The Power of the Postpartum Brain with Dr. Nikki Pensak - Part 1

Postpartum can be a complex time in motherhood, as it is often linked with feelings of depression, anxiety, or similar challenges.

Today, we're privileged to bring back trained clinical psychologist, Dr. Nikki Pensak, to talk about postpartum mental health, and her new book, RATTLED, which dives into how to manage and calm new mom anxiety.

Rather than viewing this developmental phase through a lens of struggle, Dr. Nikki helps us see it as a time ripe with potential. She explains how our brains change during this time, why our feelings might not match up, and why it's so important to take care of ourselves and get professional help when we need it.

For a deeper dive into Dr. Nikki’s book, RATTLED, and her favorite working mom tool, stay tuned for our bonus Part 2 episode coming next week.

What you’ll get out of this episode:

- A better understanding of matrescence, the rapid transformation that causes a mismatch between physiological and psychological adjustments.
- The psychological challenges of becoming a mother, including postpartum OCD and anxiety.
- How high-functioning mothers often mask their struggles, facing perfectionism and unrealistic expectations.
- Why mindful practices and Cognitive Behavioral Therapy (CBT) are effective tools.
- How to manage ‘mom guilt’ when it pops up during much-needed downtime.
 
0:48 - Understanding matrescence.
4:51 - Challenges in recognizing postpartum mental health needs.
15:28 - The experience of high-functioning mothers.
28:26 - Addressing mom guilt and the importance of leaning into downtime.
32:48 - Understanding intrusive thoughts and anxiety in new parents.
46:42 - Practical ways to support parental leave and mental health.
52:52 - Embracing neuroplasticity and growth during motherhood.

Connect with Dr. Nikki Pensak:

LinkedIn: Nicole Amoyal Pensak PHD
Instagram: @drnikkipensak
Website: https://www.drnicoleamoyalpensak.com/
Preorder RATTLED here, available April 30, 2024.
Attend her virtual live book launch event with Eve Rodsky on  May 8, 2024 @11am EST 

Please make sure to subscribe so you don’t miss an episode, and kindly review the podcast on Apple Podcasts so we can reach more working moms.

We always want to hear your thoughts, concerns, questions or guest suggestions – email workingmomhour@212comm.com.

Follow us!

LinkedIn: https://www.linkedin.com/company/workingmomhour

Instagram: https://www.instagram.com/workingmomhour/

TikTok: https:/www.tiktok.com/@workingmomhour

Working Mom Hour Website: https://workingmomhour.com/

Subscribe to our YouTube channel: https://www.youtube.com/@workingmomhour

Transcript

Speaker 1: 0:00

research being done that up to 90% of new parents, moms and dads you know, all the primary caregivers and partners can experience intrusive thoughts. That's what the that's what they're reporting.

Speaker 2: 0:12

Welcome to Working Mom Hour. Oh fuck, hi everyone. Welcome to Working Mom Hour. I'm Erica and I'm Madeline.

Speaker 3: 0:29

We're working moms, business partners and friends with kids at different ages and stages.

Speaker 2: 0:33

We know moms tend to get more done in an hour than the average human, yet are often misunderstood and underappreciated in the workplace.

Speaker 3: 0:41

We are here to shine a light on the working mom experience, to help ourselves and others step into and advocate for the superpower. We are not experts. We're two women who have been there and are still there kids, clients and all.

Speaker 2: 0:53

Join us as we cultivate more joy in working motherhood at the corner of calm and chaos.

Speaker 3: 1:14

Welcome back to Working Mom Hour. Today we're talking about the science behind mom brain Spoiler alert. The changes we undergo are significant, and when we know what's going on with our brains and bodies, we are empowered to better help ourselves.

Speaker 2: 1:27

Our guest today is a mom and a Harvard and Yale trained clinical psychologist and postpartum health expert focused on anxiety and depression after baby. She has a new book coming out called Rattled how to Calm New Mom Anxiety with the Power of the Postpartum Brain. Let's welcome Dr Nikki Pensack. Hi, Dr Nikki, Thank you for being here and welcome back, thank you.

Speaker 1: 2:06

Thanks for having me. I'm excited to be back and speak with you guys again.

Speaker 2: 2:11

We are too. We sat here with you two years ago talking about mom brain and I think I can speak for all of us that that was a conversation that we think about a lot. That's why you're back. Conversation that we think about a lot, that's why you're back. And we know that a mother's brain really changes during pregnancy and after she gives birth. It's significant and has been compared to the growth that happens during adolescence, and you taught us that this has a name matrescence. Can you help us understand what is happening in our brains during this time? Why is it happening and what does it mean for new moms?

Speaker 1: 2:51

Absolutely so. The developmental phase of becoming a mother is called matrescence, like we spoke about, and basically it's a huge opportunity for mothers and their brains to develop. It's immense hormonal changes, brain changes, without getting too much in the weeds. Like, some parts of your brain get smaller, some get larger. There's a whole bunch of new neural networks being formed that help you to orient, to caregiving. There's a whole caregiving network in your brain. And so I like to say it's like Marie Kondo-ing your mind to give moms a leg up in caregiving and it's all to basically attune to your baby. Right Now there are these intense changes that happen in a short period of time. So with adolescence it's drawn out for years and years. Becoming a mother feels like it happens overnight physiologically and the psychological change takes a little bit longer, right. So it's like your, your psyche and your identity is trying to catch up to all of these physiological changes and they kind of don't align. And so how do we, you know, make sense of that and reconcile?

