BIRTHFIT Podcast: Summit Series Featuring Dr. Alyssa Berlin (The AfterBirth Plan)

Dr. Alysa Berlin: [00:00:17] I’m really just trying to soak it in you guys because the energy in this room is amazing and — Oh see already I’m getting my first clue. So I can go like to here and to here? OK. So you’ll give me kind of like warning signs, right guys, for which way I need to move? that’s perfect nothing subtle about that. But you guys are amazing. I mean and to be in this space with all of you is really just such an honor. And I was kind of badgering Lindsey a little bit I’m like ‘I want to be the face of your postpartum side’. So thank you for having me. And I’m looking forward to these next couple of hours where we can talk about the transitions of your parent. It was nice to see so many of the friendly faces from two years ago. So really in a lot of ways this feels like a reunion. This is always fun. Maybe even better than a family reunion right? Lala’s strings attached. But lets go ahead. So my name is Dr. Alysa Berlin, I’m a perinatal psychologist. I have the pleasure of working with my husband who is a prenatal chiropractor. And at another point we could talk about the pitfalls of working with your husbands, right? That’s its own bag of tricks. But it’s very much my passion to –as most of you also have-very much my passion-there we go! I Just got a whole lot louder-to really help families with that transition to parenthood and to mitigate postpartum illnesses as much as possible. And I said families because we know that having a baby is a family experience and sometimes we lose sight of that and we lose sight of our proud papas along the way or the non birthing partner. So hopefully they’ll have a chance to talk about both of those as well. I will give a shout out to my 8 year old who’s here with me. It is Hootie’s eighth birthday. That’s right. So the big guy accompanied me to Austin. Best Travel body ever, right?


Audience: [00:02:14] Can we sing?


Dr. Alysa Berlin: [00:02:15] OK. Ready?. As long as I-


Audience: [00:02:21] Just do it in the mic.


Dr. Alysa Berlin: [00:02:23] Ready?


Audience: [00:02:23] Happy Birthday to you. Happy birthday to you. Happy Birthday dear Hootie, Happy Birthday to you.


Dr. Alysa Berlin: [00:02:43] Maybe with his permission we could talk about a little bit about his birth later on because he was my home birth water baby and if I tell you that energy has just followed him in life which is really neat. So and he is- just to give a shout out to his siblings-He is one of four. We’ve got a lot of Gemini’s so really I feel like I have seven kids. Let’s be honest it’s real. But he has an older brother and two older sisters which is really fun. But let’s go ahead and dive in. The after birth plan was really my vision of helping women and families during pregnancy think about what comes next, which is not very implicit in our culture, right? In our culture we like to think about gear and birth. Those are the two things that really kind of grab our focus and in some ways I get it, right? They’re prettier, they’re more exciting, they’re more fun. Yet in the same way that when we think about our primary relationships, right? That wedding is just one day. And then you’ve got that whole long marriage ahead of you. And we know that that’s got ups and downs and rights and lefts and you know some loop de loops along the way. And then that same way I really wants families to think about what happens after that baby is born. Especially because the idea that you can’t prepare or plan for it is actually antiquated. And when we look at some of the research we see that the more we prepare, the more we are actually able to get in shape and get ready for that baby. So here we go. Some of our objectives, right? Looking at the research which we were talking about understanding on a much deeper level when you’re working with women and even some of the questions that were coming up from the beginning. We want to make sure that you understand what that transitions of parenthood looks like so that you could be the one to disseminate that accurate information to them and debunk a lot of the quote unquote advice that people give them along the way that is either often misguided or really more of a projection of their own personal experience. So we want to have accurate information of what that transition looks like and it’s not all hallmark-y as we know. It’s not all butterflies and unicorns but it’s not all that either. And we want to make sure that we can create balance. You lied about this. OK. ‘Regulating Conflict’ Although we will not spend as much time talking about regulating conflicts, We know that conflict is a big thing that comes up after we have a baby and we’ll talk about some of the pitfalls that happen and how to again remove some of the fear factor around conflicts, right? So often and every now and again I’ll get a couple in my office and they’re so happy and they’re so proud because they’ll say ‘we never fight’ and I’ll look at them very sincerely and I’ll say ‘that’s so sad I’m sorry to hear that’. Why would that be? What do you think? What was that?


Audience: [00:05:41] Because they’re probably not talking.


Dr. Alysa Berlin: [00:05:44] Because they’re probably not talking, right? Why else?


Audience: [00:05:45] Holding things in?


What is PMAD (Perinatal Mood and Anxiety Disorder)?

Dr. Alysa Berlin: [00:05:45] Maybe They’re holding things in and oftentimes it’s because they lost the passion. Those conflictual conversations are not fun, but usually they come from this place of ‘I love you. I want to make things better and it’s worth going through the rocky road to get to a better. If I’ve given up and I don’t care why would I do that’, right? So it’s not this gold star standard that people think it is to not argue. How we argue is a different story and that’s where regulating conflict comes into play. If the gloves come off every time we argue, yeah that’s something we want to intervene with and that is something that’s going to erode the relationship really quickly. ‘Come up with ways to help clients maintain or enhance relationships satisfaction’ and that’s big. Mainly because it’s one of the biggest risk factors and precursors to what we now call perinatal Mood and Anxiety Disorders. PMADS. PMADS, and you’ll hear me talk a lot about, that has replaced what we call postpartum depression. We now recognize that postpartum depression is just a small piece of the puzzle and that the experience on the other side is much bigger. First of all we know that often times problems will arise while the woman is still pregnant and one of the bigger risk factors is if the mom is struggling during that third trimester with any kind of depression or anxiety that’s a worrying sign. And that’s an indication that we want to step in sooner than later. We don’t want-you know it was so funny-I remember one of my kids needed to get a cavity filled or I was on the cusp would they need it would they not need it. And I was asking the dentist more from the perspective of ‘is this really necessary, right?’ If I don’t have to put my child through it I don’t want to. And he looks at me and he was saying like ‘Well we could wait for the cavity to get bigger to then fill it’. And I was like ‘No it’s not a matter of me getting my money’s worth’ right I don’t need to fill a bigger cavity. It was like does that have to happen or not and if it is let’s do it and I kind of feel like it’s the same thing here. We don’t have to wait for when the baby is born and now the emotional experience is that much more dire and dramatic to step in. We want to intervene as early as possible because we can really-again-mitigate what that experience is going to be. And in Los Angeles a lot of the OBs I work with are really getting on board and starting to send people to me during pregnancy if they’re identifying that. So if as you’re working with moms during that preparation for birth you’re noticing her mood is shifting during that third trimester, that’s an indication that you want to jump in. Maybe get to know her a little better or maybe ask her some questions find out what’s going on. We want to understand the symptoms of PMADS and then treatment and intervention is really important. Right? Oftentimes we don’t like to ask people questions about sensitive topics, especially if we’re not sure what to do with it. Right? This is one of the biggest concerns in the field when we ask about suicidality it’s like ‘but if I ask can you say yes, what do I do with that’. Right? So let me just not ask. And oftentimes it’s the same thing with depression or anxiety. If I ask you and you say yes well now I’m stuck. So I want to make sure that you do you know what the options are that are out there and what role you can play within that bigger system. So mission statements: highlighting the gap in the prenatal education system by acknowledging the importance of accurate expectations parental support the primary relationship between partners. Why? Because we want to avoid becoming too baby centered and try to reduce the incidence of PMADS which is at an all time high. So oftentimes women will call me and they’ll say ‘Oh so this is a class I should take postpartum like after I have the baby’ and I’m like ‘No no we don’t want to wait’. We want you to do this while you’re pregnant. We want you to do this while ideally you’re in more of this blissful state of pregnancy, if you’re so lucky. So that your armed with that information ready to go. Rarely do we want to wait for the fire to be blazing to say ‘what was my fire plan? How did they expect that I’ll get out of this?’, Right? We want to have that ready to go. And it’s the same thing here. We want to have a blueprint of what to do and how to navigate it before it becomes a concern. And we’ll talk about what that blueprint looks like. So let’s go ahead and jump in, right. Just to give you kind of an outline of what we’re going to talk about today. We’re going to talk about some of the changes that happen in the perinatal period with a lot of the research of why this is the case. So many of you have children. Some of you brought your babes in arms and are expecting and can probably identify with a lot of different pictures up there. I call this the Good, the Bad, and the ugly side because it really runs the gamut of everything right. Hopefully we’ve had the opportunity to have these cozy warm moments and we know that the other side is also true. That there are parts that are challenging and conflictual. There are parts that we look at our partner and we say I can’t believe I’m stuck in this forever, right. I don’t like you anymore. And to recognize that a lot of that is really normal. And that’s one of the most cathartic things that we for our clients is normal.


Over 1 million first born babies born annually to couples in the U.S.

[00:10:51] No one likes to be the odd man out. You go to any sport support group right. And the first thing that’s most cathartic to hear is ‘Oh you’re dealing with that also? Oh you know what I’m talking about? Phew. I’m not going crazy. There’s nothing wrong with me.’ And even to extend that to ‘there’s nothing wrong with my relationship with my partner. This is normal’. Upward of 80 percent of couples will experience a decline in their relationship satisfaction when they have a baby. I’m a big believer that anything that 80 percent of people are experiencing is pretty normal and therefore we don’t want to pathologize it. We don’t want to leave it, but we don’t want to make it into more than it has to be. So here we go. Carl Young in the 1920s said this: the birth of the first child was among…oh The graphics aren’t coming up. There’s a really scary man going like ‘ahh’ now I’m seeing. Gotta work on that. The birth of a first child who’s among the severest shocks of adulthood which begs us to critically survey ourselves at our feet. It is the hallmark of the transition from youth to adulthood. The move from passion to duty and from ‘I wants’ to ‘I must’ so take a moment and let that settle in because that’s really saying a lot. Right. It’s not all about me anymore. It’s now about duty and responsibility and what has to get done. It’s not about being that carefree child anymore. There is now this other little entity who’s looking up at me to take care of things. And what do I do with that expectation that responsibility? And something else that’s super important that we see men more than women get stuck is the forevernesss of having a baby. This is it. This is forever. Right, if you get a job you don’t like you could go on vacation. You could switch jobs. If you’re at a school that’s not working for you, again, You can get a reprieve from it. There’s no getting away from baby. And for some people that hits them really hard. And we want to be able to identify that and really again normalize that for them so here we go. Having a baby is ranked 6th out of 102 possible stressful events that we will encounter in our life. That’s saying a lot you guys. It is one of the more common occurrences for couples with over 1 million first born babies born annually to couples in the U.S.. Nora Ephron in her book sums up the potential impact of the baby on the marital relationship. She said now of course I realized something was going to happen, right. Something was going to change. But what she talks about is that having a baby is like setting off a grenade in the relationship. It’s like an explosion in the relationship. And then she goes on to say but it’s not necessarily changing the marriage for better or for worse. But there is change that’s going to happen. Raise your hands if you like change. Raise your hands if you willingly bring on change. OK, so we have a few very brave people. Got a view wishy washy hands. For most of us change is rough, right?. And especially when you’ve just been through nine months of pregnancy labor right labor and delivery in the best case scenario is a lot. And it’s not necessarily our primed opportunity to say ‘Sure bring on change. I’m ready’. Yet it’s inevitable. Not better, not worse but it’s going to happen. So, Ruben Hill back in the day was the first one to talk about having a baby as a family crisis and when he talked about the crisis he talked about there being three variables that really impact that whole situation. The hardship of the event, the resources –and this is a big one– the resource is acceptable or accessible to the to the family having this change, and the family’s definition of the event. Our perspective is huge. Right. ‘So how are we perceiving us? Do I have the wherewithal to deal with this change? And if not, what is the hardship I’m expecting to ensue?’ Incidentally, this is the definition of stress. Right. ‘Am I sizing this thing up as good or bad? And then do I have the resources I need to deal with it?’ And if not that’s stress or that’s really stressful. Rasi came along in the 60s and said ‘I don’t know so much about crisis it’s a transition’ and that’s a really important word that we can share with our families. It’s a transition it’s not something you’re meant to figure out from day one. It’s an adjustment and an adjustment takes time. So often you’ll hear women talk about the expectation that the second that baby is born they’re meant to bond and love that baby wholeheartedly.


