The Ordinary Doula Podcast

E116: Perinatal Mental Health Basics with Sadie Clark

• Angie Rosier • Episode 116

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The moment a baby arrives, your brain and body change fast and not always in the ways you expected. I sit down with perinatal mental health therapist Sadie Clark to name what so many parents feel but struggle to say out loud: mood shifts can start in pregnancy, the baby blues have a real timeline, and “pushing through” is not the same thing as doing well.

We dig into the practical side of postpartum mental health, including how sleep deprivation affects nearly every condition, why motivation tanks when you are running on empty, and how baseline self-care like food and rest can be the most powerful first step. Sadie also shares her own experience with a breech baby and a planned C-section, plus the grief that can come when birth doesn’t match the picture you carried for months. We talk about holding two truths at once using “and” instead of “but,” so joy and disappointment can coexist without canceling each other out.

Then we get specific about postpartum anxiety, intrusive thoughts, and perinatal OCD, including the “what if” spiral, the heavy “should” list, and the relationship strain that shows up when everything has to be done a certain way. If you have a history of anxiety, depression, bipolar disorder, or OCD, Sadie explains why the postpartum window of tolerance can narrow and what to do about it. We also cover treatment options, medication fears while breastfeeding, and where to find specialized help through Postpartum Support International, the PMHC credential, and Psychology Today.

If this conversation helps you feel seen, subscribe for more birth and postpartum support, share it with a parent who needs it, and leave a review so more families can find these tools. What part of postpartum mental health do you wish people talked about sooner?

https://www.serenityrw.com/meet-sadie/

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Show Credits

Host: Angie Rosier 
Music: Michael Hicks 
Photographer: Toni Walker
Episode Artwork: Nick Greenwood 
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker

Welcome And Meet Sadie Clark

SPEAKER_00

Welcome to the Ordinary Doula Podcast with Angie Rosier, hosted by Birth Learning, where we help prepare folks for labor and birth with expertise coming from 20 years of experience in a busy doula practice, helping thousands of people prepare for labor, providing essential knowledge and tools for positive and empowering birth experiences.

SPEAKER_02

Hello and welcome to the Ordinary Dealer Podcast. I'm Angie Roser, your host, and I have a special guest with me here today. Her name is Sadie Clark. Sadie is a mental health therapist who specializes in perinatal mental health. So this is the time before and after people go through the experience of giving birth, having a baby, and all the changes that could bring to life. So, Sadie, thank you for being with us today. I'll let you do a little more of your own introduction, if that's okay. Tell us a little bit about you, your background and your work.

SPEAKER_01

Yeah. So let's see, I have been a therapist for a few years now, um, and then particularly working in the perinatal field about a year and a half. Cool. And I just had my first baby three months ago. So um I've been working in the field before actually entering it myself. And so now I'm kind of like living in that phase too. So that's been really interesting. Um, yeah.

Mood Shifts And Baby Blues

SPEAKER_02

Okay, very cool. I bet it is interesting, and we'll get into that, I'm sure, what that experience was like for you having dealt with people and their experiences, and then having your own experience and going through that through that process. So, Sadie, as you work with people, with families, individuals, um, share with us some of the common things you might see that come up or that people struggle with. Are there any themes people can kind of expect or what do you see that is kind of thematic in the work that you do with people?

SPEAKER_01

Yeah, I think there's probably a couple of things that are just common themes that I see in pretty much like every client. Um, maybe the first thing to cover is changes in mood. I think this is one that most people anticipate because I think everyone's kind of familiar with the different hormone changes that happen in having a baby. But what people often don't necessarily know and maybe aren't prepared for is that sometimes those happen in pregnancy as well. Um we like to use the term perinatal mood disorders now just because it is more inclusive in uh I guess just like covering the perinatal, like the prenatal part of pregnancy and postpartum, right? I think people um blanket statement call mental health issues and postpartum, postpartum depression, but there's a lot more to it. And so we like to use the the term perenatal mood disorders, um because it kind of covers that whole thing. And then with mood changes, um especially like in that postpartum period where you're experiencing that huge change and that huge drop in your body. Um, I think most people understand that that's normal. However, I don't know that people understand necessarily like you're not supposed to feel this way for more than two weeks. We call within that first two weeks the baby blues. So that would be pretty normal and standard if you're experiencing that. But if it is longer than that, that may be a good indicator that it's time to reach out and get some help. So I think mood changes is probably like one of the biggest things that people are somewhat aware of, but also not necessarily aware of all the different pieces, if that makes sense.

SPEAKER_02

Yeah, it's like the nuances of what to experience. Okay. Yeah. Any other themes that you see?

