Perinatal Mental Health: The Rite of Passage We Overlook

Introduction and Welcome

Britta: Hello folks, and welcome to Transformed by Birth, a podcast about the rite of passage through pregnancy, birth and new parenthood. I'm your host, Britta Bushnell, author, mythologist, childbirth educator and an emotional deep diver with a side of goofball. I'm so glad you're here. Today's episode takes us through the often turbulent waters of perinatal mental health. So grab whatever warm beverage keeps you company. I've got one of my staples, Earl Grey latte with some soy creamer and a shot of vanilla, no lavender syrup today, or take us along for a walk or a drive and join us as we dive into the emotional landscape of becoming a parent. Before we go there, let's light our candle. If you want to join me, please do so, or just take a special breath as I light mine. I'm lighting today's candle for everyone who is currently or who has ever navigated perinatal mental health challenges.

Exploring the transformation from pregnancy to parenthood as a rite of passage embraces challenges as normal aspects of the journey. Let's say it - going through a huge life quake, like having a baby rocks your world. But speaking of hardship in this way is only part of the equation, as it leaves out the reality many face of having to navigate such challenging thresholds with the added complexity of mental health conditions on board as well. In fact, pregnancy and postpartum are rife with fertile conditions for mental health disorders to take root - lack of adequate sleep, social isolation, fluctuating hormones, loneliness, navigating the unexpected physical challenges and recovery, birth trauma. I mean, the list goes on. So while society is clapping its hands in excitement at the arrival of a new baby, many parents are suffering, wondering what's happening to me or what's wrong with me.

Fortunately, in the last 25 years I've been in this field, conversations around perinatal mood and anxiety disorders, or PMADs for short, have left the quiet hallway whispered conversations and have begun being talked about more openly. And I see this as a really important shift, but I'm also not a specialist in this area, and so I need help to do this topic justice. That's one reason why I've brought my beloved colleague Molly Nourmand in as our guide.

Let me tell you a bit about Molly. Molly is a psychotherapist specializing in the spectrum of reproductive lifespan. In other words, preconception through to parenthood. Molly and I share the same grad school as well as a love of depth psychology, which sometimes is better understood as Jungian or archetypal psychology. And following the traumatic birth of her daughter, Molly embarked on becoming a birth scholar, including completing the advanced perinatal mental health psychotherapy training with Postpartum Support International in 2017, which feels like it was yesterday, but is quite a while ago now. Utilizing her experiences both as a seasoned psychotherapist and as a survivor of perinatal depression, Molly created Life After Birth, a company whose focus is supporting parents through the transition into parenthood, and which now also mentors other clinicians who want to develop an expertise of treating perinatal mood and anxiety disorders.

On a purely personal note, and I'm feeling cracked up as I say this, it was Molly who was with me when I received news of the tragic death of a beloved friend last year, and I got to feel in my body her remarkable capacity to hold space for another's profound pain, and I'm so grateful to her for showing up for me then. Molly, I've already got tears in my eyes. Welcome and thank you for being here.

Molly: Thanks so much for having me, Britta. I'm feeling a little teary myself right now.

Britta: Well, we like the emotional deep waters. Maybe we just start by going there.

The Me Too Movement for Motherhood

Molly: For sure, for sure. Well, I wanted to share - I don't know if you know this, but the first time I got a taste of you was listening to you on a podcast. It was Ellie Knoss's podcast. I'm trying to remember the name of it right now.

Britta: Atomic Moms!

Molly: Thank you. Thank you. Okay, there. And now we're done. We don't have to keep holding that question. I was hearing her voice, the voiceover of her intro, but I couldn't think of the name. Okay, so yes, I remember hearing your voice and hearing your conversation on that podcast, you know, probably closer to when I had my daughter in 2016, 2017 when she was a baby. And I just remember being so struck by you and so drawn into everything you had to say, because at that time I was just - I had a really strong appetite for learning as much as I could about birth and beyond, and I really will always remember that conversation. So it feels full circle and kind of tender and teary just to be on your podcast right now. So just wanted to name that.

Britta: Oh, thank you. Well, it feels really meaningful to me as well. And this topic is a really important one, and it's one that is challenging. I mean, I mentioned in the intro that it feels like navigating turbulent waters. And when thinking about, gosh, who am I going to reach out to to help engage in this conversation? It was like, bingo, Molly. So I really am so glad you're here. So first I'm curious - any response to what I shared in the intro, any clarifications or additions you want to make? Like, dive in there.