[00:15:50] And you know what. That’s not everyone’s experience. I remember with probably each of my kids, like they put the baby on you and they’re like ‘Do you want nurse her? Do you wanna love her? Do you wanna kiss her? and I’m like ‘Can they finish down there first? I don’t think that I have the emotional space to deal with this until they finish that’, right. The stitches the counting of sponges not the most romantic environments to be getting to know my baby. But it takes time and again normalizing for women that attachment and bonding is on your own timetable. Transition still stressful. Now Rasi is half right. Right. It is a transition it is stressful. I don’t want us to completely come away from this notion of crisis because for a lot of people it is an identity crisis. Having a baby calls into question who you are in a very different way than most things we encounter in life. And that’s important because you may have again some of your clients talking to you about or trying to you know kind of, under the radar if you will, ask questions about ‘Will my life ever be the same? Will I ever get to go back to work again? Is it OK that I want to go back to work? What does this mean now that I have a baby? Do I have to check my old identity? Now this is the only thing that I’m allowed to be about?’ And that’s a really big deal for people.


The motherhood transition.

[00:17:10] And sometimes I’ll kind of use the example you know how when you’re scrolling through emoji sometimes you know I’m like the emoji that you’re on kind of becomes big and centered and all the other ones are kind of small. And sometimes this is more of the experience that there is that initial period where that mother role does take center stage. But almost the promise that it will fall back in line and you will have that opportunity to pick up all those other things, or you know roles, that you hold dear. So no you don’t have to check yourself at the door. But it does take time and you are forever going to be changed by it. And that’s really important for them to be able to understand and to know that you’re open to talking to them about it and it doesn’t mean that they’re crazy. And that doesn’t mean that there’s anything wrong with them and this is a big one. It doesn’t mean that they love their baby any less. Right. And for a lot of women that’s the biggest concern. ‘But if I want to go back to work I must not love my baby. If I’m happy when my baby sleeps and I don’t want to spend 24/7 with them I must not really love them’. And you’re like ‘Gosh I don’t know mom around. But it doesn’t take that sigh of relief when that baby sleeps for 10 minutes, 20 minutes, maybe an hour if were lucky. And they need to hear this, because this is a lot of the things that people don’t talk about. And you’ll see what happens with the inaccurate expectations that we come in with. That’s what kicks us in the pants. When we’re not expecting… ah right on queue: ‘Expectations’! So when we look at the research it’s really important because here’s what we know. There is a tremendous connection with our expectations and what happens after that baby is born. If we’re coming in with inaccurate expectations you can put money on the fact that there’s going to be adjustment issues, because if I’m expecting the Hallmark approach to having a baby and I get a colicky baby, what do I do with that? Right. And you’ll have women who say like ‘this isn’t what I signed up for’. Right? I want to return this one and get the other baby that I thought I was going to have. If I have negative expectations going in if I expect it to be doom and gloom, it’s going to be doom and gloom. And so for women again, if we could start that conversation during pregnancy about what are your fears what are you expecting what are the things you are most afraid of. And create opportunity to talk about that. Well we have a chance to, ya know, balance it out and offer another perspective that can really impact that adjustment for them. ‘Violated positive expectations’. And this is a big one and this is something we see a lot of times in couples where you know mom more likely is coming in sometimes and it is coming in with this positive starry eyed expectation and then it’s somehow violated. What do you think? What’s the way that that might happen? Right, they feel prepared. They read the books. They know all of the things that could happen. They’ve talked to their partner they’ve made a plan. And then what? Then what happens? Well, one thing that could happen is that mom or dad can struggle with a perinatal illness that no one expected. And maybe someone’s less available than than what they were thinking. Maybe a family member who promised to be that support checks out and says ‘oh I can’t do it anymore’. Maybe a partner checks out. ‘I didn’t think it would be like this. I need to go off with friends. We’re in Austin, I need to hit the bar’. But I can’t be what you need me to be. Well you’re more needy than I thought you would be. So that sense of violation that could happen from an emotional perspective can lead to a really challenging experience. But increased thinking about expectations the more we talk about it, the more we open up the conversation and can prepare, it led to the best outcome which is why again during pregnancy we really want to be talking about this and why we want to be able to throw out some of those things that might feel like bombs that they had never thought about, but now that it’s out there what are we going to do with it. And we could process that and more importantly we can make a plan for how to deal with that. And family is a really big one. Lots of people have the expectation that even though my mom and I don’t get along and she annoys me and gets under my skin I’m going to have a baby that’s going to be great. So she’s going to move in with me for a month and she’s going to take care of me and it’s going to be awesome. And it’s like ‘Huh?’ Right? Babies aren’t magic. And in the same way that a lot of times we talk about how we live in life is how we birth our babies, how our relationships are before baby. They tend to get worse after because we’re more sensitive and we’re more vulnerable so the things that you used to say that got under my skin are now going to get under my skin my skin exponentially more so. So maybe not our best plan right? And maybe hiring someone, although not the dream, money well spent or Air BnB’s are amazing. Put them up down the road; create a buffer of space around you so that at nightfall you can take that deep breath, decompress a little bit, have that tantrum and then you know gear up for the morning. So as we continue to understand the transition to parenthood there are certain areas that are hotter topics that we tend to get into disagreements. And it’s interesting that we were just talking about mom and I’ll throw in mother-in-law, because I feel like if ever there was a category that was missing from this research that’s the one. Right? Two things that we argue most about with our partners at Anything is of life especially after a baby: one is money, and two is family. They’re really rough, right? So other things that come into play: chores and division of labor. This is a big one. And you’ll hear couples argue about this a lot especially if one partner is working outside the home, one partners in the home. Right? What happens when the outside working partner comes home. Do they help with the baby? Is it ‘hey I did my job and now I get to check out’? Hey how does that work? How do we negotiate that? You know work becomes it’s own interest entity because as you’ll see in a little bit when we talk about that identity crisis that women experience work is a big part of that. And I find that one of the biggest pitfall for relationships is when moms do decide ‘You know what I’m not going to work for a little while’. And even if the couple as a whole said ‘Yeah, this is a good idea this is what we want we want you to be a stay at home mom for the baby’. A lot of women will tell you they felt their relationship change in that moment, where they felt like they were less respected by their partner because their job no longer had a paycheck or they themselves respected themselves less. So even though in their minds they said ‘Oh I know I’m doing the really important job. But no one’s recognizing it the way that they used to’, Right? And so for them that could be a really big concern and oftentimes a course of discord for the relationship.


[00:24:22] Incidentally, I was talking to someone outside to go back to chores for a second. Gotten did a lot of research and what he found as a sidebar of the research that he did was that the biggest aphrodisiac that he discovered after having a baby was the guy the husband coming home or the boyfriend coming home and just pitching in and doing a chore, right? Nothing said ‘take me now’ more like doing the dishes or folding the laundry and you’re ready and here’s the thing: without being asked. So it wasn’t like you come home and you see the monsoon in front of you and say ‘Hi honey, how was your day? Do you need help?’ Do you think I need help? Right? But they just came in and they just did because nothing signals to the other person that we were a team and there we are truly in this together more than just pitching it. Right, when I come home and I ask you well then my assumption is that this is your work and I’m being super gracious by lending you a hand. But if I just come home and do; biggest’s aphrodisiac. So this is really important for our guys to understand because although laundry may not seem so sexy, you put it in that context and you’ve got that much more willing participant, right? When we can resolve these issues, as you would imagine, the relationship tends to be a whole lot happier. And so again it’s important to get couples talking about these things beforehand. What’s the plan? And some guys will say ‘You know what? I’d rather hire someone I don’t want the pressure’. Other people will say ‘OK we just need to get organized’. But the more we can talk about it beforehand the less we get hit from behind with ‘What do you mean? I thought this was going to be you, right?’ I was going and earning the money and your job is going to be the household and you’re like ‘who signed up for that, right? So we want to make sure that we can really discuss it. You know it’s funny because people always ask like ‘What is the best thing I can know about, you know, after I have a baby?’ and they’re expecting something like mind blowing or, you know, life altering and very often I say it comes down to two very simple things: Taking the time to talk with each other, because the more we can communicate and recognize how important that is the less likely we are to get stuck in the miscommunication that often happens after having a baby where everyone’s just assuming what the other person is needing but missing the boat. I call it the “communication misfire” and what happens is is everyone ends up feeling resentful and really frustrated because it’s like Gosh I couldn’t do more. And it’s like no one’s asking you to do more but I am asking you to do different because that’s not what I need and it may not be what you are needing but we’re completely missing each other in that process. So if we can slow down and take the time to talk to each other and ideally, I encourage people to do it on a daily basis. 10-minutes each of you and we’ll talk more about this, right: Couch time. But you’d be surprised how simple and life altering it can be at the same time. And really that’s one of the biggest things that we want to encourage people or talk to people that after having a baby is not life shattering. You don’t need anything big or dramatic. As a matter of fact the things that likely worked for you before baby are going to work again after but anxiety and transition often confuses us and convinces us well you’ve never had a baby before. So you have absolutely no tools or skills to bring up the situation. That’s not true. Right? If you’ve been in a relationship with your partner more than a day you’ve had moments of stress. You’ve had moments of miscommunication. I daresay you’ve argued. And so it ever has helped negotiate all those things back then, is going to help now also. And so we want to be cognizant of that and we want to utilize those skills. It’s tried and true. Right. So more than trying on new things. If it worked then it’s going to work again now. And that’s really important.


How do I find balance?

