Postpartum Depression After Infertility And How To Cope with Brittany Marshall MSW, RSW

I sit down with registered social worker Brittany Marshall to name the real emotional cost of infertility and the grief that can follow people through miscarriage, IVF, pregnancy, and parenthood. We talk honestly about postpartum depression after infertility, what the symptoms can look like, and how support and therapy help without judgment. 

• grief as a normal response to infertility loss and disrupted timelines 
• disenfranchised grief and why silence and stigma make it worse 
• Brittany’s lived experience with male factor infertility, miscarriages, and IVF rituals 
• depression symptoms beyond sadness including anger, numbness, intrusive thoughts, and sleep changes 
• higher risk of postpartum depression after infertility and why it can feel confusing 
• “getting pregnant does not cure infertility” and the role of infertility trauma 
• what to look for in a therapist including fertility treatment literacy and grief training 
• partner support through communication, shared tasks, and realistic expectations 

Visit Brittany at brittanymarshalcounselling.ca or Instagram: BrittanyMarshallCounselling

Transcript

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Sabrina (00:44)
Hi, I'm Sabrina Duong, licensed clinical social worker. Welcome to my podcast, What Would Sabrina Say? Here today with me we have registered social worker in Ontario, Brittany Marshall. Thanks so much for joining me today, Brittany.

Brittany Marshall (00:56)
Thank you for having me. I'm excited to be here.

Sabrina (00:59)
Yes, and I'm excited to talk about this topic, which can be very hard for women still to this day, involving infertility and that journey and the symptoms of depression that women experience later on and struggle to navigate and cope with after. So just wondering if you could share more about yourself and your services.

Brittany Marshall (01:24)
Of course. So my name is Brittany Marshall. And also with my clinical background first. So I have been a social worker now for over a decade. I did my master's degree in social work from the University of Toronto. And for most of my career, I've been a generalist, working in hospitals and family health teams and post-secondary educations. and I feel like because of the nature of that work, you don't have much of a say in terms of your caseload and you're working with whatever the issues are that they are are presenting with. And over the years I've always had an interest in working with children and working with with parents. I actually wanted to be a teacher a while back before I kind of switched career paths. and then I navigated my own infertility journey, which made things really interesting kind of getting that exposure to kind of the personal side and the the patient side of it. And I feel like it really transformed a lot of my clinical work. So I was fortunate enough to have two children. They're two years apart. And so I did go back to work kind of in between and then went back to work full time after taking an extended maternity leave. And I think I lasted about two or three months. and my daughter said to me, you know, why are you always working, mommy? And that was just really, really eye-opening, where I was realizing that it was just impacting them. And I just didn't have a lot of work-life balance because I was doing my private practice evening and weekends while having the children while juggling a full-time job. And so I just decided to to take the leap into private practice. And so I absolutely love it. I've been doing lots of podcasts, going to different mom groups and different things like that. And then now I'm focusing a lot on infertility and working with people who are maybe starting their journey, maybe are coming towards the end of the journey, are just at various points throughout it, and then a lot of patients who I think are dealing with what we're going to be talking about today, which is that postpartum depression after going through infertility or parenting after infertility. and then I'm also a clinical supervisor. So I supervise like new grads and an interns. So lots of different things that I'm that I'm absolutely loving. I do in person in Pickering, Ontario, and then I also do phone or video across Ontario.

Sabrina (03:46)
The lived experience to understand what women are going through. I think you brought up a great point around how women are still expected to juggle or families, a lot of different things while grieving, right? Expecting to go back to work right away, expecting to still, be on, be present for, your children.

Brittany Marshall (03:58)
Yeah.

Sabrina (04:05)
while you're going through the the grieving process, what women experience and go through with that grieving maybe the difference between grief and depression, because it can look the same as well too.

Brittany Marshall (04:17)
For sure, for sure. And I think one of the first things is really important to understand is that grief doesn't just occur when when someone dies, right? I think that a lot of people will dismiss feelings, especially for people who are going through a miscarriage or going through infertility. I think even for people who haven't had a miscarriage, there is still this grieving, this loss of this idealized path to parenthood or the way in which you thought that it would pan out. And so grief can be part of depression, right? It's part of kind of that cycle of those stages that you can go through. But it is a normal experience. And I always tell my patients that you have to feel it in order to heal it. And so you can't just push past it. You can't just, you know, if we use the analogy of a light switch, right? Turn it off, turn it on, decide, okay, I'm gonna grieve today. Okay, I'm done.