Molly: Okay, okay. What came to mind when you were - I love what you said about something to the effect of 25 years ago, talking about PMADs was a whisper, and now it's just more a part of the cultural conversation. And I was thinking of a woman who attended one of my after birth support circles, who's also a Pacifica grad. She wrote about her experience in one of my groups in this psychoanalytic journal. And she - I'm going to try to paraphrase her quote - she said, being part of my group, it was a chorus of motherhood me toos. And if you think about the Me Too movement like pre and post, it kind of feels similar to the conversation around PMADs, how it used to be something that no one talked about or was very shameful, and then, as people started saying me too, it really helped create less shame and more conversation about it, and more kind of just like lubrication in the conversation, you know? So just that's one thing that came to mind, is that me too.

Britta: What difference do you think that lubrication in the conversation has made to individuals experiencing perinatal mood and anxiety disorders?

Molly: I think it's a game changer, because when you know - I'll speak for myself as a perinatal depression survivor - there was a lot of shame for me in feeling depressed after birth, because culturally, there's so much "Isn't this wonderful? Oh my god. Aren't you so happy? Oh my gosh, isn't this the best time of your life?" Just being bombarded by that message.

Britta: Yes, yes.

Molly: And so to feel such a counter to that feeling, it's so isolating and so shameful. So when you're starting to hear others start to speak about, "yeah, I had it too," then it just kind of brings you together. You know? It just makes you feel less alone. And I feel like that's the medicine I wanted to create based on my own experience of feeling so isolated and so ashamed post birth, of feeling really depressed. And I was like, I don't want anyone else to feel this way. If I can help it, I want to try to help as many people as possible to have this conversation.

And I notice in my groups that I've been running for the past almost eight years, I just hear this message time and time again. It's like, oh my gosh, it just feels so good to have others reflect my experience back to me and not feel so alone. So I think that is what, you know, having more conversations about it and having it louder, to use your kind of metaphor, helps.

Britta: That the element of removing some of the isolation as well as some of the stigma, I would imagine being really supportive and helpful.

Defining PMADs: What's Normal and What's Not

Britta: So let's kind of back up a tiny bit and get some definitions on board so that we can help kind of understand and unpack, because we've got a lot of different things we're navigating here. There's the challenges of identity transformation that occurs with the rite of passage of becoming a parent. There's the struggles of learning how to be a parent, which is something separate from identity part. There's relationship challenges, there's all the various different kinds of challenges - navigating work, life, isolation, various different things. These are all aspects. There's also baby blues, right? But then there's this other collection of conditions that fall into perinatal mood and anxiety disorders as kind of the umbrella, but that doesn't even fully explain or speak to what all is in that umbrella. So help us - how do we, what are the various different things? Because it feels like so many different things. How does somebody as an individual navigate or even understand what it is that's happening for them?

Molly: Yes, I think I'm so glad you're bringing this up, Britta. And I think a common question I get asked is, is this normal, you know? And I think everything you named - identity, becoming a parent, relationship changes, work, all the things - it's something that all of us go through in this right of passage of becoming mothers. So there's that, and there's so much in that. And you know, within that, there's a lot of grief that happens of changing identities from maiden to mother, as it's often called.

And I, you know, I think the word matrescence is gaining a lot more awareness, which just to quickly define it, if you haven't heard of it, it's a great concept. It's similar to adolescence, so it's that awkward metamorphosis, you know, from one entity to another, with a lot of emotional and hormonal and physical changes. But it's like we do understand and accept adolescence as a very normal part of human development. So I love that matrescence is getting more light to it because it just kind of helps normalize this phase.

So I would say, you know, everyone goes through it to a degree. And then to answer your question about baby blues and PMADs and kind of how to differentiate - so baby blues, which I wish it had a different name, but it doesn't.

Britta: I know. I don't like it, but it's okay.

Molly: Baby blues - it affects up to 80% of birthing people, and it happens within the first two weeks after birth, and it resolves on its own, without treatment.

Britta: Okay, so I can give you an example, because I had baby blues.

Molly: Okay, let's hear it.