[00:28:13] One of the theories is one of my favorite theories when we’re understanding the transition to parenthood is the dialectical theory, because I feel like it’s very relatable and it really gets to the heart of what happens when we have a baby. So these three paradigms are what we’re going to focus on, right. This is this idea of autonomy versus connectedness. The notion of expressive versus instrumental and stability versus change and we already know how you all feel about change. So you know, we know where we’re headed with that one. So when we talk about autonomy versus connectedness, it’s really a big negotiation that is starting to happen because of how much time do I now have for myself and how much is meant to be devoted to baby or to my partner and women in particular confuse self-care and selfish all the time. Self-care feels like this guilty pleasure you all really are monogers of the opposition of that because you talk about, and really you stand for, the importance of taking care of yourself: mind, body, and spirit and it’s something that is going to take time for us to counter society’s expectation of what it means to be a woman. You’re meant to be selfless, you’re meant to be giving, you’re meant to completely drain out your batteries if you’re doing for somebody else. And this is something that’s oftentimes getting negotiated in this next phase of life. How do I find balance? How do I balance a sense of independence with a sense of dependence and an end in particular will really struggle with this. ‘What do you mean I don’t get to go out with the guys all the time? I just came home you know after a long week of working. I just want to go surfing. Why are you making such a big deal out of me surfing’, right? And it was interesting because I had a couple in my office just last week and he was like ‘I don’t know’. He was like ‘Maybe like 80 percent I should be able to do whatever I want, and like 20 percent I should be in the family’. And I saw that woman and you’re like ‘those are some really hard statistics’, right? I don’t know that many women would get on board with the 80/20 split. But it does talk about a new area of negotiation and how do we balance that and how do we figure out and recognize ‘yes to each need her own alone time and we need time for the couple while still taking care of this baby’ and it’s feasible and it’s possible. But it’s got to be talked through and it has to be negotiated and trial and error is going to be a really big part of that, right? Are you going to do alone time on the same night so you’re apart from each other less time. You know Monday night is alone night. And you get to babysitter but it’s one less night you’re apart from each other. Is finding a babysitter hard or are financially preclusive so that we’re going to take turns and Monday night will be your night and Tuesday night might be my night. And then Wednesday night we’ll be together night. But but how we figure that out is really important and it needs to be negotiated. But it’s important that we talk about and recognize the struggle implicit in that, so that we can figure out what to do with that. The next really important piece before we get there right so here we go. Young is continuing: having a baby shifts that relationship from that youthful orientation–that we talked about–to that fully adult orientation that requires individuals who may have managed to sustain a certain extent of self focus, to shift the responsibility to their child over their responsibility to each other or themselves. Throwing into conflict previously defined roles, routines, and self definition.


What happens to the relationship?

[00:31:49] I take issue with this quote a little bit and we’ll talk about that in terms of how do we prioritize everything, but it does a really good job at getting to the hard at what it is we’re trying to accomplish and recognizing the implicit struggle within that the second piece is ‘Expressiveness Versus Instrumentality’. So again you know pregnancy, assuming that pregnancy is relatively comfortable and easy going and you all are a big part of making that happen, it’s a time of bliss, bonding, coziness; We’re caressing the belly, we’re connecting with each other in a way that we never thought possible so much so that oftentimes, when you talk about transitions of parenthood, couples can’t even see it like there’s so glazed over and starry eyed it’s like ‘Well that’s not going to be going to be fine’. I’ve never loved my partner more than I love him right now. And you’re like ‘mmhm’ and that’s great. And really what we want to make sure that they recognize is that actually exacerbates the risk factor postpartum because we know that there are changes to the relationship and if we’re expecting it to be this continued bliss–well it’s going to be a pretty hard crash if that’s not the case. Right. All of a sudden we’ve set the bar really high that anything short of bliss there’s something wrong. And that’s a problem. Part of that adjustment is the recognition that the relationship does go from that blissful emotional you know baby-moon type of energy and moves into instrumentality. What needs to get done. We’re all of a sudden we’re not staying up late at night anymore talking for hours about our life’s dream and you know what’s our philosophy or our fantasy of being a parent. And now it’s like ‘Did you get the diapers? Did you remember to feed the baby? Is the baby’s sleeping? What time do they go down? When did they get up?’ and you’re like ‘whoa’. And it could be very overwhelming with just the have to-dos of having a baby. And really what happens is is that the more instrumentality sets in the more fun goes out the window we lose sight of enjoying and having fun and it becomes very much about what needs to get done. And especially women who oftentimes become the keepers of the of the schedule. And it’s like ‘there’s no room for spontaneity. There is no room for anything else. The baby is on a schedule and at 10:22 they go down. And at 12:43 they need to get up and I have a 20-minute window to feed them and we need to stick to it like clockwork’. And the guys saying ‘come on why are you being such a drag. Why are you being so rigid?’. Of course we know why mom is protecting that schedule because when the schedule goes awry and baby is fussy who’s going to be the likely recipient of that, right? Mom! No question about that. But it’s another big area of negotiation that has to happen and the recognition that when we swing so far to the other extreme we need to figure out ways to kind of even out in the middle a little that change change is coming. And what we want to think about is more than changes coming. It’s the shift from what used to be a stable environment. We have this. We know what the relationship was like. We knew who made dinners on Tuesdays we knew who picked up the drycleaning on Thursdays. We knew Saturday was the big clean up day because we let everything go to pot all week and we were in a groove. We had a system. I knew Thursday night was game night with the boys and Monday night was, you know, yoga with the girls and everything was good. It worked and we go from that sense of stability to a sense of instability because even in the best case scenario that learning curve of what does it look like. How are renegotiating this right. It’s like Groundhogs Day in the beginning where it’s this 24/7 loop with no real breaks insight of doing the same things over and over again and navigating how that works and how that makes sense in our lives and that’s really big and for many men that’s a bigger transition than for women. Because for a lot of women they’ve been thinking about this already and they’ve been getting connected with their baby and they’ve been really looking forward to the nursing and the different cozy moments.


What about my sleep?

[00:36:06] Another big area of change that happens is sleep is no longer the same. And if you are someone who really needs those six to eight hours of sleep that’s probably one of the biggest changes you’re going to encounter that and we need to give a shout out to breastfeeding because I feel like breastfeeding is one of those things that many women talk about no one ever told me. And it was the hardest adjustments that they had, right. You look at it on TV or you hear people talk about it it’s natural it’s beautiful it’s cozy. But if you think about the experience–first of all there’s a lot of pressure. There’s a lot of social and emotional pressure. I joke that the title of my first book is going to be you’re more than a pair of boobs for women to recognize that being a mom is more than just breastfeeding. If ever there was the flag that we live or die by for a lot of women, it’s breastfeeding. If that was a success, I’m a success. If for whatever reason that didn’t go well or wasn’t right for me, well I have now failed at the most important job of my life. That’s a lot of pressure right. That is definitely one of those things that can tailspin someone down the PMAD path very quickly. And another big factor in all of that is ‘what if something happened after the baby was born that precluded the mom’s ability to do that?’ A stay in the nick you sometimes. Another unexpected change can be really challenging. And oftentimes you hear women say that they felt like that was a moment I was taken away from them and we don’t really do well when things are out of our control. That really is a harder thing for us to adjust to. We really like to control, we like to have our say, we like things to go the way we wanted to. Kind of goes back to that change thing right. ‘I’m ok with change, as long as it’s a change I want and the change that I decide to do. You can’t impose change on me I don’t like that’. So if we were to take a lot of what we were talking about it really comes down to this. One of the largest determining factors right. That determine our satisfaction or dissatisfaction after having a baby is the strain on the marriage prior to the birth. So what’s really interesting is that every now and again you’ll have someone who will talk to and they’ll say everything was perfect beforehand and I don’t know I am struggling now after and I actually find that that’s very rare that more cases are not the struggles that someone has after baby are probably old struggles that are coming ahead now with a vengeance. So are our partners quirky little behaviors that maybe we were OK with, maybe we weren’t OK with, maybe we found ways to deal with it. After you have a baby we don’t have that same bandwidth to give to those things. And so old issues kind of come forward and now they’re much bigger in our minds because now we don’t have the energy to deal with that. And so for couples it’s oftentimes important to think about where are those relative areas of weakness or where others the relative areas of strain. Because again we can do a lot to put a plan in place beforehand instead of waiting for it to get exacerbated. The same is true for women as a whole. A woman I was talking to yesterday was talking to me–or two days ago rather was saying how you know she wanted to know if she had OCD and she was like You know ‘I never dealt with this before but all of a sudden I find that I’m very meticulous and I have to get things done and I can’t seem to let it go’. She’ll should be cleaning the refrigerator. It’s like who cares. ‘But the thought just gets stuck in my head until I clean it. It will give me a break’. And it was like ‘Really you never had that before?’. Well not like this. Like ‘ok so what was it like back then?’ And sure enough it was a familiar thing for her. But it didn’t bother her, because back then she thought she was dealing. She found a really effective way to cope and she had the energy to do it. But on this side now there is no extra time. And so with a 3 month old she’s very sick herself. ‘Why do I care so much about the refrigerator when so many bigger things need to happen?’ So we find that on the personal level and we find it on the couple’s level that all things really to that having a baby puts a spotlight on old issues and now brings them front and center after baby in a more pronounced way. So the old adage that having a baby brings us together may not always be true. Sometimes it has the opposite experience because we know that it comes with that stress. Any questions so far? OK let’s keep going. So the stages of the parinatal period. What can we expect? What really happens? The first big thing that happens is that rules tend to get really traditional and this is something that oftentimes again hits from behind especially because in 2018 we expect everything to be egalitarian, right.


[00:41:02] Mom could do anything dad could do, dad can do anything that mom can do. And we’ve lost a lot of those role divison some for the good, some not so good. But it’s hard because all of a sudden there’s this instinctive pull towards those more traditional roles. So for a mom oftentimes it’s this feeling of I need to take care of the baby. They’re nesting. They’re nurturing that baby. The House is really important to them. For a lot of men it’s this surge of ‘oh my gosh it’s going to be another mouth to feed. I need to provide that I need to protect my family’. And this can be very different for a lot of people. For men oftentimes it doesn’t really hit until the baby is born. Many women are already starting to think about it and notice it before because nesting is isn’t shy nesting comes on pretty strong. We’re all of a sudden I can’t I’ve never spent so much time picking throw pillows, right. But all of a sudden they’ve got to be just right I need to find just the right ones and they need to be a hyper allergenic and they need to be organic. Right there’s this pressured speech that comes with it because it’s all of a sudden so important to us. For a lot of women with that traditional role, there’s also this perceived loss of power because it’s like ‘Gosh I used to run an office I used to run a factory. I used to you know command a force and now I’m spending my day counting poopy diapers or remembering what breast I last fed the baby like that’s the extent of my day right now?’. You know and for some women not having that checklist in front of them and being able to check things off along the way it feels like I’m not really doing anything. It goes back to that groundhog’s day experience of every day is just the same. ‘And I can’t seem to get the grocery down or I can’t seem to get the beds made or we won’t talk about the last time those toilets were cleaned’. So that could be really hard for them.


Where is the dad/partner/masculine tribe?

