute to the problem and can’t be avoided. It takes time for the body to adjust.
• It’s not your fault.
• It’s a normal experience.
• I will help you through this.
• You’re not alone.
• I promise there is a light at the end of the tunnel.

Q: What are some treatment options for moms with PPD, and how do women respond?

 It’s imperative that moms going through PPD reach out to a physician. PPD is treatable, and moms and their partners don’t have to suffer through it.

• I have numerous treatment options in my toolbox: partial hospitalization, group therapy, medication, peri-natal psychiatry and a behavioral health counselor (not necessarily in that order).
• A few things to note—meds can take 4-6 weeks before they’re fully effective. Sleep issues can contribute to PPD. I might recommend medications to help moms sleep, e.g., Unisom or an antihistamine, both of which are safe for baby if mom is breastfeeding.
• Re: medications— Selective serotonin reuptake inhibitors (SSRIs) and Wellbutrin are the most commonly prescribed, and Zoloft (an SSRI) has been studied the most. Ask your physician which one is right for you.

 Q: Why are some moms reluctant to tell you about their PPD?

• There’s still a stigma associated with it, although I find this less and less. The mom may have an unsupportive partner/family. Cultural issues and associated expectations can get in the way. Some moms worry about the cost of treatment (doctors, therapists, meds) or fear they’ll lose their baby if they admit how they’re feeling.

 Q: How can partners, family members and friends help?

• Take over for a few hours so mom can rest or shower without worrying.
• Partners can bring the mom something to drink whenever she breastfeeds (breastfeeding moms need extra hydration).
• Do some household chores: laundry, meals, housecleaning, running errands.
• Encourage the mom to see her doctor if she seems really down—but do it in a supportive way so the mom doesn’t get defensive or feel more guilty.

 Q: What else?

• Sometimes, I prescribe anti-depressants during the pregnancy as mood disorders can develop then.
• First deliveries have a higher rate of PPD. You don’t know what you’re signing up for until you’re in it.
• Pregnancy and birth are such pivotal times. Before the little one arrives, I educate moms and their partners about what they might encounter. The whole thing can be scary, so the more information I share up front, the less scary it is.
• It’s gratifying and an honor to form bonds with patients and partners during one of the most meaningful and life-altering events in their lives.

 *This post reflects one physician’s experience. Please see your doctor if you or a loved one is experiencing PPD to discuss and ask about treatment options.

The photo shows our firstborn son and me, thankfully AFTER his colic subsided and my PPD improved, so much so that I could actually smile again.

I NEED YOUR HELP, POR FAVOR

Tell me what you thought about the book, and if you would kindly do me a favor, post your review on every website you can think of, such as Amazon, Barnes & Noble, Goodreads, TikTok, Instagram, your personal Facebook page, etc. Your vote of confidence in Not That Kind of Call Girl will go a long way in helping to promote the book. ¡Muchas gracias!

PS: Knowing that many of Julia’s experiences were my own, you might wonder how my son turned out. Well, as Mary Poppins might say, he’s practically perfect in every way. I’m not biased or anything!

Author Nova García hails from Laredo, Texas. Her Mexican-American family is a source of great pride. Not That Kind of Call Girl is her first book in the women’s fiction genre.
Nova writes to dispel Latino stereotypes and recognize women for the everyday miracles they make possible with determination, smarts and a generous helping of kick-a** attitude. She knows postpartum depression first-hand and wants women around the world to know they’re not alone.