SPEAKER_01

Yeah. Um, with mood, I guess one other thought too is um changes in motivation as well. Um, a lot of the times, I mean, it just is so overwhelming when you have a baby. There's so many things that you need to do, right? Like when the wake window comes and like your baby is happy and doesn't necessarily need you, there's a million different things that need to get done. But maybe it's hard to get motivated to do the things that would make the most impact, right? And so a lot of the times with this, like we just say, like, hey, baseline, like take care of yourself in whatever ways you need to. So what I've been doing with this is like first is food. So, like, when did I last eat? What do I need next? Um, because I'm not gonna be motivated to clean the toilet if I don't have enough calories for the day, right? Like a lot of the times it's so hard to get going on the things you want to be doing if you're not doing the things that maybe you need first. And so we want to be strategic with that time. And of course, like it would be nice if you could wash your baseboards right now, but maybe that's one that we let go. Yeah, set priorities a little bit differently. Yeah, yeah. So I mean, it's hard because the wake window is never long enough and you can never get done what you want to in that period to take care of yourself, but really trying to prioritize those like baseline things so that you can have energy to maybe do some of the things you want to, if that makes sense. Yeah, and those baseline things could be different for different people, right?

SPEAKER_02

Yeah, totally. Okay, totally. I mean, self-care should always be involved, right? But then people will prioritize beyond that what they want to get done. Okay.

SPEAKER_01

Right. And I feel like when you're breastfeeding, it's like, oh man, I need to eat every time the baby eats because like I just can't get enough calories.

SPEAKER_02

Yeah, it does. It burns a lot of calories. So it mood um changes. Is this tell me in your experience, is this something that the the your clients themselves notice in themselves, or sometimes does it take other people to notice that? Like is it something they always feel, or is it something more observed than obviously felt?

SPEAKER_01

That's a good question. I mean, I feel like it depends on the person and your past life experiences. I mean, if you have a history of mental health issues in the past, I wouldn't be surprised because some clients come in and they don't necessarily see it right off the bat because maybe they've developed like really different types of coping skills that make it hard for them to see. And it comes out in other ways that maybe other people are privy to necessarily. I don't know.

SPEAKER_02

And also you layer on fatigue, right? You're like putting fatigue on all of that because it's not like you sleep great after you have a baby.

Sleep Needs And Feeding Tradeoffs

SPEAKER_01

Yes, that was the other thing that I was thinking about too with this question. Sleep is a huge factor with mental health, pretty much every mental health condition that exists, right? Because you're gonna experience that mom brain on a higher level, right? Like your body is already like reconstructing things in your brain. But with mental health issues on top of that, it's gonna be a lot harder for you to function in different ways. Um with bipolar disorder particular, we want to be really um protective of sleep as much as we can, just because that one in particular, like when you are getting less sleep, you're at higher risk of developing um postpartum psychosis too. So we want to be as creative as possible in addressing rest too, because that is also a nuanced issue as well.

SPEAKER_02

I love that. And I see often in the field that we work in is a tug-a-war between um, because I'm like lactation, right? So I do a lot of lactation work and we're like feed the baby every two or three hours, round the clock. It's so important to your milk supply. That's a true statement, but we also have to look at the whole picture, right? For some situations, we might do a little more give and take on that to prioritize mental health, right? Maternal mental health, so that we can um not just breastfeed a baby, but enjoy a baby and life beyond that as well.

SPEAKER_01

Totally. And I feel like for each person, the solution is definitely different, right? Like for one mom, maybe it makes sense to combo feed because it's not possible to function without sleep, right? And maybe we have to figure that out, or maybe another mom, the answer is figuring out how to safely co-sleep. There's a variety of different things that you can try. And I guess to anyone who maybe is in this spot, what I would say is like try something and see.

SPEAKER_03

Just try different things.

SPEAKER_01

Yeah, it's so easy to feel anxious about trying one of these options in this period and your brain to be very adamant that things need to go one way. And what I usually tell people is, yeah, that makes sense because you had your heart set on this looking a specific way. What if we try it and see how you feel? Because you don't actually know how you feel until you've tried it. Maybe you do try it and it's not for you. That's totally fine. I thought that I would want to co-sleep with my baby, and that is not the case. I cannot sleep wink if my baby is in the room at all. Okay, okay.

SPEAKER_02

So I had to get creative with that. Yeah, and so that that leads us to like expectations, our own mostly, right? Like um meeting our own expectations um can be different than we might have thought.

Grief When Birth Plans Change

SPEAKER_01

Mm-hmm. Yeah, I definitely think like within this period, I mean, being a woman, if you at all ever envisioned yourself having a baby, you had a vision in your mind of what this could look like. And now you may like not necessarily even realize that your heart was attached to whatever that vision looked like. And that's totally normal and that's totally okay. When that changes, because often it does, pretty much everyone has some sort of change that differs from like what they envisioned, right? When that happens, there's a certain grieving process that I always encourage people to jump into because like you're allowed to have a vision of like what you hoped and wanted. And when it's different, if we are able to allow ourselves to grieve, we're able to move through it a lot better, and we're able to get more of those positive emotions as well when we feel the negative ones.

SPEAKER_02

Okay. And realizing where we are, right? Like where we specifically are today can be helpful. Because I think a lot of people have this vision when they whether it's super articulate in their mind or not, they have a vision of being a mom. And there's there might be like harp music in the background and butterflies flying over here, right? It's all pretty positive in our own mind. Even if we haven't seen that in other people, we see the good moments when we're in public, right? We see each other's good moments sometimes. So it can be hard to be in the in the trenches of it, right? To um have, you know, you're wearing sweats for a few weeks and you're lucky to get a shower, and there's the the harps and the butterflies don't seem to be there nearly as much in the reality of things.

