The Truth About | Normalizing Miscarriage, Menopause and So Much More with Dr. Jessica Zucker

In this deeply moving and empowering episode, we're joined by Dr. Jessica Zucker, the trailblazing psychologist and author behind the “I Had a Miscarriage” movement. Jessica shares the deeply personal story that reshaped her career and advocacy: experiencing a miscarriage at 16 weeks, alone at home, and the aftermath that followed. What began as a clinical interest became an urgent call to action as she confronted the silence, stigma, and shame surrounding pregnancy loss.

Together, we dive into the evolution of cultural conversations around miscarriage, the emotional aftermath of loss, and the healing that comes from speaking the truth. Jessica also opens up about her journey through breast cancer, how grief stays in our bones, and why it’s time to normalize every phase of womanhood—from menstruation to menopause. If you’ve ever felt alone in your experience, this episode is a reminder that you're not.

Check out her new book
Jessica Zucker, Ph.D.
Order NORMALIZE IT

Dr. Jessica Zucker’s book: I Had a Miscarriage: A Memoir, a Movement 

Follow Jessica on Instagram: @ihadamiscarriage

KEYWORDS
miscarriage awareness, pregnancy loss support, women's reproductive health, maternal mental health, Dr. Jessica Zucker, #IHadAMiscarriage movement, grief after miscarriage, trauma and healing, perinatal anxiety, perimenopause and motherhood, breaking cultural taboos, pregnancy after loss, miscarriage therapy, reproductive trauma, parenting after loss, women's health advocacy, Normalize It book, community in motherhood, healing through storytelling, female mental health

Chapters

• 0:00 Introducing Dr. Jessica Zucker
• 11:13 Creating a Movement from Personal Trauma
• 19:33 The Silence Around Pregnancy Loss
• 28:16 Measuring Pain and Finding Support
• 36:10 Normalizing Women's Health Issues
• 44:03 Motherhood and Life After Loss

Transcript

Speaker 1: 0:28

In today's episode, we're joined by Dr Jessica Zucker, who is a Los Angeles-based psychologist who specializes in women's reproductive and maternal mental health.

Speaker 1: 0:37

With over 15 years of clinical experience and a background in public health, she's become a leading voice in the movement to de-stigmatize pregnancy loss and really so many women's issues. After experiencing her own miscarriage at 16 weeks, she launched the viral I had a Miscarriage campaign, using her personal story to spark global conversations around grief, shame and healing around pregnancy loss. She's the author of I had a Miscarriage a memoir, a movement, and in her latest book, which is available to order now Normalize it she expands the conversation to include the full spectrum of women's health, all the way from menstruation to menopause. In today's conversation, we dive into Jessica's personal story of miscarriage and how it catalyzed a professional and cultural movement. We talk about the emotional aftermath of pregnancy loss, the challenges of pregnancy after trauma and the silence that still surrounds so many aspects of women's health that still surround so many aspects of women's health. Jessica opens up about writing her books confronting breast cancer, which she did after her loss, and why she's so passionate about normalizing the full arc of womanhood we hope you enjoy.

Speaker 2: 1:44

I'm a Los Angeles-based psychologist. I specialize in women's reproductive and maternal mental health and have done so for about over 15 years at this point. And I come to the field of psychology with a background in public health, and when I pursued my PhD my vision was to marry my background in that with the clinical one-on-one work, and I at the time had just kind of a theoretical interest in all of it, a passion for women's health and women's mental health, and had not lived through anything specific that informed my interest until I did so. I was 16 weeks into my second pregnancy when I had a miscarriage. When I was home by myself, I was instructed by phone by my OBGYN how to cut the umbilical cord and I promptly began to hemorrhage. My husband, meanwhile, was darting through LA traffic to get home to me and my doctor, of course, instructed me to bring the fetus in a bag to her office for testing, which we did, and then finally made it to her office and I was hemorrhaging so intensely that it was recommended that I undergo an unmedicated DNC. So all of that to say that the trauma and the drama and this sort of documentary-like feel of this experience changed the course of my life, professionally and personally.

Speaker 2: 3:10

So all the while I had been sitting across from women talking about the pain and the isolation and the alienation that follows pregnancy and infant loss and life after. But until I went through it firsthand, I really could only understand it from afar, from books and from conferences and from consultations. And I turned to the research and unfortunately, the research shows that a majority of women are blaming themselves and feeling a sense of shame and self-blame and a sense of body failure in the aftermath of loss. And I was sort of outraged. I mean, I had been hearing it clinically, but when I saw that there had, you know, been research that was done that was finding this as well, I was sort of like culture, has this all wrong? Like, what are we doing? Yeah, and so it was in 2014 that I launched the.

Speaker 2: 4:05

I had a Miscarriage campaign with my first New York Times piece on October 15th, which is Pregnancy and Infant Loss Awareness Day, and basically I had a calligrapher make a sign for me that said hashtag.

Speaker 2: 4:17

I had a miscarriage and I didn't have my face in it because I wanted anybody around the world to be able to envision holding the sign themselves, and it was a risk. I was making myself incredibly vulnerable, but I felt like it was an important risk, a calculated risk and, honestly, a way to model for other people, even other clinicians, because you know, I could have been, I guess, judged or rejected or ostracized by people in my field thinking you know, why is she sharing the contents of her life, you know, in such a public way? But I knew that the payoff would be worth it because really, the piece was a compassionate urging for people around the world to think about if you haven't shared your pregnancy loss, why, if you feel a sense of shame, what's that about? If you've come from a family where things are super quiet, what does that feel like for you? So, essentially, just asking people to do a lot of deep reflecting and also inviting them to think about letting go of some of those feelings that maybe they've held onto for years.