Speaker 3: 4:04

Wait, what do you mean?

Speaker 1: 4:04

they don't align, like we think that we're one thing and then all of a sudden we're another thing and we're just like trying to make meaning of it as we go, or Well, I just say the transformation of motherhood is so seismic, it's so profound, right, so you're trying to figure out who you are as a mother, you're learning your baby, but the hormonal changes and the physiological changes happen quicker, right, so you give birth and you know, you go into all these postpartum changes and even pregnancy is associated with different brain changes and hormonal changes, right, so there are all these pretty seismic shifts and psychologically, I think it just takes longer to sort of catch up to that.

Speaker 1: 4:43

And you know, just because you become a mother overnight physiologically doesn't mean that you, you know, make that identity transformation in the same way, right? So that's why a lot of mothers feel disappointed when they're not automatically just you know bonded with their baby. Right, it's like a huge disappointment because it's like, well, you know, I just became a mother. Why isn't the psychological part of this matching up? Why don't I feel this way innately? Right, we're as a society we're taught to, you know, that motherhood is just natural, right, becoming a mother, everything about it. We should just know what we're doing.

Speaker 2: 5:22

I knew the answer to this because of the last time we chatted and my mind is still blown, and maybe because this was a decade ago that I, or more than I went through this, but no one talked about this, as I was going through this process not before, not during, not after. Is it becoming more common for a doctor to address this, or is this still very specialized and you are just holding the megaphone trying to make sure that new moms know that this is a thing?

Speaker 1: 5:56

Well, you know there is a lot of fantastic research being done on maternal brain development. I don't think this is commonly discussed. I think that you know we can do a better job of preparing mothers. I don't think we can ever fully prepare for motherhood ahead of time, but we can certainly do a lot better of a job by having these conversations and saying this is what's going to happen to your brain. You know this might impact your vulnerability to experience postpartum, because we know that certain neurological changes, you know, with great opportunity, with this immense neuroplasticity, comes great vulnerability to risk. That's another reason why we really have to get postpartum mental health care really, you know, streamlined right. You know I can go in all different directions here in terms of you know how to do that and I'd unfortunately the onus still and I'm not losing my mind and I can explain to my husband that this is what's happening Like I didn't.

Speaker 2: 7:11

I was so confused I didn't know how to talk about what was happening. I didn't understand it. You watch the generations before you. They've all figured it out right.

Speaker 1: 7:22

They had kids and seem to have figured it out exactly, exactly, and you just you feel like you're losing it a little bit yeah, so while there's great research being done to show what happens in the maternal brain, I think of myself as more of a medium where I have this background in academic research. But but the research, my frustration with that is that it's not really translated widely right In the layperson language, right?

Speaker 1: 7:50

So I'm here cruising PubMed and being like study the maternal brain, what are these neuroplastic changes? And instead we really need to get that research out there. And also there's just not enough funding. Like only four percent of funding for research goes to women's health studies. So I mean, that's a whole like other backstory. That's insane, right? So I'm just trying to get the really great research out there, because we also as a society are in information overload and everyone has a voice, and as a mother, it can feel overwhelming to be like what do I listen to? Like what is the good science right? You know, we just have so much information at our fingertips and, as a well-intentioned mother, you're Googling, you're trying to get as much information as you can during this new developmental phase, and so you're just like a sponge right, taking it all in. And so you're just like a sponge right, taking it all in, and so we want to make sure that they're getting the right information that's science based. And so that was really where, you know, my passion for this and my mission came.

Speaker 3: 8:54

Yes To your point. You're in. It feels that you're in this space for a reason, and even as a psychologist, you've shared that you still couldn't see your diagnosis of postpartum OCD, and that was so powerful to hear. It was a headline for something you wrote and I'm going to ask you to share more about it if you're open, but I want to read an excerpt. This was published in Moms Don't have Time to Write.

Speaker 3: 9:23

I paced the floor of my baby's bedroom, my brain on fire, with various child rearing problems that I could not solve. What if I never slept again? Did my baby get enough during his last feed? Was I stimulating him enough? Most terrifying of all, who would take care of my baby if we all got COVID? As I poured myself a second cup of coffee and tried to catch up, my husband snapped me out of my troubled thoughts. I need you, he said. Eight days later, with the diagnosis of postpartum obsessive compulsive disorder and a course of medication and therapy, I began to feel better.

Speaker 3: 9:54

I didn't see my diagnosis coming, even though I'm a psychologist. It didn't matter that I was trained at Harvard and Yale, nor was it relevant that I specialized in the exact thing I would be diagnosed with None of it mattered, because I had never been a mother. Motherhood came with a postpartum OCD that revealed itself after both of my children were born, and with a vengeance the second time. If it happened to me, with my experience and many resources, what would happen to women without the same advantages? That is something really powerful words. Would you be willing to share a little more about your personal experience and maybe, like that aha moment when you realized what was happening? Was it really when your husband raised his hand? Remember?

Speaker 1: 10:40

it vividly because it was such a traumatic time. It was March of 2020. My son had been in the NICU for five weeks on reading support and he was discharged two weeks before we were on lockdown and it was a terrifying time for me. That came up kind of quickly and so, just in a broader sense, with my first child I had subclinical I would say, postpartum OCD. In hindsight, where it was, does that mean like not large enough to be diagnosed, or Okay, right, not crisis.