SPEAKER_01

So yeah, yeah. And I was thinking too, like with my birth experience, um it things didn't go the way that I anticipated. It was pretty different. I mean, I I envisioned going into labor the whole thing. I feel like pretty much everybody has this vision, right? Like, okay, what's it gonna be like? I need my bag packed, I'm gonna have to call my husband, right? Like I had that that vision that that was gonna be the thing because I mean, everyone in my family, that's what it was like for them too. Like all the women in my family have gone into labor. I have two older sisters, my mom, like everyone had had that experience. But for me, like I found out that my baby was breached, and and like we we tried the different things to try and move him, and and he didn't, and so we ended up doing a plan C section. And I had to grieve that I didn't get that experience, and part of what helped me was actually the procedure that we we did when we tried to move him. Um, that day I actually learned a lot about myself when things didn't go the way it was planned. I found myself like really emotional, but I was trying to hold it in, if that makes sense. Like, and I even know, like as a therapist, I mean, this is where this is why therapists need therapy sometimes, right? Like, I was holding my emotions in, like when the doctor was like, This isn't safe to do, like, we're gonna need to schedule a C section. I was like, I wanted to just ball, but I didn't. And I mean, I had this expectation that maybe I needed to placate everyone else in the room, right? There was probably hold it together for them. Yeah, there was probably like five or six nurses in there as well. So, like, there was a just like a lot of eyes on me too. And so I just like I don't know, you're it's also scary to cry in front of people that you have never strangers, yeah. Right. And so, like in that moment, I had a lot of emotion. Actually, like later that day, I was so exhausted, and I just was I realized later, like, oh, I held everything in and it's coming out now. And I mean, I'd been fasting all day too. Oh, yeah, for the procedure. Right. So there was a variety of reasons why like things were stressful leading up to that, but that day actually helped me prepare a lot better for birth because I realized, like, no, when I'm feeling something, I need to let it out. And I made a conscious choice after that that, like, okay, whatever happens from here on out, I need to cry when I need to cry. Yeah, like I need to just let it out no matter who's there. And and I did, I cried like right before we started the the C-section, and I think it helped me actually like feel a lot safer because I saw the response of my care team um around me, and it ended up being such a positive experience, just like the whole thing, just being able to feel cared for, and that vulnerability helped in that moment, and even though it was not what you were anticipating. Yeah, yeah. And I know that it's different for other people, not everyone is met with the kindness and care that they need to when they have those vulnerable moments, and and maybe I was lucky in that, but I do think that either way, I looking back, I would still want to make the same choice, even if I wasn't met in the same way, just because for me, that's what helps me move through things is just letting myself have the emotions and really feel them. Yeah, and that made it so that I was able to actually enjoy you know those moments that were coming right after.

SPEAKER_02

Right, right. Which I think can be so conflicting for people when um they're really sad about something and specifically about how their birth is going or will go or has gone, and then they're really happy about this baby, right? Like that's a strange place to be, to be sad and mourning something and to be happy and rejoicing. That's um kind of a strange shift to make too.

SPEAKER_01

Yeah, I like to teach people like how to use the scale of and for those moments like that. It's not my birth didn't go the way that I wanted, but I have this amazing baby. It's my birth didn't go the way that I wanted, and I have this amazing baby. So adding to it, right? Not to detracting. Yeah, because in English, when we say but, we immediately disregard the first half of the turn from it, yeah. Yes. And so when we use and it makes it easier for us to sit with those emotions that are that don't make sense together, but are both right?

Birth Trauma And Self Advocacy

SPEAKER_02

Okay, okay. That that makes perfect sense. So I'm I this brings me to another question, if that's okay. Like as you meet with people, um, do you see a theme coming up of unmet birth expectations? Like, how often, or maybe maybe we don't have a statistical number, but does that play into the postpartum experience as well and any kind of emotional challenges that might come up if people are disappointed or anything, or you know, there's birth trauma, and that can be physical, real trauma, it can be emotional. There's so many ways. And you touched on people have good experiences when they feel cared for. So if they don't feel cared for, don't feel heard, how often does that specific birth experience travel over into the postpartum emotional experience?

SPEAKER_01

Yeah, it definitely can translate into birth trauma. I think one thing that I often ask moms in kind of determining like, is this like something that bothers you or is this like birth trauma? Or maybe bothers you isn't the right word. Is this something that you're annoyed about, maybe versus like, is this birth trauma? Is it coming up for you in the present? Are you finding yourself now traveling back, right? Like they say with PTSD, you experience those flashbacks. That's kind of what we're looking for. Are you experiencing some of those flashbacks of birth and having a hard time being present in the moment? That can be that can be one way of figuring out if you have any birth trauma that needs to be resolved. And from there, what I would tell people that are kind of like in that boat of like birth didn't go the way I wanted, like, do I have birth trauma? If you talk to someone within a couple of months of your birth and you're able to process that relatively quickly, that's why in a lot of different cultures, like we like there are different traditions of sharing your birth story. If you talk about it, your brain is more likely to be able to move through it and not get stuck on different pieces where it runs into PTSD territory.