[00:42:52] Men oftentimes feel very confused and marginalized. Very often what happens after a baby is born– as I say a man was born, sure why not– that after a baby is born is you’ll see that women get encircled by other amazing women and their women are happy to usher that new woman into the motherhood fold. And oftentimes when we do that, right if you’ve ever had a group of women get together, not unheard of that women will spend that time making fun of dad or making fun of the men in our life or the inept things that they do. Even just today it’s very funny I had our friend go to my house I needed her to drop something off and she said ‘the entryway in your house looks like a bomb went off’. I was like ‘Oh you mean all the boxes accumulating right? We’re going on a ship in a couple of weeks’ she goes ‘Yes, but I know if you were home I never would look like that’. Oh but you know men, right? She doesn’t know that I said to my husband do me a favor don’t open anything because if the kids get into it I know what a monsoon it’s going to be trying to organize those returns again. But her assumption was ‘Oh silly dad, he doesn’t know how to figure out how to open a few boxes’. So women get together–and honey if you’re hearing this hi, I know you got it– but when women get together, it’s not unheard of that we make fun of men and when we are making fun of men, men get marginalized and they get pushed to the periphery. And for some men they are like ‘That’s fine because I don’t know what I’m doing here anyway. I like the stable environment that’s waiting for me at work. I know what to do at work. You’re OK here. I’ll leave I’ll go to work’. The problem with that is is that even if you are leaving the new mom with all of these great women in her life a lot of women still feel abandoned and they still feel neglected by their partner, who in their mind, ditched them and left. And that could oftentimes be the catalyst for that downwards kind of relationship satisfaction because ‘Where did you go? Why did you leave me? We were in this together’. And he’s saying ‘But I don’t understand. I left you with like a thousand people to take care of you’. Yes. But it wasn’t you. Right. And so that’s really important that we negotiated. Because when that happens, like we said it’s the beginning of that rift for the couple, but also what happens is that women then start to act as a gatekeeper creating these barriers ‘You wanna get to baby you gotta go through me. You’re going to make this right if you want to get to him’. And babies also respond as well. And what we find is that when babies don’t have that same connection with Dad, they stop looking at dad as a source of social referencing. So for all of you who do have kids or nieces and nephews right, if you’ve ever had that moment when a child falls or they’re not quite sure what to make out of it. What do they do? They look to you, they look up at you right. They look up at caregiver’s and they say ‘Was that really silly because if it is I’ll do it again. Was that scary because if it is I’ll start to cry’, Right. ‘Or if I was you know if it’s no big deal, I guess we can go on with life’. But when dad’s get marginalized, babies stop looking at them as a source of social referencing and we don’t want that to happen. So it’s important again that we keep mom and dad or birthing and non-birthing partners connected because as you’ll hear me say several times today the ability to parents really comes from our energy and our capacity to partner right. Our ability to parents comes from that partnership some of the physical and psychological changes that happen. I like to talk about sleep hibernating. It does come back eventually. Not always right away. And it’s important that again we talk to new families about what that is going to look like because most people already know if they’re the kind of person that can survive without sleep or if life crumbles around them if they don’t sleep. And if that is the case we want to really again intervene as quickly as possible to help them come up with a plan for how can they maximize the sleep potential in light of having a new baby. One of the biggest risk factors of a perinatal mood and anxiety disorder is lack of sleep. As a matter of fact that’s one of those the litmus questions that you can use with your clients. If you were to ask them why if we ask people about ‘are you feeling anxious or are you feeling depressed’. Those are again more loaded questions that people might say ‘No, I’m fine I’m good I’m fine’. And you’re like ‘really?’ and there like ‘No, no, all good’. And they may not be as likely to give you an accurate or an honest answer. Sleep tends to be a less loaded question. Many of us are all too happy to talk about the crappy night’s sleep that we had or the challenges that we’re having with sleep. And so if you were to ask the woman and work it into the conversation, right, if you were to have a room for eight hours and you knew your baby was completely taken care of; Maybe it’s a room at the South Congress hotel or a very cozy and very inviting. Would you be able to fall asleep? And if the answer is no I don’t think so. That even when the baby sleeps I can’t seem to settle my mind or I’m so so worried about what has to get done. That’s a risk factor.


[00:47:55] That’s a warning sign that there’s something more going on than just adjustments of parenthood. Right. And that’s important because sometimes it can be really hard to tease out what’s normal and what’s not normal because we know that a lot of the things that we talk about changes in sleep changes in appetite changes in mood they do happen when we have a baby. So this is definitely one of those like tricks in your pocket to be able to navigate. Do I need to investigate further or is this more likely within the realm of normalcy. Feelings of neglect and loneliness which we talked about can lead to increased negativity that happens. You know again with that lack of sleep we know that we’re not at our best when we’re not sleeping. You know there’s some more intense studies that talk about what happens if a woman or individual doesn’t sleep and what they found was is that after a month of depriving someone of REM sleep they were clinically depressed. 100 percent of participants were physiologically depressed. But again we don’t have to get that extreme because I know that if I haven’t slept well and I’m sure I’m in good company I’m irritable I’m not as patients. I don’t have the same space to give to my 2 year old who wants to tell me the same story over and over again or ask me 35 times ‘why is the sky blue mommy’. I’m just not going to have it in me the same way. And we know that translates to our partners also we’re more irritable we’re more short with them. They may summon say something benign and we’re like ‘why would you say that’.


[00:49:24] ‘What are you really thinking. I can’t believe you would do that’. And he was like oh my gosh I’ve no idea what you’re talking about. And you. So we’ve already started to talk about the relationship changes. I always like to put the caveat on top, right. We don’t spend as much time talking about the fact that having a baby is beautiful and loving and this blissful moment in our lives. I feel like for the most part clients don’t need us to talk about that side of it the same way as they need us to be able to balance out. Yes there will be those wonderful moments but just know there is another side to it. And I want to make sure again that you know the whole gamut of what it’s going to look like so that you’re prepared. So when those blissful moments happen, you enjoy them and we appreciate them. And when they go away, we have the wherewithal to regulate them and deal with them and hold on until the next blissful moment comes. So that’s really important. The stress of early parenting can interfere with our capacity to communicate in a very strong and real way which is like, which is why like I said a little while ago helping couples recognize if you just carve out time to sit and talk, you have no idea how many problems you can mitigate and avoid. Just a few minutes of getting on that same page is going to be life altering. The last really interesting thing that happens when we have a baby is that fathers tend to withdraw. And we already started to talk about that, right. They’re not really sure what to do with themselves. After all Mother Nature created the blueprint for women. Women are going to get pregnant, women are going to have the baby, birth the baby, and if they’re so inclined they’re going to deliver the baby. So far science hasn’t mucked up that system too much, right, yet. But what about men. Where do they fit into the system. If they were to look back a generation or two ago they would think I earned the bacon. I come home there should be a cocktail in hand waiting for me. I get to sit down and read the paper because I did my job. I’m earning the money. That’s my contribution to the family. I don’t know any women nowadays that would be OK with that arrangement or they’re few or far between. Most of us you know when our partners come home it’s like ‘I’ve been with this baby all day here. I need a break. I haven’t peed by myself and I haven’t eaten all day. My gosh a shower’. And they’re like ‘No, no what do you mean I’m done’. And you’re like ‘you’re not done’. And so that could be a really challenging experience to navigate. So for men, men withdraw. They’re feeling marginalized. They don’t have the blueprints of what to do with themselves. They’re already feeling this deeper surge of ‘I need to make more money. I have another mouth to feed. I’m the dad I’m responsible’. The changes happening that they don’t like. ‘I’d rather go to the office where I feel more stable and people still revere me and call me Mr. so and so’. And so and then there’s mom who like we said oftentimes feel abandoned if Dad did leave there feeling really emotional and sometimes neglected. And the answer is that gatekeeper keeping dad at bay. So dads can tend to withdraw. And it’s so important that we help men understand that their role in having a baby is so vital and unique that although it’s true that that first year of life most babies prefer a mom and not because you breastfeed. Right. Let’s let’s kind of debunk this misnomer now. So many people are happy to say of course he likes you better you have the milk source. It’s not about that, right. Harry Harlow discovered many many years ago that why babies prefer moms is that coziness, that contact comfort that he talks about it’s the nurturing that we offer our baby that keeps them close to us. But come that second year, most two to three year olds when they when they survey them they prefer dad because dad’s more fun. Sorry guys. When we play with our babies we’re doing a puzzle we’re cleaning up a little on the side, that puzzle gets put away before that next toy comes out. Think about what the house looks like after dads play with that baby. Right. It’s a storm. Pillows are everywhere. We can only imagine what the games were that created the mess that you’re now that you’re now dealing with. That’s because of Dad’s natural energy to play, our babies get some very cool gifts as a result of that. One thing that dads teach babies is the capacity to self-regulate because the pace of play with dad is up and down right and left and moving fast and slow and all around. They literally learn how to modulate their own a because I could be all the way up here and I could figure out how to come back down which is so cool because it’s something that’s happening very instinctively. The other things that they have identified as a as an outcome of the way dads play with babies is that kids tend to be more socially adjusted and that social adjustment goes all the way through their relationships in middle age they tend to be academically smarter. They get sick less often and their capacity to adjust to school is more efficient. So a lot of very cool things that come out of it. What I like to recommend for a dad to kind of hold on in that first year is let’s give him a job, right. If Mother Nature didn’t do it let’s do it and let’s help dads figure out what is that anchor keeping them in and dads can pick. Do they want to be on top of reading the book? They want to be on top of infant massage? They want to be on top of bedtime? I had one dad who was like I want total rights to dress the baby. And you’re like ‘oh that’s interesting’ it’s like ‘Yeah just to piss you off and you’re like less less interesting’. And Mom was like ‘Hey you can have it as long as baby wears a sign all the time that said Dad dressed me’. So there’s ways to negotiate everything. OK.


[00:55:17] So we know that about 67 percent of couples will experience a decline in their relationship satisfaction when they have a baby. So about 70 percent of couples will experience a decline in their relationship satisfaction when they have a baby. So remember that bliss thought we were talking about during pregnancy for about 70 percent of couples that is going to change. And it’s not to say we can’t get back to that. That is to say that it’s going to go through a refractory period for most people. 33 percent didn’t have that change happen at all. And it’s important to understand why that’s the case and what are things that we can help our clients navigate or figure out to increase the likelihood that they’re a part of that group. So before we jump into that this is what it looks like, right. Successful navigation of this change requires strength in our resolve, motivation, and a quest for unity. So Young, back in the 1920s, already foreshadowed by BirthFit was gonna do, right? How to give women that sense of strength that inner sense of strength their capacity to push the limits how to take care of themselves how to find that motivation then inner resolve. Right. That’s all that we need to make that happen. And you are. You all are really at such a pivotal time in those early days of helping women connect with that inner energy of ‘I can do this’ and starting their conversation and keeping it going. So one last word about why talking about it during pregnancy is important. These were the results that when couples spend time taking and transitions or parenthood workshop you know like the after birth plan, they find that their relationships tend to be more stable so we mitigate a lot of the change and we can create more stability there is less interrelationship hostility. And remember when we talked about the ability to parent comes out of the ability to partner, well that also is intensified because we’ve already started to think about how do we get on that same team. How do we work as a couple and as a unit? Not to mention the reduction in PMADs. For dads, we find that they tend to be appreciated more. They tend to have an increasing sense of positivity and they’re less likely to withdraw. So most of us when we were talking a couple of minutes ago about all the benefits that come from having an involved partner, we want that. Right? We want our babies to be able to regulate their emotions we want them to be successful in life and we want our partners to be a big part of it. You know very often you’ll hear women talk about yes I wanted to have a baby but I wanted to do it with you. And the fact that you’re no longer here right makes me question the system because it’s not what I was signing on for. I wasn’t signing on to have a baby. I was signing on for us to have a baby and to do it together. And so it’s often very hard when those men tend to disappear because we don’t get it and we feel like a certain degree we were sold a false bill of goods. And the other interesting thing like we said is that babies tend to be more responsive or receptive to Dad’s capacity to soothe. So social referencing and soothing is a big part of it. We also know that there’s a lot of benefits for baby. Interestingly enough, so even though those babies are not born yet, they find that there’s less language delays when a couple is doing well. We find that they tend to smile more often and they tend to enjoy the collective relationship time. So babies have a better adjustment, Dad stays more present, and the couple is stronger and better for it. OK. Any questions? So yes.