Speaker 1: 11:20

It was diagnosed from, like you know, the expert eye but probably would have gone under was going under the radar for me. But it was like, okay, there's a fine line between the hypervigilance that comes with becoming a mother and being completely psychologically responsible for a baby. That's completely dependent on you and right, so you're responsible for keeping the baby alive, which is a huge, huge undertaking, right, and there's no breaks. And so even if you do have help psychologically, if it's like, you don't get a break as the primary caregiver. So the first time it was more subclinical, like I was, and this was all before COVID. I remember more subclinical, like I was, and this was all before COVID. I remember I was, you know, calculating days of exposure for relatives to certain illnesses and bugs and like who had siblings in daycare and am I going to let them over? And like, oh, this one took public transportation, like the train, like two days ago I need to wait. Like I became like obsessed and preoccupied with that stuff, but it wasn't interfering with my functioning. I was just like really suffering more than I needed to fast forward to my second baby. So we know that when you have postpartum the first time you're, you're at greater risk of having it the second time and it tends to get worse with subsequent pregnancy.

Speaker 1: 12:40

So while I had a much more milder case my first time around, I did not need medication, but I did up my therapy sessions just to sort of get a handle on it quickly. So with my second I ended up needing medication and I remember standing there in my closet I was pacing. I had not slept for five nights and I thought that was impossible. But I actually, you know, without hallucinating, and I didn't hallucinate, I was like ready to talk to my psychiatrist, like wait, I really haven't slept in five days and I thought you were supposed to hallucinate at this point after three, anyway. So I remember, you know, running down the list of all the symptoms and just telling her you know, I'm completely committed to taking medication at this point I need to sleep.

Speaker 1: 13:23

Like this is COVID was brewing. I had weaned from breastfeeding much more quickly than I would professionally recommend, but it also I didn't realize that COVID was like really coming and so there was like this global trauma brewing. There's the vulnerability of the hormonal shifts, again, not just after you give birth but after you start weaning from breastfeeding. That was very, you know, dramatic. I'm more sensitive to that. That also aligned with my first time as well. So I know it's a lot, it's like multifactorial, but I just don't think that mothers are aware of all of these vulnerabilities.

Speaker 1: 14:00

And so I'm a clinical psychologist. I treat this every day, and yet I had all the resources. We had instrumental support, I had therapy and I knew the treatment better than the back of my hand and environmental I was getting. He was getting at it from all angles and also all the safety nets were slowly being taken away, right. So during COVID it was like no one in, no one out, right, so I no longer had any help. That felt really scary to me, considering I also had a toddler that was an early riser, right 5 am every morning, and so it was overwhelming, I was terrified and so I really needed some support and I was actually having severe postpartum OCD and what were the specific steps you took to go from crisis mode to feel better, like start seeing a therapist?

Speaker 1: 15:12

So I think that the important thing is that because, while I wasn't immune to experiencing postpartum, I did have my psychological postpartum plan in place, the way I would advise to all of my patients, to all women out there. So I had my postpartum mental health therapy sessions set up. I was in touch with my therapist regularly. I had a psychiatrist on hand already. I had established care with her prior to having my second child, because I knew of the vulnerability and because that's what we would recommend, right, even if you don't need it, have a prescriber on hand just in case, because you may have to wait months, right, to get an initial appointment with a prescriber and when you're in postpartum one, you're not going to be able to problem solve or schedule or figure out how to get the appointment number one let alone. Why would we want you to wait months when we could literally give you treatment that day? I mean, I started medication that night and I think that's what led to a very quick recovery, right, and I think that mothers also suffer quietly. So we know that the postpartum rates prior to COVID were one in five. Now they can be as high as one in three.

Speaker 1: 16:37

I've seen some reports, but even even we knew that even at one in five, that was a drastic under representation of what's going on, because mothers are afraid of reporting their symptoms, they're afraid that they're going to be viewed as being unfit. And we can handle a lot right, we can really white knuckle it and I see it all the time, especially high functioning mothers. They come into my practice and I'm, you know, scratching the surface a bit. I'm asking the pointed diagnostic questions and I'm realizing, well, you know, this is really high functioning depression and anxiety. And it's masked right, because the package all looks good, everything's put together, they're keeping up with taking care of the baby's good, nothing's interfering with functioning right. But mothers are really suffering on the inside and so I think we can just do, we can help mothers thrive and not just survive during this, this transition.

Speaker 2: 17:32

Yeah, I have to say, since our conversation it has been the number one piece of advice that I give to new moms. My sister just had a baby, our nanny's getting ready to have a baby, and when folks ask, like what do we need to prepare? I do not dive into the gadgets and gizmos. I was like get yourself set up, if you don't have one, with a therapist, a psychologist, a prescriber. Like, have your team ready to take you after you have this baby.

Speaker 3: 18:02

Setting up childcare and your mom care. Maybe, like aligning those two things, could be an interesting message to get out there.

Speaker 2: 18:10

So you mentioned high functioning mothers and I think that definition means they just are consistently performing above expectations in all of their roles, life work. Can you sort of dive into a little bit more and define the unique challenges they may be facing when it comes to their mental health? I think we have a lot of high functioning listeners.