SPEAKER_02

Interesting. I just met um recently, I met with a client, um, so a mom and a dad who had a birth a few years ago um of their first child, and it became a cesarean, which they think is was unnecessary. And it was interesting in meeting with them, I usually spend about an hour and a half to two hours with in an appointment. And this appointment lasted, I'm not even kidding you, four hours. And as we got talking with them, I'm like, wow, they have combined, like he and her have a lot of birth trauma around this unwarranted, probably I wasn't there, so I can't say, but a questionable C-section of how they were treated. Um, so it's pretty fascinating how we went back to that and revisited that and revisited that. So with their upcoming second birth, and same with you, right? Like next time, if you choose to have a second baby, um, when you approach that experience again, that can be interesting, right? Like that's what I'm finding with this couple, like they're approaching another delivery, which they're doing everything they can to change. Um, and I think it will be very different, but it's hard, they're having a hard time.

SPEAKER_01

Yeah, and it definitely like creates a lot more anxiety and a lot more emotions. And so I would say, like, create your support system in in that scenario, right? Which is probably why they hired Adula, right? Because they want help advocating for themselves. One thing that I see a lot with birth trauma is a lot of the times moms and like their partners will often feel like, but I didn't I didn't advocate for myself in the way that I wanted to. And sometimes there is maybe some judgment or shame that they hold over their heads of not speaking up, not saying how they actually felt, right? Now, let's go back to my birth experience where I was saying, like, I had this like internalized feeling that I needed to hold it together for my care team in that procedure before giving birth. Like, I know that that is not how that is not the best way to cope. Logically, I know that, but emotionally, I still did that for some reason, right? So I would tell people, you don't necessarily know how you're gonna respond to certain situations. We have to use compassion and just recognize that, yeah, maybe you wish things had been different. Let's use that as information going forward, right? Let's maybe not expect that you have to be the one doing all the advocating, right? That's why hiring a doula might be a good idea. Let's let's build different relationships and maybe get a different provider, right? Like there are different things that we can do to help you be better able to advocate for yourself the next time. And a lot of times that can be really healing for people having a more positive birth experience when they view maybe their past birth going wrong. As information instead of a moral failing, if that makes sense. Perfectly. That's great.

Planning For Postpartum Support

SPEAKER_02

I love that. I'm taking notes on the side. That's awesome. Information. I love that. Gaining information. Very cool. So how um shift gears a tiny bit maybe, um, like whether it's somebody let's say having a first baby, how can folks prepare for um what to expect in the perinatal period, but especially postpartum period? Um, I think some people are very surprised. Um, and some people anticipate it. Sometimes as a doula, I will have people say, as we prepare for labor and birth, which is a big deal, that's why they hire a doula, but they're really focused a lot on the postpartum period, which I am impressed with, honestly, because most people are they don't give that any thought, right? They're like, yeah, we're gonna prepare for this one calendar day that we have a baby. Um, and then they don't anticipate all the calendar days, the weeks and months afterwards. So, how can people prepare going in? What can they do?

SPEAKER_01

Yeah, I think I mean, this depends on the person. And this is why, like Blinken's statement before I jump into make specific recommendations. This is why it might be helpful to work with someone in the perinatal field just to be able to make a plan characterized for your own needs, right? So, like before, like prior to. Okay. Yeah, yeah. And just thinking about like in past situations of your life before, what has your life been like when you've been low on sleep? Like, what do you tend to need nutritionally? Like, what tends to help you feel like a person? Right? These are some of the things that I would look at with someone that is preparing to give birth. And if they have had other kids before, like what maybe went well last time, what didn't go well last time. So blanket statement, it's gonna be individual for everybody, but maybe I'll share a few overarching things that I have seen to be helpful. Um building your support system, whatever that can look like. If you have a supportive partner, I mean that's ideal, but often you are gonna need support outside of just that person. Both of you are going to be spent and exhausted. Right. So, who else can you ask? And that's there's a lot of strain on marriages when you have a baby. This is research-based. We know it pretty much happens to most people. So anticipate that and it does, it shifts the relationship, right? There's gonna be some changes. Totally. And when you're low on sleep, you are gonna say things that you don't mean, right? And so everybody needs a little bit of extra kindness in that period. And when you are low on sleep, who else can you ask for help? So that's what I would say maybe is the number one thing. Who else can support you aside from your partner and maybe having a network of people? Um, a lot of the times when you have a baby, people will reach out to you and they will say, like, let me know what I can do. Tell them something. Take them up on it. And maybe if there are people that can't necessarily come to your house and and restock the diapers and whatnot, if they can't do any of those logistical things, maybe if they are willing to just like let you vent, right? Like figuring out if people can help you in maybe an emotional way, if it's not a physical way. Maybe they want to send you a DoorDash gift card, right? Like there are different ways that people can support you, um, even if they can't physically.

SPEAKER_02

So there's like inner circle support, right? Like this would be partner, yes, friends, family that are very close to you, and then there's outer outer circle support too, or professional support, right?