Speaker 3: 5:30

Yeah, and I think what people who are listening to this might not realize is just how far we've come in those 10 years, 11 years since you started this work. Yeah, how much more stigmatized talking about things like pregnancy loss was then. I've been in this space writing about fertility and parenting for about 10 years now and the shift has been incredible, and it's thanks in part to people like you who have done this work and who have come out and who have.

Speaker 3: 5:56

I remember when I talked to you, it was very bold to just say outright I had a miscarriage and I know I had a miscarriage in 2017. And even then, when I would tell people what happened, they would just kind of their first reaction was to kind of like bristle, because they were shocked. Before they were sympathetic and I think there's still some of that now. Right, but it's changed.

Speaker 2: 6:21

I hope so. I mean, I don't get it. I don't get it. And I ended up doing tons of writing on various topics related to pregnancy and infant loss, because people aren't talking about marriage after loss and sex after loss, and pregnancy after pregnancy loss and mothering after loss. I mean, there's just so many aspects of our lives that are tied up in this, and so that led to my first book project, which that book is called. I had a Miscarriage, a Memoir Movement, and that came out in March of 2021. And then, unfortunately, two weeks after that book came out, I was diagnosed with breast cancer, so that sort of took me off the miscarriage map for a while and a handful of months, though.

Speaker 2: 7:10

After that, this mental health publishing company came to me and asked me to write a book, and so we are here to talk about normalizing it. So this book is called Normalize it, upending the Silent Stigma and Shame that Shape Women's Lives, and, in a way, this is an expansion it's not really an expansion of my first book, because the first book was a memoir meets manifesto, but this book appeals to anyone between the ages of 20 and end of life. Why this shines a light on all of the milestones in women's lives, everything from menstruation through menopause and then some. So it gets into grief, it gets into pregnancy, it gets into pregnancy loss, it gets into the trials and tribulations of motherhood. It gets into all of the reasons why we need to finally, once and for all, be done with silence and replace it with storytelling.

Speaker 1: 8:16

We definitely agree with that. That's why we're here After you. I didn't know that it was called a miscarriage. If it was that far along, like having to cut an umbilical cord is like super traumatic, like I mean, you saw, I had a visceral reaction. Yes, why do they call that a miscarriage? And like, at what point does it turn into a stillbirth?

Speaker 2: 8:34

Thank you for asking that and, to be honest, I well, 20 weeks is when they consider it a stillbirth, but I had a lot of feelings about this afterward because I was not offered anything.

Speaker 2: 8:49

So if you have a stillbirth, you are offered locks of hair, footprints, handprints other things like this, like a memory box, like it may be even ashes if you decide to cremate, like it may be even a burial plot. I wasn't offered anything, so I think your question is a really poignant one. We don't talk enough about that, right? There's no delineation between, you know, first trimester loss, second trimester loss, third trimester loss. Yeah, I do think that it's incredibly disheartening that there are not more ways that culture sort of recognizes the intensity of all of it, but that we don't have ways that we memorialize. And so are there, you know, concrete ways that we can have some not just memory in here, but memory in our lives of what we lived through and what we lost.

Speaker 1: 9:50

Yeah, so you had this loss and then you had breast cancer. Did you end up having children after all of that?

Speaker 2: 9:57

Oh, okay, so you don't know, I should have started with that.

Speaker 1: 10:00

Okay, so take welcome to the podcast.

Speaker 2: 10:02

Jessica.

Speaker 1: 10:04

Dr Zucker.

Speaker 2: 10:05

I felt like maybe you knew a bunch of my background and I should have maybe told you more. Okay, take this out. Okay. So let me. Let me start with a clear answer here. Also, people listening won't know. Okay, take this out. Okay. So let me start with a clear answer here.

Speaker 1: 10:15

Also people listening, won't know.

Speaker 2: 10:17

Okay, well, yes. So when I had my miscarriage, my son was three, and at the time I actually was, I had mixed feelings about the idea of growing our family. My husband is a twin, so he always knew he wanted multiple children too, ideally, and I was of the mindset let's take it one at a time, not because I necessarily thought I wanted one child, but I just wanted to see what it was like. I mean, how do we know what motherhood is going to be like for us until we're in it? And I was already so passionate about my career, I just wanted to be sure that I had the time and energy for all of it. And then I finally wrapped my mind around having a second and I had my miscarriage 16 weeks along. And then, as a result of that, in a way, I was sort of like I am not going down on this note, there is absolutely no way that I am stopping now, like this can't be the end of my story. So my doctor recommended that we wait three cycles, for physical reasons and psychological reasons, of course. So three months, that's it. And then I got pregnant and my daughter is 11. So my son is 16 and my daughter is 11. So it's interesting because traumas happen and culture wants to be quiet about it, but we live with it in our bodies and our minds for the rest of time, and so here we are talking about this.

Speaker 2: 11:46

I have these thriving children, but it doesn't mean that it didn't fully impact the course of my life, and so that's a lot of why I'm on this soapbox even though I never thought I'd get on one about society needing to change and to really sort of integrate conversations about something that is a normative outcome of pregnancy. I mean, miscarriage is not a disease. It's not going anywhere. There is no cure. So what do we do? Isn't it one in four or something like that? Pregnancies result in loss? Yeah, and then I think it's one in seven people struggle with infertility and it's, I think, in 160 and in stillbirth.