Speaker 1: 18:36

Absolutely so. It's really just goes unseen. And you know, as a field we say we're more worried about the patient that comes in all made up and perfectly put together. Actually they are masking something underneath and they have a hard time admitting vulnerability or that they're suffering. That's the patient that we're like. Maybe red flag With high functioning, depression and anxiety, there's a lot of perfectionistic thoughts and unrealistic expectations and the mothers are, and you're more at risk for high functioning. If you are high functioning, sort of like this super mom, right, you are at risk for anxiety, higher risk for anxiety. And so you know, in my practice I just see mothers with unrealistic expectations are so hard on themselves they're not enjoying the process or getting little enjoyment because it's about keeping up with everything. It's just too many demands coming from themselves and they're so it's really anxiety about making mistakes, anxiety about being seen in a vulnerable way, and so it's working so hard and treading water, you know, and just trying to get everything done. You know, in line with like perfectionistic tendencies.

Speaker 3: 20:01

I remember getting a an appointment and it was like seven weeks because I was feeling anxious. I remember going to the appointment and at that time like I wasn't able to drop into vulnerability like in my life that just wasn't. I was sort of like that high functioning appearing person Like I remember going and thinking to myself I have postpartum anxiety. Caring person Like I remember going and thinking to myself I have postpartum anxiety. And then I remember that I've been just waiting out the seven weeks to get answers on. And then I remember at the end of the session and she was like older, so maybe she had like old school thought, I don't know, and this was also eight years ago or something. She was like so I think you're good, right, and I was like I don't think, I don't even know what I said. I just laughed and it was like done, that was it Like.

Speaker 3: 20:53

She was like I don't think you need to see me anymore and I kind of couldn't believe it. I just didn't know what to do with that information. But like I, I remember not like my, like my husband's family wanting to come over to see the baby and I couldn't leave like my room with the baby. Like I was like I don't want to see him, I can't I'm still figuring this out. I don't want them to hold my baby. And they're like we, we still just want to come over. And I remember hearing them like laughing down at the dinner table and I was just like sobbing in my room Like like what? So this wisdom is such a gift.

Speaker 1: 21:29

Well, I think, like you said, this is this is also a problem, because mothers will be dismissed by providers well intentioned providers because there's a certain myth of martyrdom.

Speaker 3: 21:39

Like this is normal.

Speaker 1: 21:40

While we know it's incredibly challenging, we can still do better to better support mothers and help them through this process. And there's just so much going on. Why would we not give them extra support? Why would you not have an objective person to bounce things off of a thought partner, right? To really make sense of this? You know the identity changes, the new emotions, right, the incredible identity transformation and psychological preoccupation and responsibility. I mean, it's just a massive undertaking. It's not only about, like you said, getting treatment when you're in sort of a mental health crisis, but it's for every mother to have that added support and to bring them further. On the other side, it's not just surviving this phase, it's thriving. And even if you're not in crisis, you can benefit from therapy.

Speaker 1: 22:34

At this early phase of neurodevelopment, matrescence because it's all new learning, right, your brain is sort of being primed for forming new neural networks when it, you know, as it relates to caregiving, why don't we coincide that with learning how to take care of yourself better? Fill your cup. Why don't we coincide that with learning how to take care of yourself better, fill your cup? Not to mention, when you become a mother and those babies, you know, develop, they're going to rattle you and they are going to, you know, pull out your own, whatever childhood or you know, trauma or maybe disappointments that you've had in your own life or being mothered the way you were mothered. It calls everything into question.

Speaker 1: 23:20

And so being able to process that at this time, I think what I really like to talk about is how much of an opportunity this is to heal. And I think it goes that much further when you have therapy, when you have treatment during this, during this phase, because your brain is sort of primed for making these changes right. The therapy it's sort of, you know, like I say, you know surfing the wave of neuroplasticity, right, you're using, you're riding that wave that's happening when you become a mother and all of the benefits that are coming to tend to your baby. But we're just infusing, you know, the self-development and development as a mother, nurturing that transition for yourself, so that you know you can get, you can just become better than ever.

Speaker 2: 24:07

Just offer, or have you offer some timeframes around? What is the postpartum phase? How long does that last? What is matrescence phase? How long does that last? Mads just threw out, you know she was just waiting for the seven weeks to end, but I'm not sure how long each of the phases technically last.

Speaker 1: 24:31

Right. Well, so we sort of have this arbitrary one year postpartum market in, like the clinical world. However, in my book we talk about how it could be even up to two years, and there's a rationale for that. But the problem is is that most of the postpartum research, the longitudinal research, stops at two years. So we really need, you know, more research to investigate longer time periods. We also know that Yale came out with a great study where they well, a couple many great studies on maternal development. But so in the postpartum period, I would say, you know anytime, one to two years, right, that's what I would think of. But there are continued changes throughout your life, right, and so there's increased cognitive reserve later in life from the experience of mothering and being a mother, and so Yale put out that study recently.

Speaker 3: 25:24

What do you mean by increased cognitive reserve?

Speaker 1: 25:26

Like as your child becomes more independent, you have more space in your brain, or Like, as your child becomes more independent, you have more space in your brain or more cognitive development, basically like strengths, you know, brain strengths, increased cognitive reserve. So it's an incredible brain development throughout your, throughout your life, right. So it's just different challenges later on, but I think you know in the beginning it's just a more dramatic peak of changes, right. It's like all at once. It's incredibly demanding, physically, psychologically. The baby's completely dependent on you, so you have to be sort of all you know in. As the kids get older, you get a little bit more space, right, but there's still challenges and because of that we call it experience dependent neuroplasticity. Your brain continues to develop just from the challenges of child rearing throughout your life, and so it actually ends up being a benefit long term.