Britta: So with my first, it was probably three or four days after he was born. My husband wasn't working, but he had a client who was disgruntled about something, and he had to get on the phone. And we were living in a one bedroom studio apartment at the time, so I was literally about five feet from where he was sitting on this call with a disgruntled client, and he's navigating it, no problem. He's talking, "oh yeah, I hear you," and I burst into tears because I couldn't believe he was having to deal with this right now. I was just so moved and sad, and I just felt just tears pouring down my face over something that I have experienced many times, navigating something that he doesn't want to have to do. But it touched me in a very particular kind of way that felt unfamiliar and made tears pop out. But it passed.

Molly: Yes, yes. Oh, I love that example. And for me, also, baby blues seems so normal, you know. If we're going to - and again, I don't love the word normal, but I'm just going to use it - it seems normal to me. You just birth the baby, your hormones are regulating, your emotions are all over the place. You're trying to recover. You're trying to keep the tiny human alive. And, like you said, kind of figure out how to become a parent. If you're choosing to and able to breastfeed, you're trying to learn that skill. Like, of course, it just makes sense, all the tears, all the uncertainty, all the anxiety.

But the difference is - and I have a personal experience for when, for me, I didn't have the baby blues. So perinatal depression, it will either show up as the baby blues continuing, or showing up after that two week period. And because there is an overlap of symptoms with baby blues and with certain perinatal...

Britta: Which can make it more complicated to figure out and navigate. Wait, what is this? What is this?

Molly: For sure, for sure. And it's like, you don't want to minimize it, but you don't want to magnify it too much. Or you don't know, like, should I - you know? Is it just the hormones and the just had a baby, or is it something else? So it's great that we're talking about this.

So I'll give myself as an example. I had an onset of symptoms three weeks after birth, and even though I had had a traumatic birth, I had a lot of support right after birth. I had an amazing postpartum doula whose focus was night, so she helped really hand hold me with how to breastfeed and how to do all this baby care stuff, hands on. And she would wake me when it was time for my daughter to breastfeed, and then she would soothe the baby, diaper her, put her back to bed. Like she was just - I was like a halfway between Yoda and Mary Poppins.

Britta: Sounds amazing.

Molly: I know, she was like petite and would dress in this way that felt very Star Wars, and it was like a uniform. And she was kind of like a ninja, and just would kind of like come in and come out, and she had this bag that she would bring out everything known to man, and just be very solution oriented.

Britta: Sounds very Yoda Mary Poppins combo to me. I can picture it. Okay, totally. So she helped you in those first three weeks.

Molly: She helped me in those first three weeks. And my mom was there, I think for the first two or three weeks. I can't remember now, it's a little foggy, but my mom was in town. And then for me, there was like a cliff of help being dropped off at week three. So it feels like a direct correlation. I don't know, there's probably myriad factors, but it was like the doula left, my mom left, my husband was back to work, and I was just alone with my baby. And I was like, what the actual - you can swear, Britta.

Britta: Okay, great. But the actual fuck.

Molly: Okay. And so for me, the symptoms hit me like a ton of bricks three weeks after. So it wasn't - I didn't have the baby blues, but I just was like, whoa, this is really hard and isolating, and I don't want to do this, you know? Yeah. So it was like, for me, it was the isolation and the aloneness was like a big trigger for, you know, my genetic and hormonal disposition to come together to have depression activate.

Britta: Activate, yeah. Okay, so, yeah.

Molly: So I think that's why I feel so strongly about the community post birth, because I feel like, for me, that was a missing factor. Had I continued to have my mom, the doula, or my husband there, or anyone, frankly, a friend, someone, I think I maybe would have prevented it for me to go that far.

Britta: Community or that support can be a protective factor.

Molly: Absolutely, I believe so. Even though I had trauma in my birth, I was fine for three weeks because I just had so much hands on support. So yes.

Britta: It can be - it's not, doesn't mean that it's gonna be the panacea of, you know, magic, magic wand - but it can be a protective factor.

Molly: Yes, exactly.

The Anxiety Umbrella

Britta: So you mentioned postnatal depression, but there's a lot of other things that fall under this umbrella. Can you speak to some of the other ones as well?

Molly: Yes, yes, absolutely. I feel like postpartum depression or perinatal depression - perinatal depression, yeah, it used to be called postpartum depression, but recently I was brushing up on some statistics. I was training a new associate, and I was brushing up on some recent statistics from Postpartum Support International, and I noticed they renamed the categories perinatal, which encompasses pregnancy and thereafter. Because up to half of PMADs begin in pregnancy, so I think that's why they want to just encompass the whole thing. So we may say one or the other, but we'll try to say perinatal to be more inclusive.