Speaker 1: 12:27

Whoa, yeah and that. So, yeah, no-transcript. If anything happens like you, should know it, because otherwise you're not showing up at work for your friends, for all these different things, and so people are upset and then they're not supporting you Right? Did you all tell people about your pregnancies before you had your loss for both of you? Imagine Jessica, you did. Okay, zara, you didn't.

Speaker 3: 13:15

I didn't and I really don't like that 12-week rule Culturally. I just think it adds so much shame and stigma. I don't really know why I didn't. I got pregnant after over a year of trying so I think it felt delicate to me just because of that history. And then when I got pregnant with my twins I waited until like 20 weeks to really tell people Wow, I mean, I knew like my family knew immediately. My parents, my in-laws, people like that knew at four weeks or whatever, and close friends knew at around 12 weeks, but I didn't like really open it up at work and things until 20. I have a knew at around 12 weeks but I didn't like really open it up at work and things until 20.

Speaker 2: 13:56

I have a lot of respect for that. Like I think that everybody should do what they want to do. Like, what I don't feel comfortable with is the medical community sort of telling us to wait to share, and, and I understand it, a majority of miscarriages do happen within the first trimester, and so I think that is why they've come up with this 12-week rule. But in my mind it translates into don't share your good news in case it becomes bad news, because if it does become bad news, then you don't have to share your bad news and then you can just try again and wait to share when it's good news again. And for me there is a real sort of miss there, because don't we want to share our joy?

Speaker 1: 14:40

And our sadness and our pain. You want to share it all.

Speaker 2: 14:45

Yeah, exactly. And so it feels like a setup for women to not have the support they need and to feel kind of far flung if they are going through a loss or are in anguish over whatever it is that they're experiencing with a pregnancy loss, and so I think we should turn this on its head. I think we should tell people when you want to tell you know the safe people in your life and if it becomes bad news, hopefully those are the people you're going to be leaning on anyway.

Speaker 1: 15:20

Did you have people to lean on? You were 16 weeks right when you had your loss. Did you have a? What was your support system like?

Speaker 2: 15:29

Yeah, so I, being a psychologist, I'm a big believer in therapy and so I was already in therapy. So she was my first official call after my texts and calls to local people, but I left her a message so that we could schedule something quickly. And yeah, I have a lot of close friends in Los Angeles and friends from, I mean basically, who are all over the country from years in graduate school, living in different places, and my dad is somebody that I've felt very close to over the years. He's a physician himself. So I think that's part of why, throughout the course of my life, honestly, I've turned to him through so many moments of like when I was starting to get breasts like, talking to him he's always kind of been my anchor and my role model in that way, and when I wasn't getting my period I turned to him. So he was very much a stronghold for me during the pregnancy loss, for sure.

Speaker 2: 16:32

And I'm not one to opt for a support group and I have mixed feelings about support groups in the aftermath of pregnancy loss. I think it can be quite triggering for people. I think it can also. I've heard so much in the context of my office of people comparing and contrasting their pain, and that is a big no-no. I feel like that can be so disruptive, and so that can be a lot of where the shame comes in, because if somebody who has a miscarriage, let's say at six weeks, is sitting next to somebody who had one at 16 weeks, and is sitting next to somebody who had one at 16 weeks and is sitting next to somebody who had one at 36 weeks, the pain hierarchy or like the Olympics, which are to whose pain is worse, can be a tragedy in itself, I think.

Speaker 2: 17:24

And so if people wanna go to support groups in the aftermath of loss, I think they need to go per trimester so that they're sitting around people who can understand and they can feel like they can have as much pain and as much space to delve into it as they need.

Speaker 3: 17:43

I felt a lot of that because I had a pretty early loss and I felt a lot of that. You know, people would ask me how far along were you when you had your loss, and I would kind of not even want to say it because it was pretty early. It was nine weeks, so we had had a little bit of time to sit with the possibility of having a baby. But I just kind of felt like how can I own this experience?

Speaker 3: 18:05

when there are people who have had it so much later in pregnancy and stories like yours. But I agree with you. I just think this hierarchy of pain it's just not productive.

Speaker 2: 18:16

It's not, and it's also. It's so unfair because your loss is your loss. Nine weeks is significant to another person, six weeks it doesn't. The amount of weeks does not necessarily coincide with the pain level. So just because you're pregnant only six weeks, quote, unquote doesn't mean that you're not. Yeah, I just don't feel like number of weeks is the reason that we're allowed to feel this or that. I think we are all allowed to feel the pain and the anguish because it's our lives. I can think I'm hungry, but I can then look out the window and see a homeless person who's clearly hungrier, but it doesn't. It's all relative. Exactly, it doesn't mean that my hunger is any less because this person, you know, is obviously malnourished or needing a meal even more than I am, but it's. We can be in our pain and we should not have to feel like we have to prove it by the number of weeks.

Speaker 1: 19:29

Have either of you heard of this organization called the Dinner Party? They were big, I want to say like 10 years ago, and the yeah, it's like a grief group. Yeah, yeah, it's a grief group, but it's focused on young people who have lost parents. So I lost my mom when I was young and I remember I was forced to go to a grief group and I think I was the one causing some of that triggering for people. Now there were people in their 60s there who lost people.