Instead, it might be can we kind of turn down the volume a little bit, right? Can we learn skills and strategies to take back the control and and power over some of those really, really strong, strong emotions? But essentially we have to give ourselves to to feel how we're feeling because it's it's hard and it's tough and it's it's a lot to to go through. And then there's also this concept of like disenfranchised grief.

Which a lot of people in the infertility community will also deal with because it's something that's not always recognized. And so I think because of that, a lot of people are not sharing their experiences. They're not sharing what they're going through because there is some stigma or just people that I like to tell myself just have never been there. So they don't understand that they can't even fathom it to be able to to provide the the support. But I know for me it was definitely something that I had to work through. I was very fortunate that I had a really good support system, but I think it also came from me being vulnerable, from me being able to actually open up and explain what I was going through. that then resulted in other people opening up about some similar experiences and then getting a lot of the the support that that came through it. So I feel like we're going in the right direction, but there's still a lot of things that that can be changed and certainly can be improved upon as well.

Sabrina (06:28)
I think there's still a lot of shame it when you go through the journey or process and and also to greeting the idea of having a family, what it looks like, and then not happening, the expectations of you know what success looks like, what a family unit looks like, and so when that isn't happening to talk about it or to maybe continuously be asked, how's it going?

Brittany Marshall (06:30)
Yeah.

Sabrina (06:55)
that can be really hard, right? To to process it, especially when it's not talked about, or taboo. I think again with our society in grief. I've taken the grief educator program with David Kessler and he talks about how we hide it now, grief.

Brittany Marshall (06:57)
no.

Mm-hmm. Yeah.

Sabrina (07:13)
Or people want you to move on fast from it and just to be happy. or again, like I said, workplaces don't support it. or maybe people are scared to share about feeling that intense sadness, feeling those depression symptoms, the stigma or judgment that comes along with, and just wondering, if we're wanting to share any of your own experience or what support looks like or or what can be helpful.

Brittany Marshall (07:16)
Yes. Yes.

Yeah, yeah. I think in in my experience, my husband and I were both very clear that we wanted kids. I think it was one of the first questions that I asked him on like our first or second date, just because I was at that point in my life that I knew what I wanted. And, you know, if that wasn't something that he wanted, that was was totally okay. There just wouldn't have been a another date after that. and so, you know, we got married, we traveled. So the first, three, four years we're just kind of enjoying life and thought that once we made the decision that now was a good time that that it would happen. And so when it when it wasn't happening, I think there was a lot of, anger and frustration and guilt and shame. I had a few close friends that I told, we're trying and of course had a friend that were trying along the same time and of course it worked for her and and she got pregnant and and those pieces. So again there's that that grief that you go through even even with that, right? As happy as I was for for her for growing her family, there was this part of me that, was really sad for for myself because that was also what we wanted. And I think you envision, being at the same timeline and, you know, the kids being friends and and all those things as well and then for us it was actually male factor infertility. So I think that brought up a whole bunch of feelings too. initially I had a lot of anger that it was directed towards my husband that I had to work through in my own individual therapy, his own individual therapy, and then we did some couples therapy as well together. And, you know, eventually was able to get to a place of realizing that you know, it's it's a male issue, but it's also a female issue and it does take take two to tango and in our case, you know, there wasn't really much that he could do to necessarily prevent it. but it was more so we were on this path together and we needed to figure out a way a way to get through it. And so I think there was that kind of grieving process too with some, you know, that piece of it. But then also with like we had a few chemicals and miscarriages and things like that along t he way as well. So that was was really hard. I would write letters to my, I called them babies when they were the embryos. So I did find that piece to be really healing. I would light candles and memories. even for the embryos that like didn't take or didn't even make it when you were going through the retrieval process, you would get a call every couple of days from an embryologist and they would tell you.