So yes, perinatal depression tends to get the spotlight more, maybe because Brooke Shields put it on the map many moons ago, and it just kind of overshadows the other PMADs. But I will say that there is a whole anxiety umbrella of PMADs. So there's perinatal anxiety, which - what I see mostly in my practice is it kind of manifests as what's called generalized anxiety in the DSM, the Diagnostic and Statistical Manual of Mental Disorders. That's a mouthful. It's called, like, generalized anxiety, where the mom tends to just be very hyper vigilant, anxious about all things. Can't stop thinking, can't turn off their brain, can't stop worrying, having trouble sleeping, maybe having some insomnia. So it's just kind of like ongoing anxiety.

And I think going back to the big question of what's normal - I mean, all moms are going to experience some degree of anxiety. You know, even if your baseline pre baby was very not anxious, it's just like, oh my gosh, I have this being to keep alive.

Britta: There is an activation that happens. It's a great word - I now feel very responsible for another human's well being. And so that energy of, are they getting enough to eat? Are they okay? Is this normal? Those kinds of questions about our child comes rides in shotgun with their arrival. It's kind of an important - it's a piece of that parental vibe. I mean, I still have that, I bet, to some degree. You know, my college graduate was home recently, and when he's around, it activates more, and he's 22, right? It just - there's an element of like, oh, are they okay? Are they okay? Is that all right? And is that clinical anxiety, or is that mommy worry?

Molly: Exactly, exactly. And I would say, the image I get - I always think about is it's like an energetic umbilical cord, or just like an invisible umbilical cord that will forever connect you to your sons, even when they're in their 50s. You know what I mean? And that doesn't go away. And that's just, you know, that is the - there's a whole book, Wisdom of Anxiety, that's like, the wisdom of anxiety is, it's like your little personal assistant reminding you things like, don't forget to do that. Remember to do that. You know, which we saw in - I watch all the kids movies now because I have an eight year old - but in, I don't want to get into any spoilers, but in the movie Inside Out 2, it really personified well - Inside Out the first one personifies emotions. And then Inside Out 2 is about adolescence, and not to give any spoilers, but anxiety does kind of...

Britta: Plays a big role in that movie.

Molly: Yes, yes. And really...

Britta: Great way. That was, yeah, really. If you haven't seen it, I recommend it, even if you don't have kids yet.

Molly: Exactly. Do it for yourself, for sure. And I feel like maybe I'm being a little tangenty right now, but I would say in my field, parts work is becoming kind of the - Internal Family Systems is what it's called more formally - but it's kind of becoming the orientation du jour. There's like a huge wait list to get trained with the guy who created it. But it's like, I feel like that movie kind of explains parts work in a very layman way, you know. It kind of shows your different aspects of yourself and emotions as characters.

Britta: Yeah, for sure.

Molly: And Dan Siegel says, "name it to tame it," the famous neuroscientist. So, anyways, I'm digressing a little bit, but I say all this to say, you know, just to normalize anxiety, especially as a new parent, and not to minimize it. So I would say a big differential factor between just normal new parent anxiety and clinical anxiety is level of functioning. So if your anxiety is getting in the way with your functioning, if it kind of runs amok the way it can, that's when you may need to bring in more support and find ways to manage it and tame it and embrace it, because it can really eclipse joy.

And I guess what's coming up for me too is rigidity around sleep schedules. I feel like I see perinatal anxiety manifesting in that way of just like, I can't - I'm so groundless, and I can't control barely anything with this new baby, but I can try to control their sleep schedule, you know. And that's kind of how the anxiety can manifest. And I think, you know, anxiety and depression are different sides of the same coin. They're not like such cookie cutter boxes. So I know for myself, I had some anxiety postpartum as well, you know?

Britta: So, in the anxiety - so we've touched on perinatal depression, perinatal anxiety, but there's more than those. Those are the two that are in the name.

Molly: Exactly, yeah, there's more.

Britta: Expand for us.