Speaker 2: 26:19

Are there things that you could be doing Like? I remember folks talking to me about my nutrition, but it had nothing to do with me. It had everything to do with breastfeeding and making sure I was consuming what I needed to to be able to provide for the baby. But I imagine there are things, even small, that we could be eating, supplements to be taking that could support this brain development. Maybe, maybe not.

Speaker 1: 26:47

Well.

Speaker 1: 26:47

So as a clinical psychologist and wanting to do the most good and sort of the most bang for the buck, I would say is the best thing you can do is have your postpartum mental health care set up, so that means the therapy prescriber on board.

Speaker 1: 27:04

I can't really endorse supplements or that aspect, but I would say that you know that's going to do sort of like what's going to account for the most variance, what's going to have the strongest impact. Really, like the mental health piece is incredibly important. If you don't have you know your mental health, then like no supplement, no diet, no exercise regimen is going to like fix that right. So that's sort of like baseline and then, as you're, you know, if that's stable, then certainly there are lots of other things that can help and you can talk to you know your providers about that. But certainly we would recommend as a field sleep is one of the most important mood stabilizers. Protect mother's sleep at all costs. Exercise is always good, but we know that after you have a baby, you know you actually physically can't exercise for you know weeks, if not months, you know, depending on how it goes, and so a lot of the self-care regimens that we have intact are not possible.

Speaker 3: 28:09

This should really be like a college class or like a high school class, Like. I think that this is important for everyone to know.

Speaker 1: 28:16

I mean, I didn't even really know this while I was in it and like going forward, right. So it was after I sort of got through it and, with the perfect vision of hindsight, put everything together. You know it was like the postpartum maternal brain development coupled with the you know good postpartum mental health treatment and then the post traumatic growth from COVID and you know my son being in the NICU and everything. So it was sort of like all of these things that contributed to this. Really, I felt better than ever as I came out of it and I thought, wow, like to go from rock bottom right to feeling better than ever as I came out of it and I thought, wow, like to go from rock bottom right to feeling better than ever. I really need to share my story. But also this is this has influenced the way I advise my patients and women everywhere and what I talk about. You know my TED talk and my book, all of that.

Speaker 3: 29:06

The existence of this conversation with you on the calendar has like been emotional for me because I know that I have like some trauma stored from that time.

Speaker 3: 29:17

For me it's a lot of like guilt logically not my fault stuff, but like the milk allergy and then I went dairy free and that didn't help and then I fed her this disgusting stuff for a year and you know, I just like have guilt that I need to work through and let go of.

Speaker 3: 29:34

I want to work through and let go of, but like from a clinical perspective, when you see women and you know this is like this moment of neuroplasticity, like this opportunity to think in new ways, develop positive habits, like change the brain in a positive way rather than lodge our trauma in the brain. Like what, what do you work with them on? Like I know, talk therapy, potentially medication, like what other things? Like do you have them like journal or reflect? I know there's only so much capacity we have during this time, but like are there other tangible tips that you might be able to give? Or that, like you know, if you know someone who's approaching it, that like like I love the idea of mindfulness, but like what could that look like for a new mom Is it like one minute laying on your bed with your eyes closed, or something like that?

Speaker 1: 30:29

Okay.

Speaker 1: 30:30

So I practice cognitive behavioral therapy. So it's not just talk therapy, it's evidence-based therapy that is really effective. It's sort of our gold standard treatment for things like anxiety, depression, ocd. So within cognitive behavioral therapy there are tons of skills that we work on. We work on the distorted thoughts, we work on the emotions and we work on the distorted thoughts. We work on the emotions and we work on the behaviors, because in CBT cognitive behavioral therapy, for short your thoughts influence your feelings, which then influence your behaviors and vice versa. So we sort of tackle all of that.

Speaker 1: 31:01

Now, in terms of strategies that I recommend, there are a ton and I offer a ton in my book. I also have a whole chapter on mom guilt and, as a clinician, when I see mom guilt, it's sort of like a chicken or the egg phenomenon, because it can be as a result of depression. Right, if we feel more depressed, we're going to feel more guilty about things as well, as if you have a lot of guilt and like are really just thinking that way and everything sort of you know is preoccupied by like oh, you know, I'm doing this wrong or I shouldn't do this, or ruminating about past mistakes and feeling guilty about it. That is also going to make you feel more depressed and anxious. So it's this vicious cycle, and so I have this very specific strategy in my book that I go into great detail. But from a global perspective, when I think of guilt, it's really not a productive feeling, and so I encourage mothers to whatever they're feeling guilty about is likely the thing that they need to be doing the most of. So if you're feeling guilty about going out and having that social event and leaving the baby at home with caregiver, you know, if you're so preoccupied by that guilty feeling, right, you're not going to be able to enjoy that social interaction. But the whole point of helping you feel less guilt is to get the benefits from the social interaction that's going to help you feel better food wise, and then, in turn, you'll have less mom guilt. Now it could be anything going back to work, right, or taking that time for yourself. You know you screamed at your toddler, right, and you're feeling guilty about it, right. And then you punish yourself, and it's just this endless cycle. Right about it, right, and then you punish yourself, and it's just this endless cycle, right. And so when you are back to work, when you are doing these things that are making you feel guilty, right.

Speaker 1: 32:58

I advise my patients to really lean into it and get the pleasure right. How do we make it bigger? Right, when you're out with your friends, get out of your head, lean into the conversation order like something delicious, right, a delicious drink or you know. Get into a really fun conversation so that you can really just lean into the pleasure that you can get from that interaction. That is going to fill your cup and heal your brain right and help you feel better and better actually is going to do wonderful things for your mental health. And so the more pleasure you can get from leaning into these things, the less guilt you're going to feel. Then, the less depressed you feel, the less anxious wonderful cycle. And so you know, being able to dive into that with the, with the women I work with, is amazing, right, because you know it's really, really informative and it gives them a whole different perspective about like. I have a lot of moms that feel guilty going back to work.