You know how many embryos were there. And so we would light a candle because I think that's something that is also lost that people don't even realize it. But there's so, so much loss even when you're going through that that retrieval place because each stage they tell you that you're normally losing about 50%. so we would light candles, we would do a little prayer, we would well, I would write letters. I don't think my husband did. but that was something for me that that was healing. I think it also gave me that sense of control and power, like I was doing something, something about it. and then in terms of of support, I agree completely with what you said. I actually found out after going through it with my first, I found out that there was a few people that had been through it. And I remember thinking, I wish I knew this like two years ago.

I wish I knew this before I did the surgery. Like I wish I knew this at the time. And it was also partly on me. I wasn't open about it when I was going through it with my first. I was in a bunch of support groups and I had connections through there. I was also that person sitting in the fertility clinic that would ask the person in the waiting room to exchange phone numbers. that was just me. But I think it was the tail end of COVID too. So in terms of my immediate friends and stuff like that they didn't know. But, my parents knew, my my really close girlfriends knew. And although some of them had had kids and didn't necessarily get it, they still were very, you know, sympathetic and supportive. And I think were more those outlets, those distractions, those, okay, let's go have a fun time, let's go for coffee, like those things that didn't really revolve around around children, which I think was important.

Sabrina (11:43)
Right. So wanting the opportunity to have that outlet to feel vulnerable and grieve and with people who understand, but at the same time also not wanting to experience it every single day or part of your life and still finding ways to have that joy and and connect to people in in a more positive way.

Brittany Marshall (12:04)
Absolutely. And I think it taught me that, whatever our path looked like, even if it wasn't having biological children, we were open to other other avenues. And if it didn't work, we would still have a way to feel fulfilled, right? We would still get to experience joy. And I think that joy piece is something that's really important because a lot of the patients I work with, they're canceling plans. They're not doing things in anticipation that they could be pregnant, right? Next month or six months down the road. But I think it's so important to have those opportunities of joy to enjoy the life that we're living in now, even if it's not the ideal, even if it's not what you what you want, it's still about having those those moments. And if it's not joy, then even if it's just contentment, those pieces are also really, really important to just serve as those stepping stones moving forward.

Sabrina (12:51)
And with the grieving process, it's not anything to pathologize. It's something that you're going through in a loss, like you said, whether it's embryos and being notified or a miscarriage and through the process and the idea of what you had in in building a family versus what's happening in reality. and it's finding support groups, it's finding people to connect with.

I was wondering we could touch on maybe what depression looks like or when maybe further supports or help is is needed. I'm thinking when you're having difficulty with your day-to-day functioning, right? If there's a hard time getting out of bed, wanting to shower, wanting to see people, not wanting to eat consistently. Crying a lot.

Brittany Marshall (13:29)
Absolutely.

Yeah. So all those things that you

mentioned, right? Like depression is so much more than just the sadness piece, right? It can be the sadness, but with changes in appetite, changes in sleep, energy, concentration. especially if there are intense emotions, right? So r rage or anger, emotional numbness can be common, intrusive thoughts. Obviously, if there's anything in regards to like self-harm or suicidality things like that. crying, so crying really frequently, not being able to control it, not being able to to predict it, so not being able to to basically compartmentalize it, right? We know crying is is normal, it's actually healthy. We wanna be able to again feel it to heal it. but if you feel like it's happening

Too often. And again, you might need a therapist or a doctor to be able to decide kind of what is maybe too much. lack of interest in activities you once enjoyed, right? Difficulty sleeping, feeling like you're failing, the guilt, the hopelessness, right? I think that for a lot of people, they wait until they're in crisis to seek support. And so I think it's really important to.

To not wait, right? Even if you're feeling good, like even if you're not having any of those symptoms and you're feeling like I'm I'm managing things really, really well and I'm almost surprised. Sometimes that can be a good time to seek support too, because I'll often tell people, you know, when they're really struggling, that it makes sense. And I would actually be more concerned if it was the opposite, right? If they were coping, quote unquote, normally.