Postpartum OCD and Psychosis

Molly: Definitely. So, and this is where I kind of can like, nerd out a little bit. So, okay, okay, so I'm getting warm. I'm getting warm as I'm nerding out. So okay, so that's kind of the perinatal anxiety that I kind of describe - the more general. But then under that big umbrella of anxiety is also postpartum obsessive compulsive disorder. So kind of, in the general, you know, pop psychology world, I think people think being OCD is when you like things really tidy and color coordinated. It's not. It's a really serious mental health condition that can rear its ugly head in postpartum. And I have chills as I'm talking about it, because I've treated folks who have postpartum OCD, and it really affected their ability to function and take care of their baby.

Because what happens with postpartum OCD is it can really grip you in a different way than that generalized anxiety. There really can be stories that you're telling yourself that you have to do certain rituals to counter something. A lot of times it has to do with health, and so the moms will often have to do these like really rigorous hand washing or body washing rituals to kind of counter it. So it's very severe. And I've witnessed mothers, you know, have their baby cry and not be able to take care of them because they have to finish a certain ritual because they're trying to protect their baby from something. So it's like, right, it's really serious, you know.

And it often - we're talking about prevention and treatment too - it can also be kind of tamed with therapy and medication, and I know medication is a tricky, tricky topic in this kind of stage of our lives. I know I was resistant to it. I was afraid that would be trace amounts in the breast milk getting to my daughter, so I opted not to do medication post birth. But now that I've been in this field, and I'm kind of like, look back at myself, and I'm like, oh, why didn't you do it? You know, it would... What were you...

Britta: Shadows that come out. Yeah, right. But the importance, or the - you know, there isn't - I've witnessed this with people that I have in my own life who have navigated mental health challenges that there's no gold medal for, quote unquote, toughing it out and not utilizing the pharmacology that is available, especially when a lot of what we're talking about - and this makes me think of some of the ways that the stigma still exists around mental health - is that we're talking about like the chemical imbalance in the brain. And if we had a chemical imbalance in the pancreas where it doesn't make insulin properly, which, you know, I have in my family line, you're not going to be like, you really shouldn't use insulin. You really shouldn't use insulin. There's this - we have an understanding, oh, that part of our biology isn't lining up in a way that is creating insulin. So let's supplement insulin.

In brain chemistry, if we're not getting certain chemicals to help the brain wire, why is there stigma to add the things that can help those neurotransmitters work, and, you know, various different things. I think it's a place that still has some work to go, some distance to travel in coming into a, you know, are there ways we can support ourselves with support, meditation, you know, I mean movement, physical activity, community, all those, right? Might you still need psychopharmacology? You might.

Molly: Yep, yep, definitely, yeah. And so I'm glad you're saying all this, Britta. And I think, you know, you and I both - another Venn diagram we have - is we both come from a yoga background. You know, I think when I became a mother, I was much more in the holistic world. And not that I'm not now, but I just kind of, I see the value of Eastern and Western medicine - not medication, just Eastern and Western medicine. You know what I mean? So I think there's a time and a place for it.

So, yes, I will say, just to kind of go back to a little more of the anxiety umbrella...

Britta: Yeah, keep us on track here, Molly, because we're two women following here, so we got to keep leaving. So yes, we're under the umbrella. We're under the umbrella of PMADs. What else have we got under there?

Molly: We're back under the umbrella. Okay, so I will say, I'm going to share something that is a little bit darker. So I just want to say, if you're listening to this with kids in the car, or you just have a sensitive nervous system, just kind of give you a little heads up, little disclaimer. So postpartum OCD and postpartum psychosis are very different things, but I want to talk about one thing that they have in common, that is actually in common, but very different. Psychosis is actually - sorry, psychosis is not technically under the anxiety umbrella. So I apologize for jumping around, but I did want to talk about that for a second, and then I'll go back to some other things under the umbrella.

So with postpartum OCD, sometimes what can happen is the birthing person will get images of the baby being harmed, like, what would happen if that knife, you know, hurt the baby, or what would happen if I dropped the baby, or what would happen? They have these images of baby being hurt or harmed. However, what happens with OCD is it's what's called ego dystonic, so it means when they have these images, they're horrified. They're like, oh my god, I can't believe I just thought that. But they can't get it out of their head. They can't get these images out of their head. And oftentimes, then there's a compensatory behavior that's needed to try to scratch the itch or soothe that worry, which actually - that's a whole other tangent - but sometimes trying to scratch the itch makes it still itchy, so it doesn't - it's kind of a dog chasing its tail thing. Anyways.

