The Fourth Trimester and Matrescence with therapist Danielle Mizrahi, LCSW, PMH-C

This is a follow up episode on perinatal mental health with perinatal mental health therapist Danielle Mizrahi. In this episode, we discuss the huge life change becoming a mother is, called matrescence. We also talk about the fourth trimester, the first three months after a baby is born, from the perspective of mom's mental health.
A third episode from the perspective of a reproductive psychiatrist is coming soon!
As a dedicated therapist specializing in maternal mental health, I am passionate about providing compassionate, evidence-based care to help individuals navigate the complex emotional challenges that can arise during fertility treatments, pregnancy, and the postpartum period. My goal is to create a safe, supportive space where you can explore your feelings, build resilience, and find the strength to thrive during these significant life transitions. Together, we can work towards your mental well-being and overall quality of life. As a dedicated therapist specializing in maternal mental health, I am passionate about providing compassionate, evidence-based care to help individuals navigate the complex emotional challenges that can arise during fertility treatments, pregnancy, and the postpartum period. My goal is to create a safe, supportive space where you can explore your feelings, build resilience, and find the strength to thrive during these significant life transitions. Together, we can work towards your mental well-being and overall quality of life.

I specialize in providing support to women throughout all stages of their reproductive lifespan.
Take the first step to help. Call or Email Danielle Mizrahi now - (516) 259-6964
https://www.amazon.com/Matrescence-Childbirth-Motherhood-Lucy-Jones/dp/0593317319
Cover art by Charlotte Feldman
Please note that while I am a pediatrician, I am not your child's pediatrician. This podcast is for informational purposes only and does not constitute medical advice. For any medical concerns or decisions, please reach out to your child’s health care professional.

Transcript

0:06

Welcome to Kids Matter. I'm Dr. Elisa Minkin. As a pediatrician, mom and grandma, I understand how challenging it can be to help our kids grow into their best selves. We are so much more powerful together. Here I will be sharing the knowledge and wisdom of a wide range of people who understand and care deeply about children. I'm hoping for your input as well because kids really do matter. They are our future.

Alisa Minkin 0:37

Welcome back to Kids Matter. I'm excited today to have my first return guest. Danielle Mizrahi, a licensed clinical social worker and certified perinatal mental health professional is back for part two because our first talk rate expectations was really a broad overview of perinatal mental health. And Danielle is back today to talk about what we call the fourth trimester, and I'm also gonna introduce another term that I learned about. After I booked her just recently called Matress Essence, which is compared to adolescence, basically the birth of a mother. We're going to get back to both of those things in a few minutes. I just wanna give her bio again. Danielle specializes in maternal mental health offering evidence-based care for the complex transitions of fertility, pregnancy, and postpartum. She's dedicated to helping women build resilience and thrive through the reproductive journey. She can be reached at 5 1 6 2 5 9 6 9 6 4 and I'm going to link to her Psychology Today profile in the show notes. Danielle, welcome back to the show. Thank you so much for doing this with me again.

Danielle Mizrahi LCSW PMH-C 1:42

I'm so happy to be here again on this gorgeous day actually. So nice out.

Alisa Minkin 1:47

Yes, finally Spring is here. Thank God I.

Danielle Mizrahi LCSW PMH-C 1:49

Yes.

Alisa Minkin 1:51

So let's dive right into it,'cause I know your time is tight today. Let's talk about the fourth trimester. What is that and why is this such a challenging time for so many moms and dads?

Danielle Mizrahi LCSW PMH-C 2:02

Okay, so to begin? Where to begin. So the fourth trimester is exactly what it sounds, their pregnancy is broken up into three trimesters. For a second, third, each has its own milestones that's supposed to be reached. Each has its own series of and different things that happen. The four trimester is just a continuation of pregnancy because all of a sudden your body has this baby and it. Doesn't go back to normal. Your emotions, your hormones, everything doesn't go back to what it used to be. You're this new person and you have a baby. So the fourth trimester in my mind is actually a. It pays, it, it gives attention to the mother. Because here there's this baby and everyone's focusing on this baby and all the baby's needs, and baby has a million doctor's appointments for the first year of their life. What about the mom what does that mean for the baby if the mom is now going through this major change in her life?

Alisa Minkin 3:05

Such a great explanation and it segues perfectly into the word metres essence that I mentioned earlier.

Danielle Mizrahi LCSW PMH-C 3:10

Yeah.