Speaker 2: 33:52

Can you talk a layer under this guilt, Because you mentioned it in the things that you help with and it was something I never talked about really, mads, until we started sharing notes in this platform. I don't know if they're called intrusive thoughts or you know the thinking and catastrophizing things with your kids, with your spouse, that aren't really happening in real life, but you have created it in your head. Your mind takes you to some pretty scary places and I didn't know how to get out of that. I didn't know what that was called. I didn't know why I was thinking this way. It wasn't normal behavior for me to think this way. You know, in talking to mads and and others post having kids after they had been grown, I was like, oh okay, this is something that moms suffer from quietly Right, absolutely.

Speaker 1: 34:53

So. I mean, we know now thankfully there's more research being done that up to 90% of new parents, moms and dads, you know all the primary caregivers and partners can experience intrusive thoughts. That's what the that's what they're reporting, right. And so there are these flashes of disturbing thoughts and images like what if I harm the baby? What if I drop the baby? Right. But there's just a lot of intrusive thoughts that come out and it's the overstimulation and it's the anxiety coming with being completely responsible for this other being.

Speaker 1: 35:25

Now, as a clinician, I also look at that on a continuum, right. So while it's very typical for new parents to experience intrusive thoughts, disturbing thoughts, if they are a constant preoccupation, or if they are, you can't like let go of them, like they're really sticky and you're just focused on them, right. And then you actually do something to sort of protect yourself. So, let's say, you're afraid of dropping the baby, so you decide you're not going to hold your baby, you're going to let other people hold your baby from from now on, or you're going to avoid it. That's actually like a clinically significant anxious response, right, we would look at that in sort of the anxiety picture, not just like normal, intrusive thoughts that every parent experiences.

Speaker 3: 36:08

Have you studied, like spousal brains during pregnancy or the newborn phase? Like obviously they're going through something too, as you just alluded to, and are they, like, more at risk for mental health challenges as well?

Speaker 1: 36:23

Yeah, I mean there's also some great research out there about this caregiver network that is actually present in both parents.

Speaker 3: 36:32

Like neural network.

Speaker 1: 36:33

Yeah, yeah, like parts of the brain respond Men. We know that about one in 10 experience. Postpartum depression becomes very pronounced for men because they have to work harder to think about what the baby needs. Moms have like a little bit more of a innate push physiologically, hormonally and whatnot and so men still benefit and exhibit brain changes as well.

Speaker 3: 36:58

I don't know if you can feel brain changes, but when I adopted we adopted our son there was like a time period where I'd be like oh my gosh, there's three of them. Like like it took me a while to wrap my mind around the fact that I had three kids and I had to make space to like think about each one. Or we're at the playground and you know, all of a sudden I realized like, oh my gosh, where's the third child? Or you know it, it like took a while to be able to have that capacity. So I was telling myself I had like a little bit of this knowledge during that time a couple of years ago, and so I was telling myself, like it's coming, I'm just getting used to this. Like my brain is changing Did make me think about spouses or like non-birthing partners and what changes they're going through.

Speaker 1: 37:44

Absolutely, and we know that fathers, you know non-birthing parents when they. The more you are involved in the caretaking right, the more your brain is going to change. And so if you're actively, you know your brain is just really developing from that experience dependent neuroplasticity.

Speaker 3: 38:02

Well, what's coming up for me is like the importance of the spouse taking their leave, like taking the time to bond with their child and develop those neural pathways, because it's going to help them better care for their child. It's going to help the spouse I don't know what to call these people. There's so many ways to build a family. If I had the baby and my partner isn't taking leave, then it's almost a disservice to me because I become that default parent. Almost a disservice to me because I become that default parent and that's hard on everyone.

Speaker 1: 38:42

I hear my patients tell me that they really like when I explain you know the neural development. So I actually, when I'm trying a new task, I envision like a neural network being formed and it's sort of like a stump of a tree right or a plant right, a seedling coming up. And so the way I explain it to my patients is that you know, we're building new highways in your brain. You have all of these neural networks that are formed and they're like high speed highways. But when you become a mother and when you have a baby, when you have multiples right, you're just building new roads. But it's sort of like a forest and you have to start by first clearing out all the brush. Then you walk over the path and then the more you do it, you keep clearing over it and over it and instead of going down those old highways that are maybe non-essential or not as productive, you're building new highways in your brain and so they become more formalized. But it takes a long time to get those really, you know, reinforced.

Speaker 1: 39:37

This process happens in your brain, called synaptic pruning, where all of these useless neural networks just fall away. Right, if they're not being used, they're discarded, and so you focus on these caregiving roads, right, and I'm thinking, well, if we can have all of these new neural networks being formed from these experience dependent, taking care of our baby, responding you know, why can't we do that for the mother right? And taking care of yourself in therapy and whatnot? Like there we can. If we're building roads, why not build a lot of roads with the same resources? Right, you have a lot of cement and you have a lot of materials. You got everyone on board getting ready to build these roads. You know, why not grow some in there?