To me, that's more of a red flag that maybe they're in denial, right? Maybe they're not actually in tune with their emotions and things that are are going on. So absolutely seeking that that support can be really, really crucial to just prevent it, but also recognizing that when you go through something like infertility, you are at higher risk of developing postpartum depression after you have the baby. And you know, for a lot of us, it's like, okay, we don't care. We'll deal with that after. We just, we just want the baby, right? so I think just just being aware of of that piece. I know that was something I struggled with postpartum depression, especially after my first. And it really caught me off guard because even being a therapist, I was like, my goodness, what is wrong with me? This is all I've ever wanted.

Right. So I think it's really important to remember that having postpartum depression does not mean that you love your baby any less. It does not mean that you're not a good mom. It doesn't mean that you did not want it. you know, experiencing infertility unfortunately does not prevent these challenges from from happening. and remembering and knowing that these emotions can can coexist, right? So you can love your baby deeply and still struggle.

You can be grateful and overwhelmed. you can be a parent and a great parent and need support. So that can be something that can be really important to to remember and to be able to to hold those emotions at the same time.

Sabrina (16:42)
Right. For some women it might be confusing to feel still that intense sadness or maybe not feel that they would connect as much to their baby as they thought with it, finally happening for them and, you know, expecting the experience to look differently. but as you're saying, it's it can happen and and to receive that support, not using judgment on yourself or

Brittany Marshall (16:53)
Mm-hmm.

Mm-hmm.

Sabrina (17:08)
For having those different feelings at that time. And also too for women who might have experienced depression before starting the fertility process, right? Knowing that it's probably helpful to connect with a therapist through the journey. Well, regardless, but also too if you have depression symptoms or to you know, connect with your doctor or psychiatrist.

Brittany Marshall (17:30)
Absolutely.

Absolutely. And it can be something, you know, preventatively too, right? Even just having those those check-ins, I think, you know, for anyone and everyone, but especially people who are going through this this journey because it is it is so intense and going through infertility, going through IBF is one of those things that yes, it's it's a medical issue and there's the physical piece of it, but I think there's so much more in terms of the emotional, the mental, the spiritual, the psychological, the financial, right? It literally impacts everything single aspect of of your life. But getting pregnant does not cure infertility. And so I think that's something else that isn't talked about enough. I think there's, you know, focus on the infertility piece and then

And I know for me, I was like, okay, now I'm now I'm pregnant. So so now what? But that brought a whole bunch of other emotions and again expectations and fear because for a lot of us, we have had the miscarriages, we have had the chemical, we have gone through a lot of grieving and and loss. And so we are in this heightened state where that fear of miscarriage, that fear of something wrong, something you know, bad happening is really, really, heightened. And so it can be really hard for us to even enjoy the pregnancy, to even feel connected to to the baby. And then, once the baby is here, same thing with this similar piece with, the bonding, really feeling that that connection piece of it. So it is really important to be able to to get that support.

Throughout because going through infertility is is traumatic and you need someone to help you to process that infertility trauma piece and then adjust to whatever is next, right? Whether that's going to maybe surrogacy or donor or taking a break, right? Or adoption or child-free, not by choice, right? Or parenthood, whatever it looks like, just making sure that you're able to.

To work through all those emotions, all the grief, everything that that comes out through

Sabrina (19:35)
Right. And that's what I wanted to touch on next is just how a therapist could help and questions to ask a therapist or what to look for, right? So therapist could help through the whole journey and process. it's helpful to have a therapist that has an understanding or knowledge about the the journey, right? IVF treatments, other s other steps, surgeries,

Brittany Marshall (19:43)
Yeah.

Absolutely.

Sabrina (19:58)
helpful to have knowledge about grief so a therapist can help with the grieving process or loss, however that looks like. And then like you said, whatever part of the journey, if it it's, you know, ending up being childless, that was my part of my journey is going through that loss of infertility. Or for others, it is having a child and processing what that looks like as well too. So counseling can help with that. And I think other milestones are steps along the way.

Brittany Marshall (20:03)
Russia and

Mm. Yeah.

Yep, for sure. For sure.

Absolutely.

Sabrina (20:26)
Right.