Question from the Audience

Audience: [00:59:03] I was just thinking about what we were talking about with the prenatal series and I cant remember all the comments but there was sort of like a comment about how it was hard to get dad to come once a week and when they said that I kind of thought about ‘Yeah, wait ’til you have a kid, right’ and then so Im just kind of wondering if theres a way– because I feel like were teaching to mom with alot of stuff that we’ve done, which is great but is there a way we maybe could tailor a little bit more to dad? And what kind of ideas do you have that might help dads get pumped?


Dr. Alysa Berlin: [00:59:42] Right. And it’s a very very important question because like you said we oftentimes are kind of preaching to the choir. Moms are inherently more motivated they’re excited they are the ones to come and to some to some degree that’s natural, right. Oftentimes women are also the gatekeepers of the relationship. So it’s more likely going to be the woman more than the man to come over and say gosh I don’t think we’re doing so well or we can maybe use a little extra help or I miss you, we haven’t had a date in a really long time. And they say that’s us to be with a little bit of a grain of salt because it’s such feminine energy. But just because it’s a feminine energy doesn’t mean it’s always the woman who kind of embodies that feminine energy within the relationship. And so we just kind of want to be aware of that that in certain relationships, it’s more of the man that takes on that feminine energy and you’ll see kind of that carry through throughout. But some things that we can do to try to get dads involved. One thing is to really start to find a way to disseminate some of the information we are talking about today, in terms of helping them recognize that there is such a big part of us right and all of the benefits that their babies get because of them. Because oftentimes they don’t think that they have a role and it’s like ‘OK call me when the kid is three and I’ll throw a ball around with them’. But until then they don’t really see that they can do anything. ‘I don’t have this. What are you going to do?’. Right. Is what you’ll hear men say quite a bit. The other thing to think about is the aphrodisiac part. I find that that’s often a hook for men to come in because you know, again somewhat of a stereotype but very true, that men have that on their minds. Normally, I would say it but with our little birthday guest you know what I’m talking about. I just want to make sure you’re still listening. So it is a very natural instinct to draw them in; to know that that’s not going to disappear and that that’s a focus of getting that back on track and we’ll talk more about that. The other thing that I could think is really cool is again very in line with what you do is the exercise side of it and to perhaps think about you know almost couple exercises are ways to bring the dad into that part of it because coming to the gym is cool. You know what’s really hard is that men in general tend to distance themselves from anything that’s too girly and you don’t get more girly than pregnancy. You don’t get more girly than having a postpartum illness, although we know men can get it. And so they kind of tend to put their words up. And so you talk about a pregnancy group. ‘Well that’s so girly you go you do with your mom friends’. But if we can kind of man it up a little bit you know maybe go down that exercise route or that couples route that may be another hook to help. But you’re right it is definitely a challenge. So if we frame it not as a pregnancy series but it’s a workout series and then we throw that education in, they’re not always all too wise to that. Very often when they do classes right it was a little bit of a pull to get the guy in and then oftentimes he’s the last one to leave. So it’s that initial barrier that we’re trying to get through other ideas: what have other people done to help get the guys on the front door? Yeah. He’s like not me not me. Yes.


Audience: [01:02:58] Testimonies from other men who are taking the course so they’re not alone. Just to hear from another guy about how much they learned.


Dr. Alysa Berlin: [01:03:03] Right. Tooting it up right. Hearing from another guy is going to be really helpful because it’s like ‘Oh I’m not alone. And if he did it I can do it’. Sometimes you can almost you know pose it as a challenge ‘Are you manly enough to do it’, that can sometimes work.


Audience: [01:03:23] Is there a different teaching style for men?


Dr. Alysa Berlin: [01:03:28] I feel like sometimes the analogies are different. I’ll use a lot more like sports analogies, when it comes to working with men and try to speak more of their language. I’ll also try to kind of like throw them bones or wink at them ‘I know this is really hard right’. To help them feel more like a part of it. Sometimes I’ll also put it in the context of coming to support mom. You’re being that good that great partner if you will. You and I both know that they’re going to get just as much out of it, but there are you know there’s so much that they’re willing to do for their partner. ‘Oh this makes me a good dad, this makes me a good husband? Sure I could do it’, right? And then they all of the sudden walk in and you know are all out there studying it. There we go. You do it so much better than me. But that could also sometimes be helpful. I definitely use that in therapy a lot. Come support mom.


Audience: [01:04:19] Do you find the same for homosexual couples with the partner in their relationship with kids that they have the same type of outcomes with playing with the partner who’s not neccessarily the dad?


Dr. Alysa Berlin: [01:04:41] And it’s interesting and will talk about homosexual couples a little bit later because there are some unique things that come into play. You know specifically with lesbian couples one of the bigger concerns that they are struggling with is it’s almost like who’s the mom. And sometimes that becomes a barrier for them because they are really struggling to find their role. And for the non-birthing partner you know their dream is always have been have been the mom, but they feel kind of marginalized because they weren’t the one that carried the baby and they weren’t there not the ones that are breastfeeding the babies so they may be dealing with their own stigma associated with that. It also happens to be one of the biggest questions that they ask that they get asked all the time. ‘Oh who’s the real mom?’, which can be devastating for them. So coming into a pregnancy series with other women where the expectation is for the most part that the woman is the mom who’s giving birth, can sometimes be that barrier for them. The truth is is that we need a lot more research because there is not a lot of research to support that. But this is one of the bigger things that come up time and time again that they struggle with: that sense of identity or identity crisis. And interestingly enough you know you also then can sometimes have us being couples where the non-birthing partner doesn’t associate with being a woman anymore. You know she really associates more with a male persona and wants to be ‘papi’, which brings a whole host of different concerns and issues into the picture. So yeah if we have time I hope we’ll get to go through it together but if not just to orient you to the power point the last couple of slides and the PowerPoint are really some of the changing faces of families. Because we know that all families are not Caucasian male and female. We know that single parent families are at an all time high. And how do we support single moms and single dads. And that’s unique. We also know that there’s a lot of multicultural implications that we want to examine. One of the things I love about my practice right now more than anything is that there’s such diversity and I’m working with couples from all over the world. And it’s so interesting to get to step into their culture a little bit and you know understand things from their worlds view and help them through this adjustment. For the most part right. Spoiler alert, for the most part when we look at African-American couples they find that a lot of the same things that we’ve been talking about that the that Caucasian individuals deal with, that they’re very much the same. But with the recognition and the caveat that there’s still a lot of research that needs to be done because they are under represented in the research. Good question, thank you.


Audience: [01:07:18] If someone who couldn’t make it to the class, what are the most important for people to talk about before the baby comes? Is there a top 3? A top 1, where you’re like ‘you should totally talk about this before the baby comes’?


Dr. Alysa Berlin: [01:07:37] Sure and with your permission, let’s hold it to the ends because we’re going to talk about a lot of different ideas and then maybe as a group we can come up with what our top three would be. And I will definitely chime in with my thoughts as well. So from my perspective, relationships are like going up a down escalator. All right. So think about that for a second. Relationships are like walking up a down escalator. The second we stop investing in that relationship and actively working towards holding onto what we have right. What’s going to happen? Life is just naturally going to bring us down and divide and bring us apart because stress is real. And I’ll tell couples all the time or I’ll tell women all the time that they come in my office nothing that we’re going to do is going to make life, well I hope it’ll make life less stressful, but stresses we’re going to keep coming, right? We’re not going to be able to magically make stress disappear forever. How we deal with it though is what we want to talk about. And the same is true here. Stress is inevitable and women we’re not actively working on that relationship. Stress will inevitably bring us down. What happens when we have a baby. It just speeds up that escalator and it just means that we have to work twice as hard to hold onto that connection with our partner and really, really safeguard it. So let’s go ahead and look at that postpartum escalator for a second and I’ll tell you why I use an escalator, right. Of all the different analogies I could have used, what I like about an escalator is again if you think about what it takes to climb up an escalator it’s one step at a time. Again there’s nothing massive there’s nothing big. It’s something mundane that we do in our lives all the time so people can connect with it and it’s very doable and reasonable. And one small step in the right direction can have a tremendous impact on our relationship. So again dispelling this notion that it’s got to be a big gesture, right. Sometimes guys or people in general miss that. But the only thing that anyone’s going to respond to is a giant gesture taking you away for five days. So I know I’m just as happy if you carve out two hours in the afternoon for us to hang out or you know there is always–I don’t know–chocolate’s work for me. So, OK formatting that can go as well on the conversion. But let’s go with that.


[01:09:52] So we’ve got things that will bring us up and there are things that are going to pull us down just to orient you sleep. Ground Zero. It’s something just necessary. One of my kids came home from school the other day and said ‘Did you know that you will sooner die from a lack of sleep than you would a lack of food?’ and you’re like what are you talking about in school? But it talks about how primal and important sleep is. And it goes back again to that magic question that we talked about. None of us are any good to anyone for not sleeping. And one of the first places we will always intervene is with sleep so that’s always Ground Zero. We need that sleep. And then there are things that help us climb up and we’ll go through the things that help us climb up one by one. Here are the things that pull us down and let’s just take a moment to talk about that and a lot of them are the things we’ve already talked about so let’s just highlight it. When our relationship becomes too baby centered. That’s not a good thing. And we think it is and sometimes it’s somewhat misguided it’s like ‘But she’s so cute and she’s so cuddly and she smells great’ and you’re like all of that is true. But she’s also not gonna to miss, not only that she’s going to benefit if you’re connected to her or her parent her father. And that’s really important when the relationship becomes too baby centric, we’ve actually lost our focus. Because before that baby was ever there and long after that baby goes to college, we want this relationship to endure.