SPEAKER_01

Right. And I think another thing that probably would fall under support that is hard for a lot of moms is medication as well. A lot of the times moms will come in my first appointment. I will ask them like their thoughts and feelings on medications. And I mean, this is partially because like the people in my office often have anxiety as well, right? There's a lot of fear around trying medications, and if you're breastfeeding as well, there's a lot of fear of like, oh, is this gonna affect my baby? A lot of the times, like I will say, like, we're gonna go at your own pace. If you are not wanting to talk about medication as at all, I'm not going to push that. But medication is another tool, and it can be very helpful for some people when they're in the trenches, and it's something to consider, right? And so I will say, like, with medication, maybe other things too, of like if there's something you're anxious about, but it might help. This goes back to the idea of like, let's try it. Try it and see. Yeah, yeah. Let's try it for a few months. Could be a very effective tool. Mm-hmm. Okay, yes, because there can be a lot of anxiety around all the different choices that you have to make of like, how's this gonna affect my baby? Like you may not have to be.

SPEAKER_02

Having a great mom can help affect your baby, right? A mom who's on her more on her A game.

SPEAKER_01

So you may not know the right answer, and actually it's okay if you don't make the right answer, make the right choice the first time. And I think that's where a lot of moms get stuck of like, I'm failing at this. Well, this is your first time doing this, right? Even if you've had multiple kids, this is your first time caring for this baby, right? Like, this is a new ball game, even if you have done it before, right?

SPEAKER_02

Yeah, true, true. I just had a client a couple months ago, she had her fourth baby, and she was a champion breastfeeder with her first three babies, just like phenomenal. And her fourth baby was just losing weight, like wasn't able to nurse. And I met with her several times, and um, and she really struggled with that difference. She's like, I've done this before, like I don't, and she's she's not a full supply of milk and probably won't be for some kind of reason. Um, and we've looked at different solutions, but the biggest, the hardest part of that was settling into this baby is different and this situation is a little bit different. So yeah, that can be super hard, especially when you think you know it's you know what to expect and that you've got it down.

SPEAKER_01

So very interesting. Yeah, and that sounds like maybe another part of the process of like something new to grieve, right? Yeah. And it's normal for there to be things that come up that you didn't anticipate that you don't want, but there's some grieving involved in that.

SPEAKER_03

Yeah.

SPEAKER_01

And I think that's one thing that like we really are learning now as a society. Like, motherhood brings on like this new identity shift, and with that, there's always grieving.

SPEAKER_02

Yeah, yeah. It's true, it changes how you view yourself, right? And how you interact with the world, with your profession, your job. Like, yeah, it's a huge identity shift in a good way, it can be in a good way, but yeah, you lose some parts of yourself and gain new ones, which can always be interesting. So interesting.

SPEAKER_01

Yeah, yeah. And it it's amazing that like she had breastfed three different babies, right? That's so impressive. It's still impressive that she is is doing her best at this fourth baby, right? Yeah, yeah. Just because maybe that label doesn't necessarily apply with this situation per se, it doesn't necessarily negate the other effort that she did before, right?

SPEAKER_02

Right.

SPEAKER_01

That's true.

SPEAKER_02

And we've tried to look at some positive things with that, right? Like, oh, other people can feed your baby too. Like when he's he's bottle feeding a little bit more, um, that means maybe you get longer sleep stretches at night. You can take turns a little bit differently. So she's trying to look at the positive things as well. So I want to go back to medications a little bit. Um, as a lactation consultant, we get asked quite often, um, you know, what can I take? And and and it's surprising how many medications are safe with breastfeeding or and or the benefits um of breastfeeding with that medication outray the risks, right? And so um I I hope I hope that people taking medication or considering it look a little more deeply, and that would be, and I'm surprised the sources you have to look at, like um you'd think people who you thought might know might not. So, for instance, like if we have a mom who it needs gallbladder surgery at two months postpartum, right? Unexpected surgery, she's gonna be put under general anesthesia. A lot of times we see the that that medical team, which has nothing to do with obstetrics at all, saying don't breastfeed for you know this period of time, pump and dump and stuff. And actually it's fine, right? So um finding real sources to look at for that. Um, and until we're like at chemotherapy type medications, that's when we're like, yeah, though these are more dangerous than helpful. We stay away from those um big drugs. So I hope that people considering medication really get some accurate information on safety of medication during breastfeeding, because many, many things are quite safe during breastfeeding.

SPEAKER_01

Yeah, and what I always tell clients is like you want to maybe go to someone that's more specialized in situations like that to ask, like, okay, do we have information on this? Maybe we don't have research, but maybe we can make some educated guesses, right?

Postpartum Anxiety Intrusive Thoughts OCD

SPEAKER_02

There are there are some research, yeah, there are resources out there, um, publications that are very up to date that look at medications every couple of years and see as much as they can study human milk and human babies, right? We're not gonna we're not gonna do a lot of research on that, but we do have case studies and stuff. So yeah. Okay, you said something, Sadie, that brought another question for me. Um postpartum anxiety. So some people, in my experience, people are kind of surprised that they're dealing with that and might not even realize they're dealing with that. Talk to us a little bit about what postpartum anxiety might look like in behavior, what it might feel like internally, but and um because, like you said, this is what prompted me, we want to do things perfectly, right? There's a lot riding on this little human. Um, it took a lot to get them here, and it's a big deal, it's a big job. People are pretty invested in this role, obviously. So talk to us a little bit about postpartum anxiety.