Speaker 1: 19:57

It was always like they always thought my pain was bigger, which is really uncomfortable being on the other side of it. But so in this case, these are for all young people who have lost their parents, and it seems like we maybe need something like that for people like you mentioned, in different trimesters, based on their loss and because you have more in common with somebody who has lost at 16 weeks versus maybe five weeks. So that's something I've been thinking a lot about is like, how do we create these spaces for people who have more in common? Yeah, it is all hard, Wait.

Speaker 2: 20:29

So did you find that helpful, though, to go to that group? Now? I'm really interested? Absolutely not. Oh okay, Wait. So did you find that helpful, though, to go to that group? Now, I'm really absolutely not. Oh okay, no, no, no. So it was like your story was triggering for other people around you, which is just yeah, ceiling.

Speaker 1: 20:42

Yeah, well, in my case and we can cut this out to like in my case I was so young.

Speaker 2: 20:46

I was now.

Speaker 1: 20:48

No, it's okay, I'm so uncomfortable. No, we can keep it in.

Speaker 2: 20:52

So podcast is called.

Speaker 1: 20:53

Do you Want to Trim? I know I can talk about motherhood, but it is one of those things when you lose. So my mom passed breast cancer when I was eight and I wouldn't talk about it, and so my stepdad was. We lived in a commune and we lived in a very like hippie environment where everyone you like I was forced to talk but I wouldn't speak about it. And so my stepdad tried to make me go to therapy and finally they were like she won't talk, so we need to put her in something else. And so they put me in group therapy and I had to go once a week and it was so uncomfortable and I think I think there's something about healing.

Speaker 1: 21:25

People have to do it on their own terms and talk about it when they want to talk about it and you can't force. And for anyone listening who has maybe a kid, who has lost a parent or somebody important in their life and I know this is probably the same for, like, adoption or foster they have that loss. You can't force it, they have to come around to it. Otherwise then I think it causes people and you probably know more about this, jessica, than I do it causes people to shut down about it, of course, and then not like get through. I'm a big fan of therapy too, but yeah, it's one of those things where you're like I do think the comparison to grief because it's like, oh well, I'm so sorry. It's like we all have things that we've gone through that are painful.

Speaker 2: 22:04

Yes, Thank you so much for sharing that. I'm so sorry that you went through that. That is okay.

Speaker 1: 22:10

Thank you, so you also talk about in this book, right? You talk about all the stages of womanhood, which is something that Zara and I've been talking a lot about, because we're moms now. But the next phase I'm in my forties, it's going to be perimenopause, and then the next phase is menopause. And what has that been like? And why does nobody talk about it.

Speaker 2: 22:29

I mean, we are having, I guess, what people are calling like a menopause moment. So there are amazing books coming out right now. But why now? And will it do enough, right? So I agree with you. I mean so perimenopause. I'm not a medical doctor, but what I've read is that it, can you know, last up to 10 years.

Speaker 2: 22:49

So, how are we not being prepared for this? Just like why are we not, in sex ed, being prepared for the potential of having struggles getting pregnant or staying pregnant, yeah, Okay. So I think that it's incumbent upon society. We need a total zeitgeist shift if we want girls and women and boys and men to be informed about natural things that are happening in our lives. And so that's why this book Normalize it.

Speaker 2: 23:18

It's about can we normalize talking about the hard things? Can we normalize talking about the things that are actually normative? And so, yes, the book takes on all of these various topics, because perimenopause is no joke. We start to feel potentially like a different version of ourselves, and if maybe our friends are tag-matted or maybe there are some great memes online about it, but it would be helpful if this was integrated into conversations more broadly, because then we wouldn't feel so blindsided and we wouldn't feel like, oh, maybe I shouldn't talk about the fact that you know I'm having hot flashes or that you know my body's changing or you know all the things that come along with it.

Speaker 3: 24:02

I just think our cohort of women have opened so many doors and started so many conversations and I think that's really what we're seeing right. We, 10 years ago, we opened the door to talk about fertility and pregnancy loss and we talked about the realities of postpartum next, and then we talked about the realities of motherhood and perinatal mood disorders, and now that many of us are at that phase of life where we're experiencing perimenopause, we are bringing that conversation to the forefront, and then menopause and aging will follow, will follow. And you know all these conversations that I think we don't give women aged I don't know 35 to 40 something, 50 ish we don't give us enough credit for doing this.

Speaker 2: 24:48

I know it's like we have to brave it on our own and then we have to chart a new path, and then we have to be the ones to pull out a megaphone and start talking about it, and then we hopefully change culture for our daughters, our sons. But like, wouldn't it be nice if we could all just do it, all just do it so that it's done and we don't have to worry about walking on eggshells anymore?

Speaker 1: 25:13

Yeah, it is interesting because but it's almost like everything every phase that a woman goes through in life, from everything is diminished. It's like, let's not talk about it. Period's not a big deal, this isn't a big deal. Pregnancy is not a big deal. It's like every C-section is not a big deal. Birth is so not a big deal. Everyone does it. All these things are diminished. It's almost like, huh, maybe there's something to that. Well, it's interesting because I couldn't agree more.

Speaker 2: 25:40

They're diminished and they're not seen as sexy.

Speaker 1: 25:44

So when you bleed.

Speaker 2: 25:46

It's not sexy. If you complain about your symptoms, that's not cool, that's not sexy. Being pregnant is seen as somewhat sexy, but then you're expected to have a flat stomach within 24 hours after giving birth and if you have birth trauma, you should just quote, unquote, get over it. And if you have postpartum issues, you should just exercise more, and I mean it's eat your vegetables is what my doctor told me.