Alisa Minkin 3:11

I love that you're pointing out that we just aren't focusing enough on the mother. In fact, I think a lot of our trends are to just put all the pressure on the mother and expectations without. The understanding and support. So this word was new to me. I just learned this Metres essence. What does it mean? Tell me more about it. Please

Danielle Mizrahi LCSW PMH-C 3:28

Yeah, so it's a great term that was established. So there, there was actually a book written called Mirus Essence by this author Lucy Jones. And there have been many studies that are now starting to come out about. Or reframing this period of life as more of a identity transformation. So if you think about adolescents, let's say, right? Adolescents and pre-adolescence, there's books, there's therapists. I was one who works a lot with adolescents. There's movies about adolescence and that transition period between becoming, moving from being a child to a teenager and a bridge to adulthood. And there's so much talk about identity changing and kids learning who they are. And the focus shifts from peers or from parents to peers, right? There's so much. If even if you're not in the field of psychology, everybody knows. What it was like or remembers what it's like to be a teenager, right? So then you fast forward to this huge transition in life for parents. And it's not just the mom, it's the dad too whoever's involved in taking care of this baby. And there's actually. They're starting to, it's starting to be studied that there's scientific evidence there's been brain scans. There's been a lot of research being done in terms of what actually happens to a woman's brain during pregnancy and after pregnancy. there's the term basically. It's so wonderful because it really just defines that this period in life really is such a change in identity for a woman who had a baby or a person who had a baby. You're not the same person before, right? Here you are. Your goals or your responsibilities are completely changed. There's the hormone shifts and there's that piece of course, which plays a huge role in all of this. But who you are before having a child. never going to be the same as who you are now. So I really appreciate that this term now exists and I'm hoping that it will continue to grow in terms of just common knowledge similar to adolescents because it really is a summary, but really defines really an era in a person's life.

Alisa Minkin 5:58

You are literally not the same person, right? Like your brain literally rewires. And I just wanna make the point that, again, this is a new field. But they're learning that even if you're not the biological parent of the child, even if you haven't carried them in your womb however you have this child's adoptive, surrogate, whatever you have changes too, right? We don't know the exact details, but you're still getting various hormonal changes too, and rewiring too. So I just wanna be inclusive and just say, there's so much more we need to learn about this. But you are literally not the same person, which is. Unbelievable. Like biological proof of that, right? We just, we don't, we underestimate this so tremendously and so I love that there's a term for it. So I wanna go through a lot of the issues that the new moms go through. And dads too, but we're gonna focus more on the moms. It just is what we're gonna do. Let's start with even before birth. So I'm gonna let you start talking about the things that you ask your new patients when they come to see you.

Danielle Mizrahi LCSW PMH-C 7:02

Yeah, so usually, so I, I work with postpartum, I work with patients who are struggling with fertility. So there's a whole of the issues that people are coming into my office with, but. I'm working with a new parent or a newly pregnant parent, generally there is like a rundown of I guess just. Questions that I have for them in terms of how they're feeling. And it really starts from day one of trying to have a baby or whether the pla pregnancy was planned or not. And that's actually a question that I ask because the fourth trimester isn't just all of a sudden, it just happens. There's a lot of events that lead up to it and that will shape how a family or a mom or a new parent feels, on many different levels as they progress into parenthood. So I usually start off asking, was the pregnancy a planned pregnancy? What does it mean? If it was a surprise, right? What does it mean if it was planned? What if it means if there was fertility issues before, right? How long were you trying to have a baby? All of these factors influence how a woman will feel once the baby is born. And also a lot of times when women experience fertility issues and there's so much focus on, I just need to get pregnant. I just need to get pregnant, I just need to have baby. I wanna have a baby so badly. There's so much of focus on that process. And then once the baby is born, it's okay, now what? I didn't even think this far in my book because it was so much of a dream of mine. It was so much of so something that just seemed like it was so far away and I was trying so hard and now I have this baby and it affects the way a mom, a new mom will feel a hundred percent. It's not just again, the second they have a baby. Everything changes. There's a lot that happens before. We could do a whole other. Lesson and lesson podcast on fertility and reproductive trauma and all of that, which we could touch a little bit on today, but let's just move forward and,

Alisa Minkin 9:05

Let's move forward because that is a whole huge other topic. I'm gonna really just have to keep bringing you back.

Danielle Mizrahi LCSW PMH-C 9:11

Yes. You're making,

Alisa Minkin 9:12

If you're calm, I'll have you.

Danielle Mizrahi LCSW PMH-C 9:13

knowledge here. I really appreciate it. Okay. Okay. So it's the, what was the, what were the leading factors up to the pregnancy? Yeah,

Alisa Minkin 9:23

So that's a good beginning. I wanna move on to the birth and I think a theme that may be running through here. That may be even more true for someone who's been through pregnancy loss, fertility challenges. Is this idea of perfection, right? Like you spend the nine months in great expectations as the title of our first talk of the Perfect right? Everything. And then the birth doesn't go the way you planned Birth trauma. I wanna hear yourself, tell me something about that please.

Danielle Mizrahi LCSW PMH-C 9:51

Okay. So yeah. So then I generally will move on to how was the pregnancy, right? Were there complications during the pregnancy?

Alisa Minkin 9:58

Sorry.