So the difference between OCD and psychosis. So what happens with psychosis? Psychosis is a psychotic break, like having a break from reality. It's very serious and it can be very dangerous. And what happens with psychosis is, if the mother will have images of the baby being harmed, but it's ego syntonic, which means that what happens with psychosis sometimes is they do kill their babies, and the reasoning behind it is because when they have the image in their head of it, it's coming from a protective place. So oftentimes, they'll be taken over by a psychosis, and they think in their minds, by killing the baby, I'm protecting it. Sometimes, for example, it can have like a religious overtone to it, like, if I don't kill my baby, they're gonna go to hell, or there's certain things that can happen. So I just wanted to clarify the difference.

Britta: That are not based in reality, because there has been a psychotic break.

Molly: Exactly, exactly. And I will say, you know, on the news, we hear of horrible cases of postpartum psychosis that have ended fatally for the baby and sometimes the mom too. However, I was - you and I spoke about us spending time when you lost your friend - we were at a fabulous conference with Maternal Mental Health Now, which is like one of my favorite organizations. And I've heard people speak, survivors of postpartum psychosis speak, so, you know, it can be treated. And that's the overarching message - PMADs, they can be temporary and they are treatable. So that's the good news. So I know I just took you down...

Britta: I've had clients who have been hospitalized for perinatal psychosis and who are thriving parents now, were hospitalized for a period of time getting treatment.

Molly: Yep, yep, for sure. And it is out there, and we can maybe get into later, like, you know, kind of like warning signs and how to mobilize your system and try to prevent or mitigate.

Okay, so we'll spend a little more time on the umbrella, then we'll move on. So I think another important thing to underscore in PMADs is post traumatic or like PTSD in the postpartum world.

Birth Trauma and PTSD

Molly: You know, post traumatic stress disorder kind of came up, came on to the map as we know it, with soldiers returning from war. So that's kind of how we first learned about PTSD, but it's so broad, and there's what's often called Big T and little T trauma and everything in between. And one of the phrases I like about trauma - I don't know the source right now - but they say trauma is in the eye of the beholder, so if it feels traumatic to you, then it was traumatic. So you and I, Britta, we could have experienced the same trauma. You and I could have very different reactions to it. Maybe you had no traumatic symptoms, and I had a lot of traumatic symptoms. You know, it's just like it's, again, the interplay of genetics and environment and things that can happen.

So, you know, I work a lot with birth trauma, and kind of going back to that conversation of what's normal, I see a lot of folks who've had traumatic births, but they don't meet the criteria for PTSD, which, without going into all this clinical stuff, a lot of it can manifest as like flashbacks and nightmares and hyper vigilance and kind of not wanting to go back to the scene of the crime, so to speak. You know, kind of an aversion to where it all happened, which I see - if folks have to go back to the hospital they delivered for whatever reason, let's say their baby's still at the NICU, there can be an aversion to the space.

So, PTSD can be very serious, but I've ushered folks through recovering from it. And I think of a woman now who had a horrible situation where she was in the ICU, the baby was in the NICU, just a horrible, horrible story, and she went on to have a second child, and had a very corrective experience, had a really wonderful birth. And, you know, I'd like to think part of it was - it helped her to like process the trauma before she went into the second birth. Because the thing with trauma is, you know, it needs to be cleared. It lives in our bodies. And you know, some people may, if they have a traumatic birth the first time, they may elect not to try for a second or more children. But you know, if they want a bigger family, I don't want that to be a reason that they don't go on to have more children, you know?

Britta: Yeah, absolutely, yeah. And where we definitely see in our world, trauma showing up from birth. And even for some folks, if we pull back even further, there can be threads of trauma in the trying to conceive, the preconception journey there, through a really rough pregnancy. It isn't - we've put a lot of our focus in this conversation on the immediate postpartum period, and as you shared, the perinatal period really helps. Let's keep expanding that. Understand that these can show up in a lot of different parts of that journey.

Molly: So I'm so glad you're saying this, Britta, and I think going back to Postpartum Support International and their definitions, they do say in parentheses - I misspoke earlier - but they do say perinatal can also include pregnancy loss, you know. So it's pregnancy loss, pregnancy, birth, thereafter. So I think, you know, we're seeing, I mean, I'm seeing a lot of that. I'm sure you are too, with more and more technology around reproductive assistance. We're seeing, you know, a whole world opening up of possibilities for parents who are having trouble getting pregnant or having children older. And with that, unfortunately, we see a lot of loss and a lot of grief, which can compound things. So I'm glad you're sharing this. I think it's important.