Speaker 1: 26:14

Be grateful. Yeah, your doctor told you to eat more vegetables. She said eat more celery and if you lose weight then you'll feel better. And the best way to do that is eat celery. And I, like my doctor, this is not my OB. This is not my OB. My OB is like we gaslight women and I know there's something wrong but I can't tell you what's wrong. Is like we gaslight women and I know there's something wrong but I can't tell you what's wrong because your tests are fine. But I know you're tired and I know these things are happening and I'm gaslighting you and I'm not meaning to. So I love my OB Interesting Wow, I like that she even uses the word gaslighting.

Speaker 2: 26:47

That's really interesting. Yeah, she's great, how'd the celery?

Speaker 1: 26:50

work out for you Didn't eat it, didn't help. Had the celery workout for you Didn't eat it, didn't help.

Speaker 2: 26:55

I can't believe that was part of medical advice. Okay, that's troubling, yeah.

Speaker 3: 27:00

Yeah, it all goes back to the objectification of women's bodies, though. Right, it's because women's bodies, we just have to be pretty, you have to be sexy, you have to look good. Yeah, it doesn't actually matter how your body's functioning or how you're feeling in your body, because all that matters is the aesthetic value 100%, it's so true.

Speaker 2: 27:19

Yeah, they would prefer us to look good and be quiet about whatever it is that we're going through.

Speaker 1: 27:24

Yeah, yeah, podcasts and all these things now are like how we used to be. I don't know anything about villages in the back in the day, but it's almost like that was women's way of sharing information before, because people men would go away or whatever and women lived in community together and it feels like this is our way of trying to live in community with one another, because we don't really do that in real life anymore. Yeah, it feels like a cool opportunity.

Speaker 2: 27:50

I know, I like that idea. But you said you grew up on a commune. Did it feel then like you had a village when you were younger?

Speaker 1: 27:57

Yeah, yeah, I had a great village. It wasn't until we left the commune at 12 that I started getting in trouble and everything kind of went to hell because I had so many adults around me. That's why we moved there. We moved there when my mom got sick, but I always lived in villages before. So we lived in Hawaii on a property that her friend owned that had three homes, and so there were three families and then we lived in.

Speaker 1: 28:21

Where else did we live? That was community, I guess. And then we lived in a trailer at my stepdad's friend's house on a Christmas tree farm in Oregon, and so there was always community there. And then we lived in Ananda, which is an actual religious commune, and then I lived in ashrams in India, and so I was always in that community environment. And so for me in my motherhood journey that has been the biggest thing for me that I've tried to bring in and I've taught my husband about is because he was not raised like that, like his mom had their two sets of or three sets of friends and they were always over and they had their own mini community. But establishing that it's been very much like no you have to nurture it.

Speaker 1: 28:59

It's like a garden, totally so. Have you found it in motherhood? I have. Yeah, I I found it at 18 months. I started building it and then I would say I have a very strong community now, and now it's where my son's going into kindergarten and I was talking to Zara about this. I'm like I'm going to have to make new friends and how do you fit all those friendships Because we're very big on prioritizing my son's friends and becoming friends with the families that align with us and then it's like, okay, then you have to add more people, or you get to I should say, we get to add more people in and then it's like how do we navigate those Lego pieces of fitting more families in, which is kind of exciting? But I have a question for both of you. After you had pregnancy loss and then you each were pregnant afterwards, what were your pregnancies like? How did that feel, and were you anxious all the time or were you able to kind of be present?

Speaker 3: 29:48

I was anxious all the time. I mean, for me what helped was just having a lot more surveillance In my second pregnancy. My second pregnancy was an IUI pregnancy, so I was on progesterone, I was on, I had monitoring, I think, every week. In the beginning I just needed a lot of reassurance, I think, and then I found it. And then the end of my pregnancy was very, very complicated and so I was always worried about stillbirth. I had cholestasis, which I talked about on an episode that I recorded as a guest on the podcast.

Speaker 1: 30:22

Can you remind everyone what that is?

Speaker 3: 30:24

Yes, cholestasis is. I don't want to misspeak on it at all, but it's basically a liver issue that can present in pregnancy and the main symptom is having very itchy hands, like the palms of your hands get itchy. I also had a condition called PUP, which causes extreme itchiness, but more on your belly, so you were itchy, I was itchy, I was like I would. I was telling my husband I'm like a walking birth control ad Cause I would just like what week in your pregnancy.

Speaker 2: 30:56

Did this start, though, though that you had the cholestasis?

Speaker 3: 30:59

So the pup started at about 32 weeks and again I shared this on the episode that I recorded. But I told a male OB at my practice that I was experiencing a lot of itchiness and he was like well, your belly is getting big, so that's probably why your skin is just stretching.

Speaker 1: 31:18

Go put some lotion on. Did he say go put some like?

Speaker 3: 31:21

He didn't say that, he didn't even give me that much.

Speaker 2: 31:25

You just rub the celery and then it'll all be okay.

Speaker 3: 31:28

A lot of water in there, yeah. But then I went back in and they were like, well, this looks like pup, but we'll test you for cholestasis too. And it turns out that I just had both. But from that point on I was just incredibly scared of having a stillbirth and they moved my delivery date up to 37 weeks, because that's sort of the recommendation based on the risk of preterm birth versus the risk of stillbirth For twins. You mean, I was going to deliver at 38 weeks actually, and then the cholestasis pushed it up another week and then I had preeclampsia, which pushed it up one more week, so I delivered at 36 weeks.