[01:11:14] Resentments. You talked a lot about all the different ways that resentment can kind of come into that picture, especially with the needs that go unmet or unnoticed. It was so funny and I wanted to take a picture but I was driving but I was going down 1st Congress. And there was a sign that said “Pizza is my love language”. I’m like ‘OK I can with that’. Pizza is my love language. Resentment comes into play so often when we have no sense of what our partners love language is or worse, we’re talking to our partner out of our love language. And I’m sure you’ve all heard about the book. It’s definitely worth looking into. But this notion that we each talk a different language or what’s going to make me feel loved and connected is very different than what’s going to make you feel loved and connected. And how do we get outside of our space to connect with our partner. It was very funny because I was working with a couple and they discovered that her love language was acts of service and his love language was verbal affirmations. So after he got over the ego blow of ‘that’s such a loser love language’ and you’re like I’ve never heard that before. He’s like ‘verbal affirmation that’s not manly’. You’re like ‘sorry’. But he came at it from this perspective of: Her love language is acts of service. So she went over to her and said I know your love language is acts of service, I want you to know that when you clean the dishes that makes me feel better. And she was like I’m so confused.


[01:12:35] Well if acts of service or your loving was let me tell you how do acts of service for me. She’s like that’s not my love language to do acts of service for you. Yes. We’ll tweak that system a little bit. But this notion this notion of speaking our partners in the right language and that could minimize a lot of resentment because let’s think about where that resentment comes in and it goes to this communication misfire. As you’ll hear people say all the time: ‘My partner’s so is so you know with such an inbreed. I’m doing so many different things and they’re not appreciating any of it. Why are they not appreciating it?’. Because it’s not the things that they’re needing or asking or wanting, because chances are they’re talking a different language. But everyone’s like ‘I can’t stretch myself anymore. I couldn’t possibly give any more’. It’s like I don’t want you to give more. I want you to give different. I want you to listen to me. It’s very interesting. We have a few men in the room, we’ll see if they agree or take issue with it, But I find very often that around having a baby in that transition to parenthood. Men make great soldiers, right. We’ve got one. Reporting for duty. What does that mean? There are not always the best at identifying what needs to be done or how to do it right. You go into that first situation the moms having back pain. She’s like wow. He’s like ‘Tell me what to do. I want to help’, but they don’t know what to do on their own.


[01:14:04] Give them a directive and they’re also happy to just jump in and get it done and they go yeah there’s that strut that comes out of like ‘Now I’m a man, now I’m figuring it out and now I’m being helpful’, which is really what they want to be doing. And the same is true on the postpartum side. They meet greet soldiers, if they know what needs to be done they’re happy to do it. When we get stuck is women say ‘but then it doesn’t mean as much. But I want him to want to do it’. And you’re like ‘I get it. Let’s get over it’. Yes.


Audience: [01:14:33] Do you feel like its common for women or men’s love language to change pre-to-post baby?


Dr. Alysa Berlin: [01:14:40] No, not typically. And it goes back to about that idea that who we are before tends to be who we are after but more supercharged. So no I find that it often is the same. Do you have personal experience where you’re thinking about something?


Audience: [01:14:53] Just personally i felt like I wanted that touch and time with my husband before, but I was so overtouched and overtimed by my son that when my husband touched me he got…


Dr. Alysa Berlin: [01:15:09] No words were necessary in that moment, we got it. Yeah but to a certain degree, I would venture to wonder and you would know better if that was short lived through that initial breastfeeding get off of me I’m already being touched enough and then kind of came back as soon as you started to integrate back into your body or baby was feeding a little bit less often. So maybe we say it goes into hiatus a little bit but you’re like ‘No, still don’t touch me’.


[01:15:34] Right I still learned to get prenant so…


[01:15:39] OK. But you reset the clock that’s not fair. Well you see I feel like to get a real accurate test, we need to be six months out of the next one. So you have to report back to us. But that’s a very good point because let’s say some of our guys feel like they do have us figured out and all of a sudden we are changing the rules. How do we send them the memo that although that is what I used to like and maybe it will be what I want again, right now it’s different because my body is going through so much? And that’s again where they make great soldiers because they just want to get that memo and they’re all happy they’re all too happy to, kind of, comply with that. Physical touch is sometimes hard, because men kind of have their own agenda with that. Although I did the research, the oldest man to die not having had was about 94. So it’s not going to kill you, as much as you would like to suggest otherwise. Sorry guys. Is that it or are you taking my mic away? Am I done? And why that’s important information is sometimes to hear men talking about pressure and their needs and their wants and it’s like I get that. But again how do we kind of altrerate in that postpartum period a little bit to meet the need for intimacy, but still be respectful to what everyone’s needing. Yeah. thank you. And then the last thing we started to talk about this when we were talking about instrumentality versus expressiveness: this idea that life becomes just no fun. Right. We get stuck in the drudgery and the responsibility. And maybe for some women the responsibility is fun. Right? ‘It’s feeding time, should we go get bottle and you’re so excited and it’s nap time’, but it’s like ‘when’s the last time we did anything fun? When’s the last time we did anything that kind of harkens back to what it was like when it was just the two of us, like I don’t know cooked dinner together or watch a movie sit and talk for more than two minutes?’ And it’s really important because when we lose the fun it’s when we lose that connection and it’s when the work then feels like work. If we find a way to do it and so have a fun and good natured energy around it, well then the work is no longer work and it becomes an expression of our love for each other and we’re also happy to pitch in in that way. And that goes a lot to this notion of, and we’ll talk more about it, but ‘appreciation’. If I feel appreciated. I’m also happy to give you the world. Like there’s nothing I won’t do if I feel appreciated. When we feel taken advantage of or we take it we take it for granted or like we said we lose sight of the fun, well then it’s just drudgery. So it’s really important that we help our clients recognize the importance of appreciation and positive regard. Helping them recognize how a few kinds of words in the right direction can be life altering. You know that partner who comes in and says ‘Wow how did you manage to get dinner done today. You’re amazing. I was with the baby yesterday and I couldn’t even feed myself a sandwich, And you were with the baby all day today and you made dinner. I really appreciate it you’re so amazing’.


[01:19:01] A person lights up when they’re appreciated. The other important thing that when it comes to appreciation that we need to be careful of is that we don’t go down the correct criticism bomb and those of you that we were together two years ago may have heard me say this and I’m going to repeat it anyway, which is the notion that: there’s no such thing as constructive criticism; it doesn’t exist. It’s a moniker we gave too. I’m going to tell you what you did wrong and put a smile on it so you’re going to take it in and there’s a different way. Right. I’m yet to meet the person who’s been told how inept they are at loading a dishwasher or folding clothing or watching the baby efficiently who just said ‘Wow, I feel so much closer to you. Thank you for telling me how inept I am right here. Now let’s go’. Doesn’t work. It doesn’t work. Criticism is criticism. You will get a whole lot farther by finding those moments of doing right and capitalizing on it. And even if it’s not perfect and even if it’s a small approximation of the eventual behavior you’re looking to create. You’ll get to that eventual behavior a whole lot faster. So one thing that has happened with my kids in the past is you know let’s say I’m trying to get them to put their clothing in the hamper. Right. And let’s say you know one of my kiddos takes their clothing off in the bathroom and just leaves it on the floor and then goes about their business. I could look at that child and say Sweetie you missed the boat. Right? The clothing wasn’t meant to stay on the floor. It’s meant to go in the hamper put it in the hamper or let’s say that same child takes their clothing off and instead of putting it on the bathroom floor remembers to bring it into the bedroom. Still didn’t quite make it to the hamper, I could look at them and I can say I’m so proud of you for remembering to bring your clothing into your room with you. Right. That’s great. As I’m putting it in they hamper for them. So did they do what I really wanted them to do, which was to take the clothing off and then the hamper? No. Did they remember the first step in that sequence of events that has to happen for the clothing to get from bathroom to their hamper? Yeah they are. And if we can if we can acknowledge those earlier steps were much more likely to engender positive energy and increase the likelihood that they’re going to want to do that whole sequence on their own because chances are you’re putting that clothing in the hamper there saying ‘Right, I forgot I was supposed to put it in the hamper’, and they kind of make that mental note. And incidentally it works with kids and it works with partners. So we want to remember that we’ll get a lot farther if we couldn’t find that little sliver of positivity and capitalize on that instead of saying ‘What are you doing?’. He’s like ‘I’m loading the dishwasher’. ‘That’s not how you load a dishwasher’, ‘Well then forget it you do it’. Anyone think he’s going to load that dishwasher again anytime soon?


[01:21:46] So, ‘intimacy’. Intimacy is really important and this is one of those very taboo things that exists within a relationship that again your clients are going to be so appreciative of for you opening that conversation or making it okay to talk about. And it’s always so interesting when I go in to talk to mommy and me groups or support groups that the conversation always starts very coy. And then as soon as that one person jumps in, that’s it. Everything’s game. And you’ll hear people talk about the good, the bad, and the ugly of the struggles that they’re having in this very important part of their life. Why is that so important? It’s something that’s unique; just the two of you. I venture to say anyone else can cook for you, can clean for you, can shop for you. Hopefully this is something that only the two of you can do together. Hopefully. It’s very important to recognize that for men and women they come at this experience from very different perspectives. Men are like microwaves. Women are like crockpots. What does that mean? Men: good to go, any time. Thirty seconds later. Dinner’s ready. Beep! Women, on the other hand: if you put dinner up in the morning and spend the day slow cooking and nurturing and making sure there’s a nice emotional connection at play, then that becomes the culmination of all that stewing and simmering and slow cooking. So men it’s a means of connection. For women it’s an expression of a connection that’s already there.


[01:23:20] So you could imagine how hard it could be on the postpartum side when we come at it from different perspectives, trying to think about how to give you this example. I had a client who said she would happily disrobe right, if she felt appreciated at a minute’s notice. Right. Why did she say that because her partner is like will you use this as a bargaining chip. It’s a currency for you and she said it’s really not. I will happily do anything if I felt like you got me and appreciated me. So that’s really what it’s about. The other important thing to think about is that oftentimes the night is the wrong time to try to bring this back into the relationship, because unlike most activities, is if it has to compete against sleep it’s gonna lose. It’s not even going to stand a chance. Heck it’s not going to make it to the list. So couple of things when possible. Don’t leave it for nighttime and you do want to plan for it. And why do we want to plan for it. Yes it’s still romantic yes it can be a really powerful connection as removes a lot of the barriers that are likely going to be in play. And again it helps a lot of us get out of that mommy persona and that spit up clothing and connect more with that partner persona. If no other option is nighttime because your partner works outside the home or just as the natural time that it makes sense. Again we want you to plan accordingly. I have a musical accompaniment. We want to plan accordingly and that’s a day, does it is not like what I’m talking about.


[01:24:58] And if it’s you know it’s nighttime is the only time that we want to make sure that that’s a day that you nap or you have a baby sitter or you have that in between the charge your batteries because otherwise come nighttime you’re going to be spent. And like we said it’s an important part of the relationship. It’s also really important that we help couples develop a comfort around that. And what do we want to do. How do we navigate that? By creating communication around that and making it possible. I feel like someone trying to like overdub me. Are we going to translate to Mandarin or something? Yes.