Speaker 3: 40:21

for just for mom right, treatment, self-care all of that I think so many of us get stuck in the greater the sacrifice, the better the mother mentality, and I know that it probably stems from this postpartum period and being locked into those neural pathways. How might we start to think differently without sacrificing the health and well-being of our families? Like not feeling, like it's all on our shoulders?

Speaker 1: 40:52

Well, even if it's all on your shoulders, can we come to that with you? Just need even more for yourself. You need to fill your cup. You cannot serve from an empty vessel.

Speaker 1: 41:05

My academic research was centered around caregivers of patients with advanced cancer, right and hematopoietic stem cell transplant. Their immune systems were obliterated and the caregiver was responsible for keeping the patient alive for the first 100 days post transplant. And I was thinking, like the parallels between, you know, that kind of caregiving and the relentless demands of having a newborn, and so it became to like make sense. But in caregiver research, we know, right, you put your oxygen mask on first, and you know, and there's resources out there. It's the same thing for mothers, right? You do not have to suffer through this. Do not sacrifice your mental health. The most important thing for the children are is intact maternal mental health. Happy mommy, happy baby, whatever you, if mom's sleeping, if mom's able to, you know, take care of herself. And you know it can be in small chunks, it doesn't have to be like it's not huge thing, but it's also, you know. I have to say if you're starting to experience some, you know, intrusive thoughts, or you're just not enjoying it or you feel something's off, you know, get, get an objective, professional talk to them, get an assessment with someone that specializes in postpartum mental health care, because they'll know what they're looking at. And that's really important because so easy to get dismissed and it's a lot easier to treat mental health issues and depression and anxiety when it's caught early, right, and we like to, you know, in the bud, so you know. If there's ever, you know, an argument for getting that assessment early on, it's that.

Speaker 1: 42:42

Why are we putting the responsibility on mothers above everything else? You know to diagnose themselves, right. They shouldn't have to figure this out. Just go set up an appointment prior. You know, have established, do your check in, check in at various time points where you know that you know you might be vulnerable to experiencing postpartum. You know, match it up with weaning, breastfeeding or if it's right after birth and you can't or choose not to breastfeed, you know. Then then have a check in earlier on if you have a traumatic birth, right. So we know birth trauma occurs in like 13% of mothers. I've seen some higher stats. Every mother has a story. You want to talk to someone and not take that on yourself, feeling like you have to diagnose and figure it out Like let the doctors do their jobs. We want to. We really do.

Speaker 3: 43:30

Don't you have an offering that can be given as a gift? We really do.

Speaker 1: 43:34

Don't you have an offering that can be given as a gift? So I was looking at some major companies registries, yes, as a registry gift, yes, and I had the idea of, like why don't we put mental health therapy like a budget no-transcript gift to any you know new mother, like have a budget for therapy sessions and I'm sure a lot, of, a lot of you know friends and family would love to contribute to that. So why not put it as an item on your actual history?

Speaker 3: 44:39

please go do a media tour on this, Like I think this is a million dollar idea.

Speaker 1: 44:46

I used baby list for my own registries and I thought that you could go to Amazon and like all of these other stores and, just like you know, put it on your list. It didn't have to be from like one store. And so I ran through and then I like, sent it to BabyList and they're like, oh, we're going to send it to our marketing team and I haven't heard back from them yet.

Speaker 2: 45:05

On BabyList, I'll end on this. We don't have to include it, but I just went through because our old nanny is having a baby. She had a section where you could contribute to parental leave. Like, her husband didn't have a significant amount of parental leave and you could contribute to parental leave so he could stay home a little longer with the baby. So I feel like we'd be open to this idea.

Speaker 1: 45:30

Wait, so does BabyList have a section for that?

Speaker 2: 45:33

I don't know, but I definitely saw that it was a like contribute to our parental leave fund was a was a section like if you could make it up like you could probably make up a fund.

Speaker 1: 45:43

Well, I don't know. I don't know if he made it up or if it's actually like BabyList should just have it as an option.

Speaker 3: 45:48

Yeah, like in a drop down or something.

Speaker 1: 45:50

Can you sell them for me Like, can you just? Let's let's, let's do this?

Speaker 2: 45:56

I do. I do think there is a level of paralyzation that happens. That probably prevents. Look, I have a 13 year old and 11 year old and ask me how hard it is for me to schedule my annual doctor's appointments. I don't know why. I don't know why there's that mental block, but I could imagine that in that time and space, there was no way I had the capacity to make a doctor's appointment for myself. However, if it was a gift, if it was already taken care of, if it wasn't something, if some of that mental load was removed and it was a well, I have to because all of these people contributed to this I would be interested to see the data around how many folks get the help because the help was gifted to them versus trying to seek it out themselves.

Speaker 2: 46:52

You know what I mean. Yeah, there's something here.

Speaker 4: 46:57

Absolutely. Um, I want to jump in really quick. Um, because I think it's important to talk about what happens at the doctor's appointment, because I think it can be really overwhelming. As someone I have not had a child yet, but I have experienced tons of anxiety, ocd tendencies, so I totally understand what it means to have intrusive thoughts and not know what's going on when you're in the doctor's office and I also think you noted this before. Sometimes it's so hard to advocate for ourselves or meds, like you were saying. Sometimes you get paralyzed. The doctor says you're fine, and then you just leave and then it's like wait, I waited months for this appointment, what now? So can you walk us through, like what mothers should be preparing on their end, like maybe it's a little note like my physical symptoms are this, my emotional symptoms, are this, before they walk into that doctor's appointment, and also to give them a message of like how to let go of the fear, to reveal like what's actually going on in our minds?