Grief in the Transition to Parenthood

Britta: I appreciate you speaking about the word grief, because I do think that is - you spoke about it early on, even around the conversation of the transition into parenthood - for those who don't have a clinical experience of mental health disorder or of a PMAD but may still experience grief, that the normalization of grief in an over culture that is kind of shiny and speaking about let's be happy, you have a healthy baby. And even coming back to sort of some of the conversation about birth trauma, the tendency to placate or minimize the experience of the birthing parent who may have experienced birth trauma with the pat on the back, "at least you have a healthy baby." That is so minimizing and can set a parent up for, "oh, what is wrong with me that I'm actually grieving the loss of what I wanted while I'm holding a healthy child?" Or they're thriving but needing extra support in the NICU or, you know, whatever it is.

That dance of splitting off, the bifurcation that happens in the over culture that says you can only have one experience at a time. You can either be happy or sad, but you can't possibly be both at the same time, which is so mind blowing to me and really sets parents up for extra hardship in this journey. Because if there is ever a time where it's a plurality of experiences, it's this journey - 100%. There's a lot of possibilities. You can be clinically depressed while simultaneously really glad you have a baby. And one doesn't preclude necessarily the other, and that is part of where I think some of the stigmas show up as well.

Molly: Yeah, definitely.

Britta: So you and I know could talk and talk and talk and talk, because we've done some of that. But yes, to make sure that - well, first, is there anything else you want to address under the umbrella before we go into talking about some of the things that can be helpful?

Molly: Sure, I can quickly touch on two things, and then we'll move on. I will say, and there's - I will say, bipolar disorder. So this is a really shocking statistic, but 50% of women get a diagnosis of bipolar in the perinatal period. I was shocked by that.

Britta: Of those who have a diagnosis, their diagnosis is during that time, or 50% of all women?

Molly: Let me try to say this. 50% of folks who get diagnosed with bipolar disorder get it during the perinatal period.

Britta: Wow.

Molly: Right? I thought that was like, shocking, but then not. I don't know, but also not. Okay, so I thought - and bipolar disorder really quick is just like extreme highs and extreme lows, so either mania or hypomania and depression to kind of meet the criteria for both. And that's another mental health disorder that really can benefit from medication and therapy and, of course, all the other things too. But it's, you know, it's one of those.

And then also the other one I wanted to mention - I know I'm jumping around in and out of the umbrella, doesn't matter - panic disorder was the other one I wanted to mention, which is part of anxiety and is marked by panic attacks, which are no fun, but can be treated and helped. So those are just some other ones I wanted to pepper in that are kind of, you know, out of the range of just the normal.

Defining the Perinatal Period

Britta: But fall under this umbrella that sometimes doesn't feel like it says enough about what are those possibilities. And when we are talking about these conditions in regard to perinatal, what is the - is there an end point where it's no longer considered perinatal? Like, what? Yeah, what is the current - because that has changed as well. So I'm like, what's the current statement about that?

Molly: Yeah, no, I kind of feel a little internal eye roll, because it's like - I feel like, you know, the school that you and I both went to, Pacifica, you know, we had to kind of learn all of these disorders and diagnoses and everything in the DSM, and kind of have a different lens. So it's like, you kind of, you have to know the rules. You know, you have to know the game. But as we're having this conversation, I'm just thinking of, like, culturally and across time, you know, how did people define these symptoms, and how do they make sense of them. And, you know, we're talking about it in a very kind of clinical Western boxes today. Well, not just that, but I'm kind of just, you know, helping with the definitions to kind of see where's the range of normal.

So, yeah, I have a little internal eye roll about that, in general, about diagnoses and labels and stuff. I will say to answer your question, I believe the perinatal period, in terms of these being perinatal definition, is like a year after birth. You know, and yet you and I know, which is speaking to the other part of what you were saying, that the transition and all that comes with it certainly doesn't pay attention to a calendar.

Britta: Right, yes. More experiential, personal, and chaotic and wild and untamed in a way that doesn't fit that over culture, Western, put it in a box kind of thing.