SPEAKER_01

Yeah, I think maybe what comes at a shock for a lot of moms is when they start, if they start experiencing intrusive thoughts. Um, I would say that's probably like our biggest flag that you are experiencing some anxiety. Um, maybe some other things to look for is are you overdoing it, overfunctioning in coping with the stress? Are you genuinely feeling like you can't rest until XYZ is done? Right?

SPEAKER_02

Like so it's hard to let the things go, the baseboards, right? Like clean dusting the baseboards every day. Like it's when we can't let those go.

SPEAKER_01

Yeah, like baseline, if people are fed and clean, like safe, fed, yeah, that is what matters, right? And if your brain is really stuck on the fact that you didn't get the laundry done today and you're beating yourself up over it to where like there's a lot of shame going on, you're caught in this endless loop of all these different thoughts of all the things that you need to do. That might be a good indicator that this is anxiety. It isn't necessarily things that you have to be doing. A lot of the times intrusive thoughts can look like what if thoughts, or they can look like should thoughts. And maybe like all the different tasks falls under the should thoughts, like I should be getting the laundry done. I'm home all day, right? I should be making a meal every night for my family, right? Some of those shoulds can be massive weights, and a lot of the times that's when I will see a combination of anxiety and depression coming on too. Like then you feel this huge weight on your back of all these things that you can't do, and your motivation slips and your mood slips, it's gonna spiral down, right? Anxiety and depression impact each other. So a lot of the times um I won't necessarily see people in my office until they are also experiencing depression, which is hard because if they had skills for that anxiety, maybe it wouldn't get to a point where they're depressed and struggling with functioning.

SPEAKER_02

So and I imagine um if there's postpartum anxiety, and I've seen it when I work with families, other people they live with are gonna sense that as well. Like there's expectations placed on other people, like partners or other children. Um, that can be kind of big, and maybe we're overdoing it with others as well. Is that a fair statement to say?

SPEAKER_01

Totally, totally, yeah. And maybe your brain has this chatter going on. This is something to look for of specific tasks needing to be done a certain way, right? It can be easy to look at your partner and say, like, the baby doesn't like being held like that. Like, you're not gonna, you're not gonna get them to sleep that way, right? And to a certain degree, yes, if you are like the full-time caregiver, yeah, you want to give a couple tips every now and then to other people that are joining in on caregiving here and there, right? To a certain extent, it's normal to give people tips. But if you feel like it is really hard for you to let other people do things their own way, that's where we want to say, yeah, this might be anxiety territory, might even be OCD territory, be a lot of perenatal OCD as well. Um, and all things needing to be in a specific way, having different rules and different intrusive thoughts around that as well.

SPEAKER_02

That's true. I've seen that um be a huge strain on relationships when um the the partner cannot do anything right, and that's and they're trying, right? They're trying to support and help. Right. Um, and that brings me to another uh just example, like a poignant one in my mind that comes up. There's a family I was helping with postpartum care, and they had twins, and she was really struggling with um depression, anxiety, and reached out for some postpartum help. And when I arrived at her house, I spent several months there actually, um I realized part of the problem, like uh she had twin boys and you know, other kids as well. And if the baby spit up as they do, if milk dribbled out onto their jammies, just like a little, you know, dime-sized spot, we we had to do all the laundry. Like they that clothes, those clothes come off. We put fresh new clothes on. Um, we were changing sheets every couple days, like um, and and not even sheets that you know, in my opinion, need to be changed. Um, but I was seeing her like, oh my gosh, I can see, I can see your struggle here, um, which was part of the OCD part, I think, which is hard to hard to hang on to those expectations when you have children and babies and right letting things go.

SPEAKER_01

Yeah, and what's happening underneath the surface, from what I would imagine with that example and things that I've heard from other people, is it feels like there's some sort of consequence attached to that. Like if they wear those jammies that are dirty, like there's some sort of consequence that comes after the what if. What if they wear these? And maybe there is something along those lines of like my baby's gonna get sick if they're not cleaned the instant that they dirty a diaper, right? Like if you are feeling like there are some intense consequences coming like right over your shoulder all the time, that might be a good indicator that it's OCD. And it's not necessarily a lot of people think OCD is like, oh, well, people are compulsively cleaning all the time. That's not necessarily all OCD is. A lot of the times, OCD is just people have really intense, intrusive thoughts about the people that they love, right? And when you're in motherhood in the trenches of it, like you have unlocked these brand new fears about very vulnerable little humans. And so, of course, your brain is gonna get louder about some of those intense fears, and it feels scarier because yeah, like if someone coughs near your baby, like, yeah, there are germs in the air. Yeah, you're gonna protect your baby. Yeah. Right. So if there's some of those intense fears and you feel like you are drowning in some of those fears of not just like things needing to be done a certain way, but also the fear behind why, that might be a good indicator that it's OCD as well.