So sometimes it's about if you, do end up having a child, the loss or grief of a child who you might have miscarried and they didn't get a chance to meet these milestones

Brittany Marshall (20:39)
And that's something I'm reminded about, like that loss that I talked about at the beginning, right? My friend, those kids are, a year or two older. And so birthday parties, right? As happy as I am, it's also that reminder of, our kid would have been this age, right? At this time, right? Like those milestone pieces, right? It's it's heavy. And so

Therapy can definitely help us to process any of these pieces, any of these emotions. It can help us with the adjustment to get to that place of acceptance. Acceptance doesn't mean that we like it. It doesn't mean that it's we're glad that it happened. It doesn't mean that it's even good, right? So I like to even reframe it and just use the word acknowledge, right? Just acknowledging that it is what it is. But in order to get there, we have to go through the sadness. We have to go through.

The shock, the denial, the anger, the bargaining, the guilt, the depression until we can finally get to that place of acknowledgement. So I think as therapists, that's really what we can help people to do is process that to find ways to move forward. It's not about moving on, it's not about any of those pieces. It's more about finding a way to move forward in a compassionate way. We can help to reduce anxiety.

navigate depression, learn healthy coping skills, healthy ways of of processing these emotions, but also ways of responding to ourselves. I work a lot with people on just self-compassion, right? How can we treat ourselves like we would a friend, right? Maybe it's a simple exercise, just like taking a breath and putting your hand on your heart, right? And just that soothing, soothing touch can be something that can be can be really, really powerful. and building on the inner strength, building on the resources, I tell all my infertility patients, the resiliency that these people have and what they go through to even just have a baby, because of course it's not a guarantee, is just so, so remarkable. And so I feel like we don't even realize it when we're in it because there's just so many appointments and you're juggling so many tasks and you're just on to the next thing. But sometimes just taking a moment to be like, holy crap, this is this is a lot, right? No wonder I'm feeling this way. And giving ourselves some credit to to just acknowledge that. And for a lot of people, they've been trying for years to concert to conceive, right? There's a lot of fertility treatments, losses. If they go through IBF, it's it's extremely, extremely evasive. And I think there's this pressure to to be happy, to juggle it, to hold it all together. but it's it's okay to to drop the ball, right? We're gonna drop the ball every once in a while. So how can we take those timeouts? How can we have those those resets to just slow down and really be be in the present moment?

Sabrina (23:29)
And you you brought up what a great point of what women experience and go through again, the the tests, the medical appointments, what you feel like you're putting your body through, right? With and and now we see more of a link and connection. It's in research of what women have felt all along, the connection between hormones and the relationship with your mental health and your health. And so that piece you're also going through and experiencing during that.

Brittany Marshall (23:51)
Mm.

Sabrina (23:57)
time as well. also wanted to touch on the process for the partner, whether it's same sex or, a a couple, any couple who's going through this journey, I think sometimes the person who's not carrying the child, I don't want to say they they get left out in the process, but

it seems to be it's a different experience or maybe needing to feel stronger for the other person. so it's really I think important like you said, you went through counseling couples counseling together, right? To be able to communicate and talk about grief. And it also looks different for people as well. Mm-hmm.

Brittany Marshall (24:19)
yeah.

Yeah.

Absolutely.