Speaker 1: 32:07

Okay, that's crazy, and Jessica what Everybody's healthy. Yes.

Speaker 3: 32:12

Healthy little six-year-olds.

Speaker 2: 32:14

That sounds pretty intense, though I'm sure you were scared out of your mind. Yeah, I don't think I took a deep breath until my daughter was born. Through that whole pregnancy I was terrified. I think after we got the results back that she was healthy, I did sort of exhale maybe halfway and then she was born and my son came out screaming and my daughter came out quiet and that scared the living hell out of me. And my daughter even knows this video really well because I've shown it to her just to, so she can see herself as a newborn. But the nurse had taken her to clean her off and I say is everything okay? Because she's still not emoting. And the nurse says in the most beautiful way she's like she's fine, she's just looking around and my daughter even imitates her perfectly because she's watched the video enough. But that's when I realized and this is in my first book that the worry wasn't going to go away.

Speaker 2: 33:26

Just because, she was now earthside and healthy.

Speaker 3: 33:30

That was the first thing I said after I delivered too. I said is he okay, Really? Because my son came out and didn't really make a noise either.

Speaker 1: 33:38

My son also didn't make a noise.

Speaker 3: 33:40

That's so funny because everyone tells you they cry and that's how you know they're okay.

Speaker 2: 33:44

I thought they all come out screaming. That's the thing, yeah, interesting, yeah. So that is scary to have that quiet, even though in a way it's peaceful, but it's certainly.

Speaker 2: 33:56

Is she grieving? Yeah, so I continued to be nervous and I realized that I was having a lot of anxiety after she was born because of all the grief I had been through and hadn't really had a chance to thoroughly process. Hadn't really had a chance to thoroughly process even though I was in therapy during my pregnancy and you know talking so much about the loss and the fears and stuff, but still I think there was a lot of grief and concern in my bones.

Speaker 1: 34:24

Basically, yeah, I didn't have pregnancy loss, but I will say I had my first deep breath after having my son. I swear it was at 12 months, when he turned a year old. I was like, ok, we made it. Now I think, now we, I think we can keep him alive from here on out, like I think we got this. I don't know if either of you had that happen on the one year.

Speaker 3: 34:44

Yeah, I mean, there is such a fragility in that first year that I can understand that.

Speaker 2: 34:49

Yeah, I think I don't know how old my daughter turned when I felt like she was going to be okay, or that I was going to be okay, or that all of us would be okay. I don't know how old she was, but I think, yeah, it progressively got better. My anxiety progressively got like palpably different as she was able to do some more stuff on her own and I hadn't felt that way with my son. I wasn't interested about like life and death with him, to be honest. But I think, because of what I had been through, I was just so aware of, like you said, the fragility of life and how easily things can go awry.

Speaker 1: 35:31

Were you still counseling people at the time, right? Were you still counseling people at the time? Oh, yes, yeah, okay. So I'm really curious about that. What somebody who's counseling people who has gone through something traumatic in your life? How do you show up?

Speaker 2: 35:43

Yes, I'm going to send you all my books after this.

Speaker 1: 35:46

Okay, perfect.

Speaker 2: 35:48

Yeah. So I admit in the first book that I went back to work very quickly after my pregnancy loss and the reason for it was because I didn't know what else to do. I mean, I felt like I don't know. I just felt like I did not want my patients to be worried about me. That was number one. So and I also felt like what am I going to do? Like lay in bed, like what is that going to do, you know?

Speaker 2: 36:16

Sort of alone, thinking about this all day long, like that just didn't seem productive or helpful or healthy to me at the time. I mean and I like admitting this because it shows the fallibility of therapists it's like I just couldn't. I didn't have the clarity that I needed and I think, because I work for myself, it's not like I had HR to turn to. I didn't have anybody to turn to to say what do I do here? Should I take two weeks? Should I take four weeks? I mean, I have patients who are able to take months to recover and because I didn't know and because my patients are going through this very thing, I was worried to email them that something had gone wrong and then sort of not show up for a while. So I went back the following Monday. Oh my gosh, I know, yeah, that's fast, I know. I thank you for that reaction because it's just, it's true, it's just like crazy.

Speaker 1: 37:19

I just you're probably still in shock. So it's like when you're like not really processing it and you're like let's just go back to normal.

Speaker 2: 37:25

Exactly and like, and that's our system.

Speaker 3: 37:28

Right and I try to get you know. There's no leaves.

Speaker 2: 37:31

Yeah, Well, that, oh, I thought you meant. Actually our physical system is like let's just go, go go.

Speaker 1: 37:36

But you're right.

Speaker 2: 37:37

Also, our healthcare system doesn't give us time to grieve. But I think I just I didn't know. I didn't know, I didn't know there was no sort of roadmap, there was no role model for this. I didn't have time to kind of like think through what would be best for me. I just was thinking what would be best for my patients and thought that I would be okay, I didn't know what lay ahead. I mean, how can we with trauma? We don't know how to process these things until it unfolds.

Speaker 1: 38:09

So were you in there? You mentioned you were in therapy, so how did you get through it? Like, I know, you went back to work and all that, but how did you get through that? And did your patients act differently with you? Well, yeah, I mean.

Speaker 2: 38:20

So some of my patients were, of course, very upset for me, but I think, felt a lot more connected to me and felt like, oh, you understand Other people, though I think it's scared, and one even said something like if this can happen to you, that means it can happen to me. So a couple people left, which is true it is. But it's also magical thinking, because it's like it's acting as if, or it's thinking as if, pregnancy loss is somehow contagious.