[01:25:38] What about during pregnancy? I have quite a few moms that say their husbands stop wanting them when they got pregnant. They have this ravenous sex drive.


[01:25:38] Shh, we’re not using the ‘S’ word but right. It’s true. And it’s so challenging whether postpartum or during pregnancy, anytime we’re not on the same page with our partner. It is it’s really challenging. Sometimes that is someone that you may want to suggest that they talk to someone because some guys have hangups about hurting the baby. What does it mean to be that you know to the baby? I’m now seeing you different than I used to. Where you can’t be my partner because you’re my baby too soon to be mom. So sometimes that is an emotional thing to think about. Sometimes it’s worth starting from a place of general non-threatening intimacy kind of like you know the waist up massage and going in slowly and seeing where it goes. I know there was one woman at one of the support groups that said that they don’t talk about it as like ‘S night’. They talk about it as like ‘disrobe and see what happens’ night. And they found that that also takes the pressure off of it. So sometimes the words that we use can be really helpful. But if we kind of come into it like this is going to happen and then it doesn’t, then everyone kind of leaves really dejected and disappointed. So some we sometimes want to kind of like trick ourselves into it because you may not start out thinking it’s OK and then you know we can create the mood and get into it in a different way. Not too cryptic. Thank you. Date moments! Date moments are really important. Notice I don’t say date night. Because why? If it’s competing against sleep what’s going to happen? Not dates! Dates are not going to happen. So date moments and it’s really important that you help couples, right, that you help your clients start to rethink what you can look like. That it doesn’t have to be leaving the house and that it doesn’t have to cost money, it doesn’t have to be a baby sitter. That it could literally be staying home and you know putting the fireplace on and having dinner on the on the floor ;having a picnic in the house I’m going to scoot ahead a little bit because I really want to get to PMADs and I already got my 30 minute warning. Couch time was those daily conversations we were talking about and you guys have the PowerPoint. Yes. Or you’re going to have them. Yeah. And if not if not email me and I will send it to you personally with pleasure, because there are some do’s and dont’s of how to help couples navigate that that time together really efficiently. Support is really important and it’s important that you all recognize that you’re a huge part of your client’s village and that support comes in all shapes and sizes and if anything was about perspective this is it. So we never want to make the assumption that if they have family in town or a sister or mom or close and see that they have support because as we know family can be a very double edged sword. And you are again a pivotal part of that support system that they have. And going to be one of the more likely sources of information especially if they are feeling confused. This again goes back to that notion of when we feel supported we can sprout wings and do anything. Although now being in Austin I feel like I should change the picture to a bat. I’ve haven’t seen the bat bridge yesterday. Right, we did! Hootie will tell you all about it later.


[01:28:59] Here is what you want to know. Do you remember when we go back to the beginning and we said those couples don’t earn the gold star that they’re expecting when we talk about frequency of arguments. It’s because it doesn’t mean anything. Frequency of arguments isn’t an indicator of anything and it’s important that clients know that. Arguing it happens. What the research finds more than anything is that it’s about the match up that you know if two people are bickerers but they’re OK with that energy, then it’s OK.


[01:29:28] It’s when we have that mismatch of one person who likes to communicate one way and one person who likes to communicate a different way that we tend to get in trouble which is a good majority of our relationships. And so it’s how do we navigate that. But it’s not the number that means anything it’s the how that we want to be cautious of, so let’s jump into the signs and symptoms of postpartum depression. And here’s a bunch of different things to kind of think about and to navigate. And you may be one of the first people to notice that a client that you’re working with is struggling. So before we get into postpartum depression let’s talk about the blues 80-85 percent of women experience what we call the postpartum blues. It’s normal. It’s something that we used to consider pathological that we don’t anymore. Anything 85 percent of women are experiencing that’s pretty normal. And it has a lot to do with the mood fluctuations the irritability the feeling not grounded or not centered within themselves. And we do know that brains, right, need to recalibrate after having a baby. They’ve been through a lot. Not to mention the change in hormones some of the symptoms that come along with it are the weepyness, impatience, irritability, restlessness. Again that sense of I’m just not quite myself, I’m crying for no reason, I’m laughing for no reason. I just feel all over the place. The baby blues usually starts two to three days after having a baby and can last two max of 3 weeks postpartum.


[01:30:56] Once we crossed that 3 week mark we’re not in the realm of baby blues anymore and that’s important to recognize that now we are in the symptoms of something more. The other things that keep in mind is that the baby blues oftentimes will go away on their own. And a lot of the things that you are helping them connect with in pregnancy is going to be really powerful postpartum. Exercise, Touch! Touch is huge. Eating well, taking a shower. Anything they do to take care of their physical self is going to really feed their emotional self. Talking to their partner, right.= Keeping that relationship strong, fresh air, and having a plan. And that’s really where the afterbirth plan comes into play when we talk about postpartum depression. Now these numbers are getting astounding and let’s even back up first second because when we talk about postpartum illnesses what’s interesting to recognize is that oftentimes postpartum illnesses will look more anxious than they will depressed and this is really hard for a lot of people because they don’t recognize that they’ll be like ‘No, I’m so postpartum’ first of all postpartum that’s a time period if you’ve had a baby your postpartum. And it’s important for women to recognize that postpartum is not like a dirty word. It’s a time period. Then you’ll hear women say ‘But I’m not depressed, so I can’t be having a postpartum illness’. And it’s important again for them to recognize that oftentimes that postpartum illness will look more anxious sometimes rageful more than depressed sometimes and that’s an important distinction for them to know. Ten percent of dads will be postpartum or have a postpartum illness I should say. And that number is somewhat misleading because we know that when mom struggles with postpartum illness dad’s risk factor goes up to about 50 percent.


[01:32:43] What’s interesting is that the time frame is different so very often women will struggle. We know that women can struggle within that first year. That’s kind of the clinical timeframe that we look at DSM the Diagnostic and Statistical Manual. They change the time frame and they’re wrong, from a clinical perspective. Really people out on the field we see that for the year. And usually you know very often you’ll see it those first six months happen. For a lot of men, it will kind of kick in on that later half of that year. So it’s almost like they help their women get through it and then they kind of take that slide themselves. But that’s important to recognize. It’s also very important that whenever you are working with a woman or man who is struggling with a postpartum illness that they recognize it’s not their fault. There’s nothing that they did or didn’t do to cause this to happen. It’s not if they eat better, exercise more, walks different, sat on their head that this wouldn’t have happened. It’s just for some reason this is how some people’s bodies respond to this change in this transition. And so what we want them to know is that it’s not their fault. It is treatable and with help it will get better. Postpartum Support International was the one who coined that universal message and working on getting it out to women so that they recognize that it’s not your fault. It is treatable with help you will get better. And that’s important. Some I’m going to skip through that.


[01:34:07] Here are some of the symptoms of postpartum depression and what’s really interesting and what you want to keep in mind is that it looks different than regular Major Depressive Disorder and very often what we see with postpartum depression is that it’s not that typical profile of the woman who gets into bed and pulls her head up over her–pulls the covers over her head and then you know just sleep day in and day out, for a lot of women it’s a lot of insomnia that they struggle with. And here is some of the signs and symptoms. And what’s really important is when you’re talking to a woman, rarely will she come in and say I’m feeling lethargic, right. I’m struggling and anadonia. She’s not going to use these words and if you ask are you depressed are you anxious again she may be quick to say ‘Nope that’s not me’. So we want to get good at speaking the language that she is going to speak or if she’s not using a language talking in this less threatening language to get a sense of what’s going on. Right? Do you ever feel like you’re kind of just going through the motions? ‘Oh yes sometimes’. Do you feel like you’re in a fog? Do you ever think that your baby may be better off without you or would have been better off to have a different mom? Someone who is struggling with a postpartum illness will oftentimes identify with a lot of these thoughts and these feelings. That one, to go back for a second, you know Karen Kleinman who is very big in the world of maternal mental health said that the juxtaposition of one of life’s greatest gifts and one of life’s most unkind illnesses is what makes postpartum depression different from regular depression, right. So if we take a second and really think about having a baby we all look at it as this really happy sweet moment. And then when you get hit with a postpartum illness it just feels very unfair. And you’ll hear a lot of woman talk about that. Right. This is so unfair. When they’re coming out of that illness they’ll talk about feeling robbed and a sadness about the time that they lost while struggling with that illness, right, Underscoring like we were saying why it’s so important that we intervene during pregnancy to mitigate and prevent as much as possible or at a minimum jump in and treat as quickly as possible. Most–I shouldn’t say most–a majority of women are much more likely and I’ve noticed this in my practice that for the women that I worked with during pregnancy their their reaction time of when they’ll call me postpartum if something goes wrong is a much shorter than a woman that I’ve never met before. And the reason for that is is that it’s much easier to reconnect with someone who saw you when you were feeling better than feeling like this person is seeing me for the first time at my worst. And you know that’s not even talking about the shame and the stigma that still exists within the world when we talk about perinatal mood and anxiety disorder. I did a training at the Mayo Clinic on Tuesday, Monday. You know for a bunch of nurses we were we were training the nurses in labor and delivery and postpartum.


[01:37:07] And this one woman chimed in and said that it took her daughter-in-law about three to four months before she would share with her that she was struggling. And it’s like well gosh and you were a nurse like you’d be like the perfect person to talk to. But that’s shame and that stigma. What are you going to think of me? And are you going to take my baby? Are you going to think that I’m not a good mom or are this me and somehow that I don’t love my baby? Are really strong feelings that these women encounter. Not to mention that depression is such a paradoxical experience because it robs you of the motivation and the energy to take action in the ways that we need to. That we know will help you feel better. So just so we know we want to give a nod towards our dads who can experience you know paternal mental health, paternal postpartum depression. For men it looks a little differently. So go ahead and take a look at it for them oftentimes they’re more angry they’re more withdrawn. It has a different feel to it. But we want to be aware of men and one of the things that we want to make sure both partners know, is that everyone needs support. Sometimes men will be like ‘No no no. Mom doesn’t need anything besides me I’m going to do and I’m going to be her rock and I’m going to be her everything’, and that’s all nice and good but it’s not realistic and it doesn’t leave space for men to get support and they need it.


[01:38:24] And you know that right. You’re in the trenches all the time supporting women. And if we don’t support you and make sure that you take care of yourselves when you really then can’t help others because we can’t give what we don’t have. So we want dads to recognize how important it is that they take care of themselves so that they can then come and be that support for mom and baby. Postpartum anxiety, like we said, it’s more likely to look anxious than it is to look depressed. Hopelessness, confusion, disorientation, going through the motion a lot of overlap in this symptomatology that we talked about. And let’s just give a quick nod to postpartum OCD. This is something that we’re seeing in about three to five percent of cases these days. And one of the hallmarks of it is intrusive thoughts. So we all have intrusive thoughts in our lives. No problem, right. You’re sitting on the airplane ‘Gosh what would happen if that had just opened right now and everyone just flew out’. And it’s funny because I was using that example recently and someone was saying well ‘you know it could happen’. I’m like ‘she fell out a window ok it wasn’t the same’. No. But that notion of these random thoughts that we have. And for most of us will have these random thoughts and then will come dutifully back into our body and we’ll say that was really weird. I wonder why I thought that and we’ll go back to reading our book for people with OCD. What we find is that in general these thoughts get stuck and they can’t seem to shake it.