Danielle Mizrahi LCSW PMH-C 9:59

How is No, it's okay. It's, yeah. We're right where you wanna be. Where, were, how was a woman feeling? Were they sick in bed for the whole pregnancy? So many women are, right? How does that impact someone's mentality and mood during pregnancy and postpartum? And then to get to where you were going, Elisa, is how was the birth, right? Did the birth go? Was there birth plan that the mom wanted to follow? And I have such mixed feelings about. There's a, I don't know if it's a trend or there's, there's a part of preparation for birth. A lot of people will come up with a birth plan and they'll come up with how they want the birth to go and who they want to be there and drugs or no drugs, C-section, is that on the table or not? And then they get to the hospital and their baby has other plans or their, their labor and delivery just does not go according to plan. I feel like it sets up the mom for automatic failure, right? There's this idea that I can control everything that's going to happen, and if anyone who's ever been through birth, I've been through three, thank God nothing goes according to plan. So it's important to be able to advocate for yourself in the hospital, but also to keep an open mind that, things will happen and there's only so much you can control. So a lot of moms will come to me with this birth story and we'll go through it and it's traumatic. Even if it's, even if it's something small I can't say small, but even if it's like a shift in oh, I couldn't get my epidural in time, or I had to get an epidural because I was in so much pain and I thought I could handle it. There's so many things that happen that can lead to a woman feeling like I failed. I did not do this the way I wanted to. Things didn't go according to plan. So we talk a lot about the birth experience and then of course there's severe more severe complications. And there are women who really do experi experience like what I call BT Big T trauma, where their life was in danger or the life of the baby was in danger. And then. NICU moms, babies that have to go to the emergency room. There's so many different things that can happen during that experience. And for many women, it's the first time where they really feel like they don't have control over anything going on. And here you are. So then you get home from the hospital with this new baby again. And so much has happened already. Oh no, sorry.

Alisa Minkin 12:24

This is why we have editing.

Danielle Mizrahi LCSW PMH-C 12:26

Yes. You get home from the hospital and you've been through a war, really you're coming home and you've been through a war and you're expected to take care of this new baby and potentially other kids at home. in a way, as even I'm talking about, it's like the system of giving birth. It doesn't set you up on like the best for the best foot in terms of feeling confident in your abilities and feeling like you have a handle on what it means to be a mom. So again, fourth trimester here you're coming into this new stage and often there's such a shift. from the second that you give birth to the baby taking care of the baby. I wanna save the baby. What does the baby need? I'm gonna buy the baby. All these presents and stuff like that. But what about the mom?

Alisa Minkin 13:17

Liver. It's I'm going back to what you said about wanting to have control, because I do think that is a theme that goes through this all the way from little T medium T to Big T trauma

Danielle Mizrahi LCSW PMH-C 13:31

Yeah.

Alisa Minkin 13:32

with the birth experience. The pregnancy experience. I had forgotten about that. That, you may have this idea of the perfect pregnancy where you're sitting there, having ice cream and pickles and having just this little perfect belly. And I think one problem that we talked about in our other talk we don't have to go into here is the social media. Pressure, for everything to be perfect and to be in control. But I think a major lesson that I know I learned, and I feel like I talk about a lot with parents in my practice, is that you do not have control. You never did, it's a problem when you experience it in real life, right?

Danielle Mizrahi LCSW PMH-C 14:08

it's it can be a shock to the system. And then on top of the hormonal changes and When we talk about postpartum anxiety and depression, and we did touch on that and on the, in the last podcast there are so many factors that can lead to developing a parent. Postpartum mood disorder or, and there's definitely a scale, of how the adjustment goes, but there's just so much that needs to be figured out for this new mom. And it gets complicated to say the least. Go ahead.

Alisa Minkin 14:40

Yes. It really does it, it really does get complicated. So back to this idea of perfection. And we're gonna, we're gonna put aside the, the mood disorders, the baby blues for a little bit. But really that other talk was an overview of that. And we're not gonna focus on that as much today. We're gonna focus really more on what I call the normal things that might not feel so normal, especially if you don't know that it's normal. So again, you think you have this, baby, this, baby that you've had this Gerber baby image of this perfect baby. And then reality hits. So I wanna talk about some of the most common challenges that a new mom and dad will be dealing with that maybe they didn't anticipate. I'm talking about feeding, sleeping, and attachment at this point.

Danielle Mizrahi LCSW PMH-C 15:25

Yeah, for sure. So yeah, so there I think anyone who's never experienced the sleeplessness of having of a new mom. It's unlike anything else. And yeah, I'm talking from my personal experience when it comes to that but sleep what are the three things that people need in order to survive the most? They need to eat, they need to sleep, and they need shelter, right? Food, clothing, shelter. So here you are. You're responsible again for this child or this baby to feed them to help them sleep while you're trying to feed yourself and sleep yourself. It gets very complicated and how a baby's sleeping can affect how a mom is able to function, what kind of help the mom has if the baby's not sleeping right. It's inevitable that babies aren't gonna sleep through the night for quite some time. Some people get luckier than others but. The sleep pattern of this new baby is such an adjustment during that fourth trimester. And it's something that is a real challenge. And then in terms of eating right, is the baby breastfeeding? Is the, are you breastfeeding? Are you nursing? Are you pumping, are you formula, are you supplementing with formula? Like again, there's ideas that moms have before. I guess having the baby of what they wanna do, is it in line with what is working for their child? Like I know I wanted to breastfeed and my baby was rushed to the NICU day one. Thank God he was okay, but like I couldn't do the skin to skin that was expected in the hospital because he needed. He was huge and he needed to eat like right away. And I wasn't with him. So that's just went out the window. So again, these preconceived notions of what things are going to be and then how it actually turns out. And it all impacts how a mom feels. And this sense of I think, I'm glad that you brought up the word perfectionism, right? Feeling that they need to be perfect and that this whole experience is supposed to look and feel perfect. And there's this. Instant bond that, that develops from the second the baby is born. And here you are far away from that ideal image of what it's supposed to be. And how do you cope with that? How do you bargain with yourself to be okay with that? And how does that look in real life? Because there's just so much there.