Speaker 2: 38:55

And it just isn't None of these things are, but understandably so, a couple of people left. I think it was too intense and it's difficult, because I'm the kind of therapist who thinks that by not answering certain questions, it can be incredibly shaming for the patient, and that's precisely what I don't want to do. It can be incredibly shaming for the patient, and that's precisely what I don't want to do. However, of course, therapists need to have boundaries and protect their patients from certain elements of their lives, but in that moment there wasn't a lot that I could say to soften the blow. I mean, it was what it was. I mean they saw how big I was.

Speaker 2: 39:31

I'm a small framed person and so it was very obvious. When I was pregnant, and especially at 16 weeks, I'd looked like full on and I couldn't get around answering their questions directly, nor did I want to. But I mean I, it's like I, I just I. It was very tricky because I wanted to protect them, but I could. I wasn't going to tell them something that wasn't true, you know. So if they said so, oh, you showed up at your doctor, you know, last week, and there was no heartbeat and I was like, no, that's not how it happened for me. So what happened?

Speaker 3: 40:07

You know it's like.

Speaker 2: 40:08

I want to know, but it's like are you sure you want?

Speaker 2: 40:11

to know this because you're trying to get pregnant right now, and I don't want this lodged into your mind, into your psyche, into your soul, that this is even something that's possible, because the truth is, over these 15 years, I've never heard a story like this. I haven't so well. Actually, somebody on Instagram reached out just yesterday, and so no, there are, of course, where it happens in the context of their home, but for the most part, miscarriage is found out through bleeding and or no heartbeat.

Speaker 1: 40:44

Yeah, that's how I thought they were always found out.

Speaker 3: 40:46

That's another thing people don't realize is there are so many presentations and so many experiences. And have heard of Ashley Spivey. She was a contestant on the.

Speaker 1: 40:57

Bachelor a long time ago.

Speaker 3: 40:59

She's been really open about. She's had a stillbirth and she's had a few losses and I think she's going to come on and chat with us sometime. But she actually shared a picture of her jeans with blood on them and I interviewed her after that and I just said, you know, this is, we don't see, we don't see what a miscarriage looks like. Ever in our culture we hear oh, I had a miscarriage, but nobody actually knows how that happens. And I remember when I had mine I had one friend who kind of looked at me and she was like so how does that happen? Huh, when I said that I had a miscarriage and I, you know, kind of told her what happened to me, and she was like I had no idea. I, you know, I just didn't know, I didn't know how it all unfolded.

Speaker 2: 41:44

Interesting. But wait. So did she mean? Like what did she? She just didn't understand the sort of physical process of it, or she thought you had done something? No Okay. She didn't understand the sort of physical process of it or she thought you had done something no Okay.

Speaker 3: 41:55

She didn't understand the physical process.

Speaker 2: 41:57

Yeah, it's because you're right.

Speaker 3: 41:59

But of course there's some of that too right. People will actually ask you do you think you had too much coffee or did you what yeah?

Speaker 2: 42:07

Yeah.

Speaker 1: 42:21

I traveled at like five weeks pregnant in my first pregnancy, and someone was like well, you probably shouldn't have taken that trip. Go eat some celery. Yeah, man, that's wild. Yes, yes, it's a lack of education too, though, and it is like everything is some fault. Can't have a vaginal birth? Well, you should have tried harder, like all of these different things. You had a miscarriage, it's your fault, but I wonder too if it's like a sense of control. Well, she must have done something, so it won't happen to me, because I'm not going to do it. There you go.

Speaker 2: 42:40

That's, yes, perfectly put. I think we do that to ourselves as well. If we can find a thing that we did, a reason that this happened outside of ourselves, we can say, oh, and therefore next time I won't do it again, and it gives us a sense of control where there is none.

Speaker 1: 42:57

Yeah, it is that magical thinking you're saying too where it's like. It makes you think that you're in control, because, as Zara has said to me many times, motherhood, nothing is in your control, like with fertility, pregnancy, motherhood, our bodies. Yes, I had another question that just flew out of my head with the perimenopause. Oh, don't tell me that is that what that's like? Just wait, tell us about that, tell us what is but see what do we need to be on the yeah, tell us, I want to know?

Speaker 2: 43:28

well, actually, yeah, so if your mom had breast cancer, I don't know if you were able to find out if she had a gene, do you know?

Speaker 1: 43:37

I don't think she had a gene. I haven't gotten tested for BRCA because I am too nervous about the ACA being repealed and so I won't get it. 23andme says I don't, but I'm actually going in to talk to my doctor about getting an MRI because my aunt also had it and so on that same side so my whatever that thing that Olivia Munn talked about my score is high and so I talked to my OB, who I love, and so we're going to talk about it.

Speaker 2: 43:59

But yeah, what were you saying? What I was going to say about that is because, I mean, there's mixed research and again, I'm not a medical doctor but you might want to look into it but a lot of people in perimenopause or menopause start to think about estrogen or progesterone replacements. But if you're prone to breast cancer, it may just be something to think through with your doctor. So my breast cancer, I do have a gene. It's not a BRCA gene, it's called CHECK2. But my tumor was mostly estrogen and progesterone positive, so therefore it's not recommended for me to take estrogen, and so I have to take an estrogen blocker, which does not mean that I'm in menopause I still get my period at 52 years old but I have to take a medication that blocks the estrogen, so it feels like I don't have estrogen, which results in brain fog and so many other fun things.