Speaker 1: 48:04

So are you talking about the actual doctor's appointment when you bring the baby to like the pediatrician, or?

Speaker 4: 48:10

the mental health appointment.

Speaker 1: 48:11

Guess what? Moms don't have to prepare anything ahead of time. We're going to assess you. That's our job, right? You don't have to bring me a list of symptoms. I've got that. It should be automatic. You know we're not there yet. We're just not there yet. So the onus still falls on mothers to make the appointment and to show up, and then that's it.

Speaker 4: 48:29

I guess think about what happens if you have a therapist that doesn't feel like they're giving you what they you need, because I also feel like that can happen too.

Speaker 1: 48:39

It's about trying on different pairs of shoes, right. What's going to work? You know it's about finding the right fit, and unfortunately that can take. You know, several tries, and so this is even more. Several tries, and so this is even more.

Speaker 1: 48:58

You know more of an argument to set up that postpartum care prior to having your baby, so that you can figure out which therapist do I want to work with, which one you know understands me. Also, they can get a good baseline assessment so that we know when you're coming in postpartum, what changes, what, what would be like changes, right? So we're continuously assessing anyway, but it's a great benefit to have a solid baseline assessment prior to pregnancy or delivering. And so, because it can take time to figure out who you want to work with, that's why you want to do this. You know, I tell you know, in my TED Talk I was like you know, once you pee on that stick, find yourself a mental health care provider that specializes in postpartum, right? I mean, let's think about this, let's get this lined up, because unfortunately it takes time. Good psychologists and providers have wait lists Like you have to be kind of proactive about it.

Speaker 2: 49:48

And now I imagine you could do this online. Right, you can do this remotely. You don't have to pack yourself up and head into a doctor's office.

Speaker 1: 50:01

That's been a blessing, you know. After COVID, I think we've learned that virtual therapy and there's actually been research on this that it is just as effective as in person. And I think that's especially helpful for new moms, right, Because it's so hard to get out of the house, Can we?

Speaker 2: 50:17

jump back to you. You had this phrase of surfing a tidal wave of neuroplasticity and I would love if we could elaborate on that a little bit. And you talk about it in such a positive way, maybe talk about some of the ways we can take advantage of this tidal wave, yeah.

Speaker 1: 50:36

So I think in this context I'd love to talk about, you know, the truth about mommy brain. So mommy brain really needs a rebrand. When we think about mommy brain, there's this stigma and this, you know, idea that any dysfunction is a representative of mommy brain. But it's much bigger than that. Yes, there are, you know. There's the subjective experience of mommy brain the fogginess, the forgetfulness, right, the being interrupted constantly. I mean these are very real experiences, but the research actually shows that there are. There's not really strong support for differences between mothers and non-mothers when it comes to certain, you know, memory tasks, right. So this is really important to hold on to, because in our society we think of mommy brain as a deficit, and so it's. There are actually boosts in learning that occur, right, in addition to like the feeling subjectively worse, right, and there's great benefits that occur during this period. And so what I mean by when I say surf this tidal wave of neuroplasticity, is that your brain is changing so much, you know, some of it feels really, you know, hard and negative and some of it, you know, can really propel you, right, if we kind of use the momentum from these neuroplastic changes, these increases in efficiency, increases in social cognition, increases in mentalizing and leadership and you know, all of these things that are benefits to the developmental phase of becoming a mother. We want to nurture that process so that you can come out on the other side right, better than ever.

Speaker 1: 52:11

There are so many roadblocks that get in the way. Right there's the you know postpartum mental health disorders that happen. There's trauma. Right there's, you know, financial stress. There's lack of, you know caregiver support. There's lack of maternity leave and all of it. I mean there's just like so many barriers, that and ways that mothers are at a disadvantage. But when the process goes right, it can go really right. I do believe that you can become more brilliant and better than ever if this process goes right, and so there are ways that we can nurture it right and kind of use these neuroplastic changes to our advantage. And so that's what I mean when I say surf these changes of neuroplasticity, and part of that is making sure you have your postpartum mental health care intact and having that work for you right. With good treatment, you're going to feel better than ever.

Speaker 3: 53:02

Now, is this related to the concept of post-traumatic growth?

Speaker 1: 53:07

It is so with trauma. There's this phenomenon that happens in about a third of trauma survivors. That is called post-traumatic growth and it's really this enhanced resiliency finding new meaning and new purpose in life after experiencing a trauma, like the growth that comes from it. Oftentimes it can shift your perspective about things. You make changes and whatnot. It's very similar, right. It's one of the opportunities that you can come out better than ever and more resilient.

Speaker 1: 53:35

And so in motherhood, I think that you get the highest highs right and some of the lowest lows, and I want mothers to be able to experience and primary caregivers to be able to experience. You know the incredible, you know moments right that happen and really you know be able to be present with their babies and, even though it's relentlessly challenging, what helps us get through it is being able to take in those incredible moments and build on that resiliency. And I think that when you are blocked either by postpartum mental health issues or really significant distress or barriers like all of the ones that I mentioned, it takes away from you being able to really benefit from those interactions with your, with your baby, right and experience. You know what you're supposed to. You know what you know the greatest feelings, the bonding right. If you're so stressed out and suffering, you're not going to be able to get the benefits of this incredible time.

Speaker 3: 54:44

Thanks so much for listening to this conversation. Next time we'll be back to talk more with Dr Nikki about calming new mom anxiety and more from her upcoming book Rattled in a bonus episode.