Alisa Minkin 17:51

It's really true. And I wanna talk more about attachment.'cause you mentioned having your baby whisked away and I know years ago it. I think it's really been debunked. I dunno if it's as much as an issue as it was years ago. There was this concept of if you don't have the skin to skin, if you don't have that baby right on you, you're not gonna attach properly. I'm hoping that's been, not a thing as much anymore. It, it really was decades ago, there was like this whole Sears attachment parenting and tell me it's not as bad as it used to be, please, because that's not true. People, you'll be fine. Your baby will be fine.

Danielle Mizrahi LCSW PMH-C 18:20

think it's still there. I think there's still a push to breastfeed and even hospitals are being, I guess I've heard from nurse nurses that I work with or friends that are nurses, right in the postpartum, like there's like incentives to for nurses if they get a mom to breastfeed in the hospital. So there's definitely still a push to do things that way. And breast is best, however you feel. Or whatever the research is there, and I'm not saying here nor there, like it's not my job as a therapist, not my job to convince someone one way or the other. But there's definitely a pressure to do things a certain way and when it's not possible, whether it's like, again, a baby not being with you or a mom just being so physically exhausted from a 36 hour labor, whatever it is, like there's definitely that feeling that I'm not doing what I'm supposed to be doing. And it really plays a role into this feeling like, can I do this? Am I a good mom? Am I ready failing my child from day one because I can't nurse'cause I can't breastfeed.

Alisa Minkin 19:26

I look at it as a pediatrician from both the angle of the mother and the baby. And what we're not really talking about yet is the mother wants to do what's right for the baby. It's not just about her feelings, right? We're talking more about her feelings, but it's both. So I wanna talk back. Go back to attachment because breastfeeding and the pressure to breastfeed is coming from breastfeeding advocacy. That's not the same thing as attachment. That's a whole separate conversation that I do wanna go into because it's really a big part of the fourth trimester. I wanna go back to attachment because we didn't really talk about if you don't have that skin to skin you still can bond. And by the way, it is normal to not feel this rush of perfect maternal glowing love immediately.

Danielle Mizrahi LCSW PMH-C 20:04

Let's face it, a baby's coming out. They're bloody, they're good gooey, they're smushed. They don't look like themselves. You don't even know. Okay, what is this thing? Oh, this isn't what it's supposed to look like, but it's exactly what it's supposed to look like.

Alisa Minkin 20:17

Right.

Danielle Mizrahi LCSW PMH-C 20:18

and for some moms there is that instant bond, it's it's, but there, but again, there's so much more to it. And attachment again, happened before plays into attachment too. And whether the baby. Was planned and just, feeling whether it was hard to have the baby, whether it was hard to get pregnant. What does it mean? And a woman's own attachment style and their own history. That's what's so fascinating to me, what, how a mom was raised in how the attachment style that developed for the mom. How does that a affect the new baby and it's not just from day one in the first tri, in the fourth trimester. Throughout their life. So again, another talk for another time, but but yeah, there is this expectation or this I guess this, pressure to be perfect, right? And we're supposed to do everything right and it's supposed to look perfect. Everything's supposed to look and feel a certain way, and then you have this real experience and it not often what was planned or expected.

Alisa Minkin 21:27

And if everybody's treating you as incidental, right? And the baby as the main character, right?

Danielle Mizrahi LCSW PMH-C 21:33

Yeah.

Alisa Minkin 21:34

It is normal to have a lot of feelings, including just being absolutely exhausted and just wanting to go to sleep.

Danielle Mizrahi LCSW PMH-C 21:40

Sure.

Alisa Minkin 21:40

And resenting that you can't. Right? So that affects things too. So that's normal. But I also see such a great use for therapy here. If your issues from before or even now are impacting how you bond with your baby, right?

Danielle Mizrahi LCSW PMH-C 21:55

Yeah, absolutely. And I think in a lot of ways it's probably one of the more important times to go to therapy and it's conveniently when there's absolutely zero time for the mom.

Alisa Minkin 22:08

So great.