[01:39:44] And that’s where then requires them to engage in some kind of behavior in order to alleviate that anxiety. Well specifically with postpartum intrusive thoughts can take one to two of the more likely ways or shapes that they’ll take not to say that it couldn’t be others but two of the most common intrusive thoughts: One is a fear of dropping the baby. So the grove by us is an outdoor mall, right? So a woman may be at the Grove and she’s like ‘Gosh what would happen if I just dropped my baby right now’. And the other very common one is with a knife slipping. So maybe they’re in the kitchen and they’re making themselves a snack and all of a sudden they have a flash or a fear of ‘what happened if the knife just slipped right now and I cut my baby’, right. And so even if you take a look around the room look at your faces it’s like ‘Oh. Ah.’ And it’s hard and it’s a lot to think about. So imagine for that woman who’s struggling with it, how hard it might be to voice it is that this is a thought that she’s having and she’s scared about it. But you want to know is the fact that she is disturbed by it is a very telling sign that it’s OCD and not something worse like psychosis and very often that mom who struggles with OCD who has these thoughts are going to take dramatic steps to prevent it ever coming from ever coming to fruition. You may see that child never carried the baby up the steps. She’ll always make an excuse of why she used to take the baby up the steps.


[01:41:03] She may get rid of all the knives or move out, because no knife, no problem. But again if you have any suspicion that a mom is struggling with OCD sometimes the things you know you may say ‘hey have you ever thought about that?’. And usually a mom is all too happy to be like ‘Oh my gosh, I’m so glad you said something because it was making it was really concerning me that I would have such a weird thought’. When in out always consult any thought of harming the baby we always want to intervene and look into it differently. But like we said the hallmark of it more likely being OCD versus psychosis is the fact that mom is disturbed and will do things to prevent that from happening. Some of the risk factors some of the risk factors for PMADs. And take a look through the list. Call out which one seems surprising right some of them are more obvious and unplanned pregnancy and keep in mind unplanned doesn’t mean unwanted. So we never want to make that assumption. But some of them are more obvious which ones might strike you as not an obvious risk factor. Any thoughts?


Audience: [01:42:06] Infertility?


Dr. Alysa Berlin: [01:42:06] Infertility! That’s A big one right. Because after all mom really wanted this baby. Mom worked hard to have this baby. And with that comes a very real risk factor for a number of reasons. One is: Have you ever had the experience where while a crisis is happening, you’re all systems go and as soon as you weather that crisis that’s when you fall apart? Well mom, who’s gone through infertility, has likely been on a very long journey to have that baby in her arms. And now that that babe is there there’s a lot of emotion that comes around everything she had just been through. And the other part of it is that oftentimes a woman who’s gone through infertility doesn’t think she has a right to be depressed or anxious. She works so hard. She wanted this. She made this happen. She’s got no business being depressed and she doesn’t give herself the latitude to be okay with that and would all tell women all the time when I work with them especially through infertility it’s like if you think about it, what you wanted more than anything was to be just another normal pregnant woman. And it’s almost like that’s what it is. You’re just another normal pregnant woman. And once you’ve gone through that infertility and just like any other normal pregnant woman or normal postpartum, woman it’s possible that there is a postpartum illness and we want to give them permission to feel whatever it is that they are feeling and to know that it doesn’t take away from what they wanted or how much they loved this baby. It just means that they are normal postpartum woman who is struggling. And to give them permission to join the ranks of other postpartum women. I think most of these are are pretty self-explanatory. Pre-menstrual moods dysphoric disorder, that’s just one to keep in mind. Women who have a lot of emotional and mood fluctuations during their monthly periods are at a greater risk of developing postpartum depression or anxiety on the other side as well as a history of past experiences of anxiety and depression in their life or in their family. And so those are things to be aware of.


[01:44:10] Interventions. Support. Support is huge. There are so many things that we can do early detection and intervention is tremendous and like we said a lot of times that during pregnancy. So the earlier we can detect it and the earlier we intervene the faster they’re going to recover. Self-care is huge and we want women to know once it segues into a postpartum illness. Self-care isn’t enough, but it’s a part of the puzzle. And women can oftentimes feel very empowered that there’s something that they can do to help in their own recovery. Like we said also anything you’re going to do to physically take care of yourself is going to speak to you emotionally. So we don’t want to minimize you know a good meal, a warm shower, a walk around the block. Something interesting that they discovered in research was that women who go outside and can commune with Mother Nature have a better sense of themselves and higher self-esteem. So and this kind of gets very interesting because in a lot of cultures right now the notion of 40 days inside is really kind of catching on like wildfire and first time that’s a wonderful idea especially if it’s of their choice. Remember always said about control though: We don’t like it when other people impose on us. So if someone else is imposing you should stay inside for the first 40 days, it doesn’t go as well. It’s also something we want to keep in mind and let women know that they can always change their mind because for some women, the notion that ‘I don’t get to go outside for 40 days’, can be a breeding ground for an emotional illness. So we want to be careful of that routine can be really helpful. And this is we’re activating the village can be a big part of it in terms of do I have friends that come visit me? Do people drop off food?’. Those can all be very helpful thing is having a sense of when ‘I’m going to get a break. When when my partner is going to be available when a nanny might come’. So some predictability within the impredictability can be helpful. Tiffany Fields talks about 15 minutes of massage a day can oftentimes approximate the effects of an antidepressant. So it’s not to say that it takes the place of an antidepressant medication is necessary–and I know that’s a whole nother conversation–but we are at our core social beings and we respond to touch and I tell people all the time and for you to share with your clients if your partner is not the touchy feely type get a massage therapist to come in go; get a massage because touch is something that helps us feel connected in a very profound way. Medication that medication has a piece in the puzzle there’s no question about that. The conversation around medication is changing quite a bit. So the old adage that when you’re pregnant you should come off of medication is not always what we’re looking at anymore. And now the recommendation oftentimes is is that if you are stable on meds, we want to keep you stable on meds.


[01:47:06] Why that’s the case is what we’re recognizing is although the thought used to be that the conversation was exposure to meds versus no exposure at all. We now know that that’s a fallacy. That when a mom does struggle with with an illness depression or anxiety during pregnancy or postpartum exposure is inevitable. The question is what is the type of exposure we’re looking at. Is it exposure to an untreated mental illness which we know has implications both for the fetus as well for birth related complications? Or are we exposing the baby to the medication? And so for a lot of people the recommendation is what we call the least therapeutic dosage. For women who are very anti medication we want to be very respectful and we want to help them identify with all the other opportunities that are out there for them to address the illness. Exercise class, right, a prenatal postpartum class. Acupuncture can be amazing, hypnotherapy is tremendous, psychotherapy can be really wonderful. So there’s a lot of different opportunities out there. But I do like to open up the conversation where medication is not this evil thing that we’re to avoid at all costs but to recognize it has a place and we want to use it responsibly when necessary. Psycho education is huge. Psycho education I would venture to say is probably one of the most important things. And it’s education not just for the woman or the man who’s struggling with the illness, but for the family as a whole it could feel really scary when you’re experiencing something and you don’t understand what it is. And as soon as we can put language and words so why did is it all of a sudden lowers the fear factor. And it’s very important not just for the person experiencing it but for the family as a whole to help them know what’s a helpful thing to do and to say what’s not helpful. Right, so the person who was like ‘Just pick up the baby, you’ll feel better. Just, you know, do Eps. Come on just get over it just go outside you’ll see it’s no big deal’. Let’s be very straight. It doesn’t feel good to be depressed it doesn’t feel good to be anxious. If they could just do anything they would. But here’s where again we get into that communication misfire because partners think they’re being helpful. I’m trying to be encouraging. I’m trying to help her through it. I’m trying to create a plan. And so helping partners recognize again more of the consolation of what it looks like and what’s a helpful thing to say or not to say is really important. And one of the biggest things that we want to do is to really reframe Maternal Mental Health into Family Mental Health. That when a parent struggles when a mom or a dad struggles with that a postpartum illnes, this is a family concern and everyone is impacted by it. Mom, Dad, baby, other kids, family generations to come. For another time, we could talk about the whole topic of epigenetics and how behavioral experiences get encoded in our genes and passed down from generation to generation.


[01:50:08] So we know that this impacts everyone and when we can come at it as a village and as a family we’re more likely to be successful in treating it and minimizing that stigma associated with it. We started to talk a little bit before about culture, right. So just a word towards culture is you know it’s so important that we identify any biases that we have when working with a multicultural couple. And that again we really let them be our teacher and jump into their world and figure out how to help them best from within their construct. If we suggest something as however brilliant that might be if it goes against their own cultural rituals they’re not likely to follow through they’re more likely to leave any one of us. So it’s important that we recognize what’s okay or what’s not okay. And here are some suggestions of kind of how to listen with all your senses and what to do to be able to meet them halfway. Everything we’ve talked about today kind of led me to put together the afterbirth plan, which was a two page document that I put together to help minimize feeling overwhelmed during this experience. And it’s really you know how can we remove as many barriers to enhance the likelihood that a woman or a family that’s needing help will get it. I kind of feel like Lindsay we should rewrite it and make it the BirthFit after birth plan and incorporate all resources together because you guys bring such a wealth of different options to families and the more that we could just disseminat it globally the better off we’re gonna be. But if you look at some of the categories very quickly: “Self-Care” not a luxury but a necessity. It’s important that we remove that stigma and it’s not being selfish it’s important. “Daily Stress Reducing Conversation” that’s what I call couch time were those 20 minutes that couples can sit and talk and remember what the other person looks like. ‘Oh right. That’s what you look like. It’s good to see you again. Wow I don’t think I’ve said five words to you’. But if they do it on a daily basis we ensure that no more than 24 hours ever go by without having a conversation which is important. Dating, babysitters, emotional support, lactation, Mommy and Me groups and the list goes on of different things that we might imagine a couple needs to really again have the healthiest transition. And like we said if they’re struggling to know what kind of resources to offer them to address whatever that concern might be and then I want to kind of turn it over for questions because I know we only have a few minutes left, but you’ll go through the other sides and it’s really just the change you like my changing face as the family to all the different ways that could look. And then there’s a slide on single parents, couples of advanced age which it’s a little hurtful when the research talks about advancing age and optimal age was in your 30s. Ouch. That’s advanced? Oh my god. I think Hootie wrote that one. African-American couples. And here is again some information and some research on lesbian couples. And one of the most painful questions again of who’s the real mom here. It is something that they contend with in a really deep way. And then to end it was just this idea of you know what being a mom is all about. Which you know, I’m preaching to the choir here, but that idea of that loving and nurturing energy that we give to our babies is what really defines a mom. And this is true specifically for our lesbian couples and for our couples as a whole. Thanks ladies. Enjoy the rest of your incredible workshop!


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