History Risk Window Of Tolerance

SPEAKER_02

Very interesting. Um, brings me to another question. If folks have a history or propensity of anxiety, depression, or OCD thoughts or behaviors before they give birth, are they more likely to, is that more likely to follow them into the perinatal period and postpartum period? Like, is there a way to anticipate this a little bit for some people?

SPEAKER_01

Yeah, I I think to some degree, definitely, right? Because you are going to be pushed in different ways that you can't control, if that makes sense. Yeah. I like to tell people about the window of tolerance. Um, it's this idea that like you have this window of prime functioning. And let's say maybe instead of a window, since people are listening, you can't look at a visual per se. Let's let's say it's like driving on the road. If you're on a pretty wide road and you are veering to the left and the right a little bit, and there's no cars coming, and it's a wide road, you're gonna be fine.

SPEAKER_03

Yeah, right?

SPEAKER_01

Like you're gonna be able to handle some disturbances in that, but when you are in the perenatal period, that road is so much narrower in a sense. And so any amount of veering, like you're gonna experience some symptoms when you get off the road, so to say, right?

SPEAKER_02

It's any kind of or close to getting off the road.

SPEAKER_01

Yeah, it's gonna be so much harder to function mentally and emotionally in that when the size of your road just shifts, if that makes sense.

SPEAKER_02

Yeah, absolutely. And it might be rainy and dark on your road too, with a narrow road, right?

SPEAKER_01

Like literally all the things, like most sleep, like having issues, you're recovering from childbirth, yeah. Yeah, like any other, like I don't know, any other pieces that maybe go and right, like maybe you're dealing with a C-section, you didn't anticipate that, right? Like there's a lot of different things that can go on that can maybe like change the size of your road and make it hard for you to stay on track and keep going in the way that you want to. So true.

SPEAKER_02

And I think something that um gosh, I'm gonna say this statement and I'm gonna save it really quickly. But um, something that impresses me about women is here we put them through this experience of childbirth. We don't do it, like it just nature does it, right? But you go through this experience of, well, pregnancy before that, right? Nine months, that's a long time. And then we put women, we don't do it, but they go through an experience of labor, childbirth, um, which is hugely physical and emotional. And then we hand them this little baby, right? That they have to care for. Um, and their their body's different and their body is tired. It goes into this huge project tired with a pretty demanding client, this little baby. We can't like turn them off, you know, and and delay care. Um, that sounds like a train wreck ready to happen. However, what I'm impressed with that I see, I don't know, thousands of times, people do it, right? Like women, women specifically, families, partners, like society really, we have the capacity to do that. So while it's a lot to ask, people are capable and can be empowered and supported along the way, correct? Okay, because it sounds like a lot.

SPEAKER_01

To some degree, and what I will say to that is like, yeah, you probably can do it by yourself, but that doesn't mean you have to. Yeah, there's help. Right. And a lot of the times, one of the intrusive thoughts that I hear sometimes this isn't in the should frame, maybe it's is should territory, is I should be able to handle this by myself. We view anxiety, likes to make us view anxiety as our capacity is what we can accomplish while sacrificing every part of ourselves. And it as women, we are taught that we are supposed to sacrifice ourselves, especially in this time period, right? But actually, our capacity is what we can give without sacrificing our physical, mental, and emotional health. Right. And so if that looks like letting your baby cry for a minute because you need to set him down to go to the bathroom, please do so, right? Yeah, like there are there are small ways that you you can let go of that mentality and care for yourself while you're taking care of a baby, right? And for everything else, like like I said before, we want to widen that support network because it doesn't mean you have to do it by yourself.

SPEAKER_02

Yeah, there is help to be had out there, and part of it is um having realistic expectations, right? It's okay if you don't take a shower today, you can do it tomorrow. So, okay, okay, yeah, cool, yeah.

Finding The Right Perinatal Therapist

SPEAKER_01

That's there's always a creative way to figure out how to care for yourself if you're stuck. Maybe ask other people to do the brain work and do some problem solving for you, right? Maybe it's so hard for you to figure out how to shower and make that happen. Maybe we use some baby wipes, right? Like maybe there are other things that we can do that you just haven't thought of as solutions yet. Right. Like that's often why it can be helpful to work with a therapist because sometimes them just being an outsider looking in, they can be like, Have you already tried this? And maybe you can just be like, Wait, no, I haven't. Haven't thought of that. Yeah, yeah. Right. So that's why it's helpful having other people in your circle just to be able to be a sounding board sometimes, too. Very cool, very cool.

SPEAKER_02

So So um if you Sadie, if you were to, if you were to create a a pathway or a service for every person, every person having a baby, what would you wish for them, like as far as taking care of this part of themselves at this time of life, if you could give a little package deal to, you know, like here's what everyone needs, what would you in general say?

SPEAKER_01

I feel like for me in particular, like definitely help with meals and help with sleep. No, I feel like I can kind of do the night by myself.

SPEAKER_02

My baby is relatively good at sleeping, but during the day And your baby's three months old, that helps too, that your baby's older, right? Yes. Yes.

SPEAKER_01

Having the ability to like nap during the day at some point is a game changer for me. Um, so I feel like that would be a big thing. Someone to just come and take the baby and put the baby to sleep and do all that, so I can maybe have like an hour or two before the next feed to just get a little bit more sleep. Perfect meals and sleep, I would say.