Danielle Mizrahi LCSW PMH-C 22:10

Telehealth helps though. I will say that it's Access to so many more. Services available and for moms to be able to access it because even if the baby's there, like I'll have sessions with my clients and the baby's just sitting right on the lap and they're lap and it's not like ideal in terms of being able to focus, but at least you get a little bit of a picture of what's going on at home. And it makes it more accessible. But yeah. There's so much focus on the baby and all of these, the needs that the baby has and, but for the mom is. Solely focused on the mom and what their needs are and how they're feeling and what this transition is like for them. Because again, we talk, we started off by talking about a shift in identity as you become a parent, right? Shifting into this new role where who you were before pushed aside for a bit and it comes back and parts of it come back. But you'll, like I said, you'll never you're never the same. And so how do we explore, how do we discover who you are as a mom? What does it mean to be a mom? What does it mean to be your own person? And all of the factors that come into play, there's a lot of loss there too, you're like, a lot of moms will come in and I don't even know who I am anymore. The grieving, who you used to be and what life used to be and. Many people, I think will come in saying I need to get back to who I was. But like I said, you there's this change. It's not when you're a teenager it's I wanna be a little kid again. Unfortunately it's not gonna happen. But how do you take pieces of who you are and your learning experiences and your attachment styles, and all of those things that have happened, and how does it culminate into who you are now?

Alisa Minkin 23:54

Absolutely. I just wanna point out that there's a great show, an Australian show called The Letdown. Have you ever seen it?

Danielle Mizrahi LCSW PMH-C 24:00

I've heard of it. I've heard of it.

Alisa Minkin 24:02

Yeah, I think it's on Netflix. It is such a good depiction. Of this period in time, it is really worth watching. If I can remember, I'll link that in the show notes too,

Danielle Mizrahi LCSW PMH-C 24:14

Okay.

Alisa Minkin 24:15

and I've been binging on that lately, so that's really good. Yes, but. This period, this identity shift has to do with becoming responsible for another human being in a different way than you've ever been before. And I'm just thinking in my mind of what it feels like to keep waking up to that siren sound of your baby screaming at all hours. That is, it is such a jarring shift, right? From being able to be in charge of your own eating, sleeping, going to the bathroom, to having a human being that you are responsible for,

Danielle Mizrahi LCSW PMH-C 24:46

yeah.

Alisa Minkin 24:47

S

Danielle Mizrahi LCSW PMH-C 24:48

and as the baby grows, the responsibilities change and obviously there's more of a shift into. Helping the baby become a little bit more independent and they're just more capable. But in those first three, four trimester, I guess you could say it's three months it's a lot longer than that. Just the postpartum period

Alisa Minkin 25:04

yeah.

Danielle Mizrahi LCSW PMH-C 25:04

longer than just the, I think it's longer than the year after giving birth. How do you navigate that? And back to perfectionism, right? There's this that we need to childproof the world from everything. It's like we need every tool in the book. And the market and society they play into that, it's I need to have this thing on my baby's foot that will tell me when they wake up or their heartbeat. And often it's it's just, it fell off, you, there's an alarm that goes off and the monitor fell off of their foot, but like your insides or just freaking out because you think that something's wrong with the baby. So there's this, there's this push to just childproof. You're responsible for protecting and making sure that all these babies needs are being met. And the same goes for kids, but the reality is we, who's protecting the mom, first of all, who's helping the mom through this? Who's there for them and helping them with their needs but there's this. It's really more that we need to like World, sorry. Let's say this over again. Okay. It's not so much that we need to childproof for our babies, it's more that we need to world proof our child. And it's the reality is that things don't always go according to plan. Moms will learn that right away. And it's okay for things not to go exactly according to plan. That's part of the process. As a baby grows and they learn that in order for them to be, up, to be, human beings who are functional society, everything is gonna go perfect. So I think there's pressure that everything has to be, you know exactly how it's supposed to be, but the reality is that's not how life works.

Alisa Minkin 26:44

Yeah, so you're bringing up my favorite topic, which is resilience. And the ability to tolerate discomfort and that the mother can model this, right? So that gives you a reason to take care of yourself if nothing else.

Danielle Mizrahi LCSW PMH-C 26:58

Yeah.

Alisa Minkin 26:59

So I wanna move on to breastfeeding versus formula feeding, because I find as a pediatrician that is like possibly the number one conflict that I see new moms and dads struggling with. And I wanna talk about it from a therapy perspective, not the details of formula versus breastfeeding. I wanna talk about it from the profession, from the pressure, from the beginning to be that perfect parent that easily nurses, let's put it that way, because that's where that was coming from. That nurse in the hospital was pressuring the mother to breastfeed because these hospitals are under a under a what they call a baby friendly hospital policy of promoting breastfeeding very aggressively.