Speaker 1: 45:00

Yeah, my injector told me that I just started seeing her, but she said that she takes testosterone shots. She's in peri, she's in menopause I think she's like 53 as well, but she takes testosterone shots to help her symptoms of menopause. I had never heard of this. I was like I don't know what this is, but now I'm going to have to go on an investigative hunt on what you said and all of these things. You were really young too when you had breast cancer. It sounds like.

Speaker 2: 45:28

So it was 2021. I was 47 when I was diagnosed.

Speaker 1: 45:33

Still pretty young.

Speaker 2: 45:34

I mean I felt like a baby, so it was the most shocking thing. There is this gene in our family, but I didn't know that because I'm the first woman in our family to have breast cancer. So it comes from my dad's side. So his brother has had melanoma and then. So my dad must have the check too. I have it, my sister luckily doesn't. My brother has it.

Speaker 1: 45:58

Oh, everyone got tested for it when you were.

Speaker 2: 46:02

Oh, that's great. Exactly so it's. I mean not my children, of course, but they're too young and you know people want to secure maybe life insurance and stuff beforehand, but totally yeah. So I mean it's just important information, you know, so that you can navigate this next phase with as much information as possible, I think.

Speaker 1: 46:23

Yeah, okay. So brain fog. Pay attention to brain fog.

Speaker 2: 46:26

That is what all right, I'm going to mark that.

Speaker 1: 46:28

Yeah, it's like what's the difference between motherhood and perimenopause Cause like?

Speaker 2: 46:35

that should be a book. That's what you're going to write. What's the difference between motherhood, perimenopause?

Speaker 3: 46:42

brain fog. Yeah, that's a good one, and they just call it mom brain right.

Speaker 1: 46:45

Yeah.

Speaker 3: 46:45

Exactly.

Speaker 1: 46:46

I wonder how much a mom brain is like sleep deprivation versus perimenopause, especially with so many of us having children later. Yeah, which, zara? I know you did not have a geriatric pregnancy, but I certainly did. I know we don't have a lot of time no-transcript. Whatever, whatever physical, psychological, could be a recommendation for a baby carrier, Like what advice do you wish? I guess it could be what advice, what do you wish? Someone would have told you before you became a mother or went through whatever part of this journey.

Speaker 2: 47:30

I wish someone would have simply said be gentle with yourself. This is a profound life change. You will question so many things that you do because there is no roadmap. But dig deep, know that other people are going through similar things and try to trust yourself and when you feel like you don't have the information or the answers or the support, find it. I think, unfortunately, we live in a culture that makes it seem like it's somehow weak to ask for help or to secure support, and I think we've got to be done with that. I think we need other people, we need community in order to feel like we can mother without a map.

Speaker 1: 48:18

I like that mother without a map. I haven't heard that.

Speaker 3: 48:22

And then, what is a part of motherhood that has brought you unexpected joy?

Speaker 2: 48:26

Well, that I could go on for days about, I guess I think right now just relishing watching my children thrive and knowing how sort of settled they seem within themselves. I mean I could go back and talk about, you know, when they had little feet and they were running around and the cuteness of them. But you know, my son is 16 and just watching him prepare for his AP world history exam yesterday it's like he is so committed and so he's a lover of learning and it's just beautiful and so unexpected to watch. And I still look at him like he's five years old and it makes me emotional to think that he'll be leaving the house in a couple of years. So there's so much joy in just seeing their joy and the fact that they're loving their lives and that they have such beautiful friendships and that they are, you know, thriving academically and mentally and physically.

Speaker 2: 49:31

It's a wonder, I don't know. I mean, I don't. I've been feeling so wistful lately. I feel like he's going to college in a flash and it's freaking me out. So I'm just trying to find a pause button. So if anybody can find a pause button on motherhood, I would love that, and I know that there were phases when I wish there was a fast forward button and there wasn't. But right now I'm in a phase where I wish we could pause, because my daughter's about to start middle school and my son you know. High school just goes by faster than I remember it going by for me.

Speaker 1: 50:08

So yeah, that's great to hear. I hear the years from. Is it five to 10 or like the golden years? Is that true? And I think so. I mean it sounds like they continue, like I mean your kids are older than that.

Speaker 2: 50:25

My son, you know, could push buttons and stuff.

Speaker 2: 50:27

My daughter never went through that really, and so it's kind of been golden with her all along, although yesterday we had a little tiff and she was like, oh, mom, you know, it's just hormones.

Speaker 2: 50:39

I mean, both me and my brother right now we're both having like hormonal change, and so you know, and you are too I wasn't going to add that to the conversation yeah, and I'm getting my period tomorrow and here we go. Yeah, and it was beautiful though her articulation, I could not even believe it and we were going to sleep and so I mean, if she could see my face, my reaction to, like, her ability to name it, it was wonderful and she's like, but you know, I don't mean it, it's like I'm just like getting frustrated in the moment. You know how much I love you and I'm like, wow, so, but yes, I mean I do think, yeah, five to 10, those are just phenomenal years because hopefully they've worked through the sort of, you know, self-regulation stuff and they're through the tantrums and the stuff that happens with other kids in preschool and hitting or whatever kids are doing, and yeah, you watch them flourish and it's wild.

Speaker 1: 51:34

We have taken up a lot of your time and we're so grateful to have you here and for you guys to connect again.