Absolutely. My husband and I just went on a podcast recently actually with our fertility clinic talking about the perspective not only of like male factor and fertility, but even just the IVF piece and what partners can do to support the the partner who is going through it. Because even though it takes two to tango, it is very much the female partner that is doing the appointments and the psycho monitoring and and all those those pieces of it too. So it can be very, very isolating. So I think the open communication piece is is certainly huge. I know I was in some support groups as well, which was just really helpful to connect with people that were in essentially the same boat as as you. But in terms of the partner, I think that, you know, my husband and I in our case were very different. I wear my heart on my sleeve.  He's an engineer by trade and he I feel like that's just how his brain is, right? He's a bit more robotic. He doesn't really show his his emotions. And so it was very hard to read him. It was very hard for me to kind of feel the support. because he was also someone who was just very optimistic. and I was very cautious, especially because of what we had been through. And I feel like I was maybe a bit more educated in terms of knowing the stats and knowing, that it wasn't, you know, a guarantee and you know the odds weren't always in our favor. but he was just so steady in terms of not even just knowing that IVF would work out, but more so he would just tell me, we're gonna become parents. Whatever it looks like, you're going to be a mom, right? Whether that's through adoption, surrogacy, whatever, it's it's going to happen. And so he was very, very steady in that belief piece. But he also allowed me to have my moments where I hated life, I hated the world, I hated God, I hated him, I hated just everything. And he gave me that space to to be able to process that and to to work through that. When it came to going through the the IVF piece, he drove me to every single appointment. So every single cycle monitoring which was daily he drove me to he gave me every single injection except for one, which I was determined to do by myself and I almost stabbed myself in my thumb because I was holding it the wrong way. I had like a vasal vagal response. So my blood pressure would drop. I would pass out. I would puke. It was it was not good. So there was a lot that I had to work through and for us the first time around was the tail end of COVID. So he wasn't even allowed into the clinic. So it was kind of a whole procedure I had to go through just to even get my blood work done. I had to lay down and essentially you know, he was always on video with me and just making sure that he was calming me down, he was listening when I needed to vent, processing that piece of it. But I think because he did the needles, he was kind of in charge of the medication. So he would have his timers, he would mix the menopaur, like he would do all those pieces of it. It really reduced not only just my mental load.

But I think it also gave him that sense of control. It gave him that sense of power where he felt like he was contributing. He felt like he was being helpful and he was. And so that was something that I really needed. He would also write notes. So he would put little sticky notes on the mirror, just with words of of affirmation. That's my love language. or even just encouragement, right? Of you can do this, we're gonna get through this when it came to.

the PIO. So those are injections that you have to do for about three months. and they go into your into your buttock. So it's quite quite painful because it's going into the muscle. And so we would have a whole ritual. He would play this special song. he would do the injection. Then I would have a heating pad, then he would massage it, then we would go for a walk to try to like mix up the oil. and he would always give me a chocolate or candy at the end of it. And so it kind of became our thing that I wasn't necessarily looking forward to the injection, but I was looking forward to just kind of that ritual that that we went through. So I think he was able to find a way to to use humor and to make light of it to make it something that was was fun and was symbolic. And even to this day, whenever we hear the song, we both we both laugh and it brings back those those memories. He also documented the whole journey. So I have a lot of like pictures and videos of those pieces of it. So anytime I question my own strength or resiliency, I'm reminded of that. And he makes sure that he is there to to remind me of it. So I think there's there's a lot of different ways that, you know, partners can can help to to feel involved, but to also be involved in terms of of being there. But it's also not about being their rock, right? I think when we first started dating, that was something that he really took on. I had gone through a traumatic brain injury and was kind of at a difficult point in my life. And so he did become this rock for me. And I think over time, I think expected himself to to be that. And so, you know, I had to explain to him that I don't need you to be the rock right now. I just need you to be kind of like that sounding board. Right. and so it wasn't all on him. It was on our community. It was on, you know, my friends, my family that support network.

But he had his moments too where he was upset, where he, you know, felt really bad. He felt like he had caused me this this pain and suffering and that there wasn't much that he could do apart from from giving his sample. and so that was something as well that we had to to work through in terms of just the expectations that we had of of each other, but also ways that I could support him and and vice versa as well.

Sabrina (30:11)
Right. it's it's a lot of pressures, for both partners. And I think both are trying to be strong for the other. And it's great to share about the rituals that you had created together to get through it and to try to make it as as comfortable as you could with with the situation that you were experiencing. so

Brittany Marshall (30:20)
Mm-hmm.

Sabrina (30:34)
Just wondering about where people can find you online for further information or support or seeing about the counseling that you do offer if you're on social media or on websites.

Brittany Marshall (30:45)
Absolutely.

Yeah, so both. So my website is Brittany Marshall Counseling.ca and then my Instagram is at Britney Marshall Counseling. I know they are kind of long, long names, but I'm sure you'll link it in the in the show notes as well.

Sabrina (31:01)
For sure, definitely. Well, thank you so much for your time today, Brittany, and your expertise and also for sharing your own story and and journey. I really appreciate you being able to share that with with our audience and I'm sure there's many women that can relate and also appreciate what you've talked about today. So thank you so much for being here.

Brittany Marshall (31:22)
Course, thank you for having me.