Danielle Mizrahi LCSW PMH-C 27:40

Yeah. And. Again, putting pressure on the mom to do everything and I always say fed is best. I am not here to push one way or another. And it's just, when you look at the wellbeing of the mom. A baby needs a mom to be healthy. A baby needs a mom to be. Stable and functioning at, a reasonable level, right? No. Again, not everything is gonna be perfect ever. But if that's something that is causing a lot of stress then and the baby is, whether sometimes babies, it's just not enough. Breath milk, right then. Again, fed is best, so whatever it takes, and I work with a lot of the moms to accept that and recognize that. And we look at the whole picture. And what are some of the needs where some of the things that are causing the most stress and there are times where. Women will come to my office just crying. And this is the biggest issue. And we work to really just make a decision, right? The indecisiveness of, should I do this, should I not right? It's, it sometimes that in itself just causes the most stress of all, and then once you come up with a plan it can subed a little bit.

Alisa Minkin 29:01

And it's not an all or nothing thing. First of all, if you've had your baby whisked away to the NICU and you haven't had your skin to skin and initial breastfeeding, whatever, it doesn't mean you can't breastfeed later,

Danielle Mizrahi LCSW PMH-C 29:11

Yep.

Alisa Minkin 29:11

That can be done later. And you can also do it part-time. So I think this perfection, all or nothing. Attitude can get in the way of, perfect. Should not be the enemy of the as, as good as you're going to get. Fed is best a million percent, and it has to work for not just the baby but the mother. And that's another example of you're not chopped liver, you're not in clut, the mother, you matter.

Danielle Mizrahi LCSW PMH-C 29:34

For sure.

Alisa Minkin 29:36

So I also wanna talk about the idea of support because in other cultures there is. A village, a real village. Like I talk about my virtual village here, but there's a real village. And on today's nuclear families it's not really the same thing. And different people have different amounts of support. So I wanna talk about the concept of having support. What's, have not having enough support, how that can impact the mother.

Danielle Mizrahi LCSW PMH-C 30:03

Yeah. And I'm so glad you brought this up because it's definitely a big part of. The feelings and just the whole postpartum experience. Who's around to help and what kind of help are you getting right? Are you, do you live in a community that can cook meals for you? Or. Are there close relatives and we'll table this for a second, but I do wanna go back to the relationship between a a mother and a new dad and just how that changes. We can we'll talk about that in a minute, but there's different people serve different purposes and there's often. There are many people that come in and they don't really have that source of, the village that's coming in, right? There are certain cultures where there's that sitting period where Asian cultures and Chinese cultures. I have a client now who's about to give birth, she'll she doesn't leave the house for 40 days, right? And the whole purpose is to bond with the baby and to take all of the pressures off from outside world. But what does that look like in a world where. Women are expected to do everything. So who's there to help you through? And often a big challenge to find those people who are going to be helpful. Having come over, I wanna see the baby, I wanna see the baby. And then just sitting there, just like holding the baby while you're just, catching up with everything, whatever it is. It's not helpful. What is helpful?

Alisa Minkin 31:26

I heard somebody say something along the lines of, this is the kind of person you wanna have. The one who will say, what can I sweep? What can I cook? What can I clean versus, can I hold the baby?

Danielle Mizrahi LCSW PMH-C 31:36

yeah,

Alisa Minkin 31:37

pictures with all of you together?

Danielle Mizrahi LCSW PMH-C 31:38

Yep.

Alisa Minkin 31:39

but I think that the idea that you need this, you are worth this. And pushing aside this expectation of the. Successful independent parent. It reminds me, I may or may not have discussed this in our, my talk with you the first time about how I saw a video of a woman who has quadruplets and she was taking them shopping by herself and she's I know I don't have to do this and I actually have help, but I just wanna show you that it can be done. And she's showing you how she does it by herself. Four babies. I'm like, please

Danielle Mizrahi LCSW PMH-C 32:06

Wow.

Alisa Minkin 32:07

curate this for me. It's not an ideal to be so independent. And if you are alone, find ways as much as you can to make it easier for yourself. I've seen parents who try to, get outta bed and start cleaning the house for guests and stuff like that right away, or cook or whatever. That to me, is something that you can say no to, even if you don't have as much help as I wish you did.

Danielle Mizrahi LCSW PMH-C 32:31

Sure. And I think every woman has a different tolerance threshold of what they're capable of doing. And again, if you have multiple kids, right? If you're home with your. Third or fourth child is, looks very different than coming home with your first and just who's around, how much noise is in the house. This is a really funny video that I saw about what it means to be a third child. It's hilarious.

Alisa Minkin 32:53

I.

Danielle Mizrahi LCSW PMH-C 32:53

and it's just like the kids just, dancing around the little, bouncer and then one falls and the whole thing just turns over and it's that poor child, but it's just

Alisa Minkin 33:02

I love it.

Danielle Mizrahi LCSW PMH-C 33:02

child. That's just what it is. And it's really true. And so there's just different factors that come into play. But again there's just so much of a focus on what the baby needs and not so much okay, what would be helpful to the mom?

Alisa Minkin 33:19

And I'm thinking of that story of the woman who hides herself in a room and eats the one egg she has and the kids say, where are you? I'm making you a mother. There's a story. It's ugly because like she has one egg and she's not feeding her kids. She's feeding herself, but it's an allegory. Okay?

Danielle Mizrahi LCSW PMH-C 33:38

I am sorry.