SPEAKER_02

It's good priority. Like you said, if everybody's fed and clean and happy and safe, then that's our good baseline. So very cool. Right. Yeah. And then tell me, I have people often ask me um about um a mental health therapist for the perinatal period. What what could what can people know about that? What's a good resource for that? How do they select and fill out a good one? So a good one for them.

SPEAKER_01

Yeah. Yeah. I will say in finding a therapist, like it's totally normal for you to shop around with that. Like, finding a good therapist is like finding a friend. You don't have to be friends with everybody that you meet. And so, like, you can you can vibe check different therapists, and like I totally get that I'm not gonna be everybody's cup of tea. Like, I'm not gonna be offended about that because like match, maybe our personalities don't necessarily vibe. So I would say that bottom line: if you try someone, you're like, that was horrible never again, don't write off therapy entirely. It might just be we need to figure out a different fit personality-wise, too. So I would say that before anything else. But as for like finding someone in particular for the perinatal period, um, in Utah, I work for Serenity, Recovery, and Wellness. Um, we are one of the um, probably one of the first um organizations that started specializing in perinatal mental health here in Utah. Um, we do have some clinicians that are licensed in other states that could maybe see you through telehealth, but um there is also Postpartum Support International, and there's a database on there as well. You can search for therapists on there. You can also look for a therapist that is um that has PMHC after their name, which stands for Parinatal Mental Health Counselor. So those are a couple of ways you could go about it. Um, you could also look on Psychology Today. Psychology Today is kind of cool because it has a lot of different filters that you can plug in. Um, like you can even insert like this is my insurance type, and it will show you only therapists that take your insurance. Um, and you can establish different preferences there too. Like you can maybe say, I want this type of treatment. Help me find someone with that. I want someone in person, or I just want telehealth, right? So psychology today is another good resource where you can have like some different filters and try and find someone a bit more specific to maybe what would best meet your needs.

SPEAKER_02

Very cool. I love that. So some people might want to look at this beforehand, right? But just it's good to know, have in your back pocket that there's um there's a pathway to go down if if you need that kind of if you need that support and that help.

SPEAKER_01

Yeah, totally.

unknown

Okay.

SPEAKER_01

There's a whole like wide network. It is getting a lot more um, I should say, normalized for a lot of therapists to have more experience in perinatal mental health. It wasn't that way five, 10 years ago.

SPEAKER_02

Oh, I totally have seen that because it used to be like we had one or two that would even touch that.

SPEAKER_01

Yeah. When I was in school, I didn't necessarily know that I could go into this. I was I was drawn to the moms that were on my caseload when I was in grad school. And I was like, this would be really cool, but I didn't necessarily know how to get into it. And yeah, it's it's the network is building with a lot more parenatal support, which is really exciting. And it is cool.

When To Get Help And Closing

SPEAKER_02

We need it, we absolutely need it. That's cool. Yeah, very cool. Um, Sadie, as we wrap up this episode, any last little nuggets you want to leave with us or um points you want to touch on before you wrap up this episode?

SPEAKER_01

Yeah, I think in summary, maybe like the biggest thing that I would say is like, yes, if you're having a difficulty functioning, it's it's probably time to get support. But also if you're just having a hard time enjoying things, that is probably another good indicator. Just because you can grin and bear it doesn't necessarily mean that you have to be doing it that way. Right. I see a lot of moms come into my office that are like, man, I didn't know that I had O with my other kids, and now I'm enjoying this baby so much better because I got help. Right. So I think that can be so hard for a lot of moms to reach out at that point. But I would definitely say if you were in that boat of like, I'm having a hard time enjoying this the way that I want to, that might be another good thing to look for. And your joy, kind of your joy radar, right? Like is it can you feel your joy? Right. Because I mean, any of the mental health conditions can are gonna impact your ability to enjoy the experience in the ways that you want to. So absolutely.

SPEAKER_02

And who doesn't want to enjoy, right? That's that's hopefully a big part of paradise.

SPEAKER_01

You're having the baby in the first place, right? Yeah, we hope so, right?

SPEAKER_02

Yeah, so perfect, perfect, cool. Well, Sadie, thanks for being with us here today. It's been great to learn from you. Um, I've I've gotten a lot of new tips and and learned a lot of new things from you. So I sure appreciate that.

SPEAKER_01

Yeah, of course. It's been a pleasure. And thanks for all you do with the birthing process. Oh, thank you. It's it's fun.

SPEAKER_02

So I love it. Um, we'll wrap up this episode of the Ordinary Doolo podcast. As always, want to make sure that you reach out to someone. This kind of fits our topic of the day. I always kind of wrap up our episodes, um, urging people to make a human connection, whether in person or virtual, any other way. Please connect with the human today. We need each other. We're important to each other. Hope you have a good one, and we'll see you next time.

SPEAKER_00

Thank you for listening to the Ordinary Doula Podcast with Angie Rosier, hosted by Birth Learning. Episode credits will be in the show notes. Tune in next time as we continue to explore the many aspects of giving birth.