Alisa Minkin 33:40

The idea is that you really do have to take care of yourself, and when you take care of yourself as a way to take care of your child as well, it's not selfish, and there's cultural pressures to not do that, and that's what we're talking about now.

Danielle Mizrahi LCSW PMH-C 33:51

When you're running on empty and you haven't eaten or you haven't taken a shower, it's impossible to take care of your baby. And it's so important to be able to realize, to put your oxygen mask on first, right? Because if you can't, if you don't, then you're gonna crash and that's ultimately the baby needs you.

Alisa Minkin 34:12

Exactly, and now we must talk about our partners.

Danielle Mizrahi LCSW PMH-C 34:14

Yeah those people. There's not every person that has a baby is, every family is different. So whether it's a husband, a wife, or partner, or some women do this on their own too, which is but the relationship shifts. Think about, again, we're talking about identity shifts. We're talking about. needs of a, an infant, right? And here you are, you're a bond, you have a connection with a partner, and that's being shifted. So there's the shifts of what your needs are, right? Which often as a mom gets pushed to the side, unless. You're able to really focus on them which is the whole point of this conversation. But what about the needs of your partner and how does that shift your relationship with them? And how involved is the partner in what's going on? A lot of moms will come in and yeah, my husband doesn't really do anything, but he doesn't know how to do make a bottle. He doesn't know how to change a diaper. He doesn't. Know how to do all these things and no one's gonna do it the same way that I am. it's okay, maybe part of why they're not involved is'cause you do feel like you need to be the one who does everything. And what are ways to involve your partner in what's going on? And the new change. The new changes, and then, and just what it means to have a baby and what it means to live with, in a part of, as part of a family now. So I always encourage parents or moms, new moms too. Try and get the, their partners involved as a way to, first of all, making them feel important because they absolutely are important and they're a huge part in this. And yeah, I think in the beginning, especially if you're nursing there's a much bigger load on the moms. But there are ways to. Not neglect in that relationship. And whether it's by getting them involved in, and them taking a role in the responsibilities or just finding a time to just sit and have a conversation. It's easier said than done but it's definitely a big it's a, it's an adjustment for everyone involved.

Alisa Minkin 36:17

It really is, and I, this is something that I pat myself in the back to this day when my oldest was born multiple decades ago, is that I empowered my husband to feel really good and competent. And that, by the way when you let them do things, you have to let them do them their way, right? Gonna be your way. It, it might be, and you have safety first, of course. But you have to be okay with it not being done exactly your way. It's letting over, letting up control Go of control,

Danielle Mizrahi LCSW PMH-C 36:47

World proofing the child, right? Different caregivers are gonna have different ways of doing things. And exposure to that is really the healthiest thing for a baby even at such a young age. Because it helps them develop right? Okay, if they can't take a nap in their crib, if they need to take a nap in their crib with the lights off and the sound machine on, they're only gonna know how to sleep in those situations. But if you help a baby by, different people have different opinions about napping in a stroller or a bassinet or going on walks, right? They're exposed to a lot more, they're more adaptable to the surroundings that they're in. And that's really the goal of raising, healthy human beings than being able to adjust and go with the flow and understand. Or have a sense of comfort. Or comfort, even if it's not just with their mom. When moms go back to work, and I work with a lot of moms at this point where they're like transitioning back into the work world and shifting from being their sole provider to now having to share that load and them going. Going back to their other responsibilities, which are then added on when they go back to work. How, what are the basic needs that need to be met? And what are the things that a baby be okay if they're not exactly the same as the way that you do things? So it's oh yeah, I want the baby to have stimulation and to be playing on the mat and interacting and, a lot of social interaction. Like I sit with the baby and we play, okay that's okay if that's great that the baby has that. But for the eight hours a day, what are the things that are non-negotiables that need to be dealt with or that are, that create safety for the baby? And again, we can go back to eating, sleeping clothing, right? Being able to say, okay, the baby's fed. The baby's, the baby is sleeping, or they're getting enough rest. What are the, those needs and what are the other things that it's okay if they're not exactly how I want them to be.

Alisa Minkin 38:48

I really do love that and I'm thinking of a story that when I interviewed Dr. Bubby of Ask Bubby, Flo Rosen is her actual name. Anyway, when I interviewed her, she told a story that a grandmother told her, where the grandmother was basically excommunicated because she gave her granddaughter a bottle of water when she was babysitting. The mother was breastfeeding and left her with nothing. So she gave the baby a bottle of water and that was it. She was. Stu that she was not allowed near the grandbaby again. And that's an extreme example. But I think it's really important to to be able to delegate and to be able to give up this idea that, you have to be in full control and full charge of this one human being. I, I. Imagine like how crushing that must feel and you've given so many great reasons for why it's really good for the baby, even if things are done differently, in fact, especially right, if things are done differently. So I really love that. I wanna just I know that we are, need to be finished really soon. So I just wanna go really quickly. I wanna bring up the concept again. We talked about it in the other episode, so please go back to listen to that. About two things, intrusive thoughts and when you need to get help. And we're not gonna talk about medication, I'm just gonna say that we talked about it in the other episode, A and B. At some point I'm going to have to introduce, interview a reproductive psychiatrist on this topic because it is an entire other topic in terms of the role of medication, before pregnancy, during pregnancy and after the birth.

Danielle Mizrahi LCSW PMH-C 40:20

Yeah. So just I think going back, and I'm glad you brought this up because it's important in terms of when we're talking about more of the postpartum anxiety, depression, all of those factors, right? Intrusive thoughts are. Often part of this whole experience, right? Worrying about the baby, of course. Again, we wanna do everything we want the baby to be okay. What are, the things that the baby needs in order to be okay, and what are all the things that could go wrong? And I think I mentioned last time there are books written about just the anxiety of keeping a baby safe and what if the baby falls? What if this, what if there's a bird on the tree and it comes down and pets that my baby's head, whatever it is, I, how did I come up with that? But but there's just so many things that. Are going on in a mom's mind. And I'm here to say that it is normal to have these thoughts, these inter intrusive thoughts, right? And there is zero correlation necessarily. There is no correlation between the between. What the thoughts are and them actually happening or you being capable of doing, of whatever the fear is, right? So a lot of women are afraid that like they will hurt their baby, right? Or that like they're capable of hurting their baby. And it makes them feel even worse about themselves of course. Like how could, like, how could I even have the thought that I could possibly do something like that? But it unfortunately, or unfortunately fortunately, like this is normal to have these thoughts. It's when the thoughts are in line with believing that this is what you need to do, that we need to get worried. And that goes into a whole realm of, postpartum psychosis and really just going down a different route. But it's so rare. It's like 0.1% of or 0.2%, something like that of all of the postpartum mood disorder cases. That it leads to that. But there's an overwhelming amount of women have these scary thoughts about what can happen and it's terrifying. And that's something that can be worked on through therapy, but it's important to recognize that. It's normal and that most of the time it's not, they're not going to happen. And we work on that. Recognizing that and accepting that.

Alisa Minkin 42:41

And I'm just thinking about the role of sleep, if you can get it, because I am quite confident that sleep deprivation, which is a form of torture, Is related to these thoughts, right? And the anxiety.

Danielle Mizrahi LCSW PMH-C 42:55

possible. Yeah,

Alisa Minkin 42:56

Yeah.

Danielle Mizrahi LCSW PMH-C 42:57

plays into it.

Alisa Minkin 42:58

Yeah, I think that's gonna be a whole other topic. Maybe to cover with the reproductive psychiatrist that I must get. And in terms of when to get help, not just for those thoughts that you're talking about, being on the more severe end, but in terms of anxiety and depression, the postpartum that's beyond the typical baby blues. We did discuss it in the other talk. I'm not gonna make you go through it. Again, but I'm going to link this talk as well to the hotlines that I'd linked the other talk to, just in case people just see this one, because I think it's really important to always have those resources because all of this is on a spectrum and not only is there no shame in seeking help, but it is really important to do that if you need that.

Danielle Mizrahi LCSW PMH-C 43:40

For sure, and the first line I would say is. Talking to your OB, GYN, they do the depression screening. And I think there's a lot of work that we can do in terms of educating our doctor's offices and pediatrician offices and detecting some of these issues or just being there to support the mom a little bit more. But there are, there is help out there and there are ways to the help that you need if you're feeling. Overwhelmed on a lower end and, depressed, having some of these scary thoughts, whatever it is there is so much support there.

Alisa Minkin 44:16

And you can also talk to your pediatrician. Hello.

Danielle Mizrahi LCSW PMH-C 44:19

Yes,

Alisa Minkin 44:19

We screen for this at multiple visits and we are, equipped to point you in the right direction. So I think that's another really important resource. And I wanna thank you so much for doing part two,

Danielle Mizrahi LCSW PMH-C 44:32

I'm so

Alisa Minkin 44:32

and I want you to come back to talk about more facets of this because there's so much more to talk about. But I promised you that we would end on time. So I wanna thank you so much for doing this with me.

Danielle Mizrahi LCSW PMH-C 44:45

Thank you for having me.

Alisa Minkin 44:47

Pleasure again.

44:51

Thank you for listening to Kids Matter. Raising Healthy, happy Children Takes a village, and I'm grateful you are part of ours. If today's conversation resonated with you, please share this episode with another parent, grandparent, teacher, or anyone who cares about kids. Together we can build a supportive community our children deserve. I'd love to hear from you. Share your thoughts, questions, or suggestions for future topics at Kids Matter podcast@gmail.com. With no explanation for your voice truly matters. Until next time, keep advocating for the children in your life because kids really do matter. They are our future. I'm Dr. Elisa Minkin and this has been Kids Matter. Please note that while I am a pediatrician, I am not your child's ped. This podcast is for informational purposes only and does not constitute medical. For any medical concerns or decisions. Reach out to your child's healthcare professional.