Molly: Definitely. And I love your labyrinth metaphor. I reference it. And for those of you - I try not to botch it, Britta - but for those of you who don't know Britta's labyrinth metaphor, to my understanding of it, she talks about when you're pregnant, it's like walking into the center of the labyrinth. And when you're postpartum, it's getting out of the labyrinth, and that everyone's time and path is different getting out of the labyrinth.

Britta: And the twists and turns are not all the same, but the likelihood that you will face them is there. You will face turns. It's just not knowing which ones they will be, or when they will be. And I actually need to just give a shout out to one of my mentors, Pam England, who introduced me to the labyrinth, and I have continued to use that symbol that has been really impactful to me in my own life and journey, but was really introduced to me by Pam. So, you know, just making sure we acknowledge and stand on the shoulders of those who come before us.

Molly: Exactly, I was thinking the same thing, everyone's shoulders that we're standing on.

Britta: Although I don't always love that image either. I'm like, I don't want to be standing on your shoulders, man. It's just heavy. But I know, totally, totally.

Britta: Lifting each other up and continuing to acknowledge our teachers.

Molly: For sure, definitely.

Protective Factors and Support

Britta: So okay, all of these that we've spoken - and I love that you just brought us into a wider lens view that brings us out of the uber clinical and the uber Western cultural, linear way of looking at things. Because I think that pulling back is actually helpful when we start to talk about protective or supportive things that can be done through the entire rite of passage of the perinatal period to support us in what's happening, to support our mental health, to support our brain chemistry. Not always, but that there are some things that can be protective and/or helpful if they do show up. We mentioned meds, we mentioned therapy, we mentioned support, like actual people to support. I'm going to let you roll. What are the other things that can actually be really supportive and helpful?

Molly: I would say sisterhood and having that - I know it's like an overused term - but just having like the proverbial village. You know, I think we're all just longing for the mother and the sister and the aunt and the cousin and the neighbor just to kind of be with us. And we don't have that.

Britta: No. And I don't have that. I find there's a fair bit of grief that shows up around that, just to speak of grief again, but yeah. And a frustration that shows up as well when it's like, I almost can hear listeners being like...

Molly: I know, yeah. Like, I know, I know. I've heard I need a village. Where the fuck's the village? Yeah, yeah, yeah. No, totally.

Britta: So it's like, we can say you need a village. The village will be protective. How do we find a village?

Molly: Exactly, yes, yes. So I'll give some tips. Okay, for sure. So basically, I mean, I alluded to this before, and I'm not saying my groups are the end all be all, but in my little world, I created what I wish I would have had. So pre pandemic - well, pre pandemic - I created an in person support circle for new moms within that first year of parenthood. I was longing for honest conversations, a deeper dive into all things - identity, relationship, sexuality, body, friendship, career, everything. And I'm sure there's a range of different types of mommy and me groups, but I wasn't getting that in the mommy and me groups that I went to. I'm not saying they're not great, because you meet people, you get out of the house, you learn things. But I was just wanting more of like, more of just that sisterhood.

And what I created, which is different than traditional mommy and me groups, is women within that first year of motherhood. So it's not just everyone who had babies within two weeks apart, because I find there's value in that, in that you're like at the same exact stages, and it's cool that your kids are the same exact age, but you're all kind of deer in headlights. Whereas if you have a few of you, but then you have others who are like a few weeks further, a few months further, or even closer to that year mark, the older ones - not older, but the more sophomore ones - can say, "Oh, I know I was so depressed and I had the worst time nursing. Trust me, it gets better. Here's some tips."

Britta: And then the one giving that advice can feel like, "oh, wow, I used to be there, but now I'm here." So there's value for both parties.

Molly: For sure, for sure. So now I do my groups currently virtual. And so, you know, in person is the best. I can't compete with that. But like, virtual is convenient for moms to jump on, and they don't have to be...

Britta: It's easier to be there. It's easier to be there than put a kid in a car and drive and think about naps and the food and the this and that.

Molly: Yeah, totally. I mean, the medicine is to be there, and virtual, you know. And so, yeah, that's one way - finding a group, if it's not my group, finding a local group in your area, or kind of search for something. If that feels like too much work or it just isn't happening in your area, I think - you know, you and I both love ritual - I think the ritual of going to the same place every day and not having to think about it really helps.

For me, that was a local park. I live off of Coldwater Canyon, not drivable, very isolating, potentially, but I had a three minute drive to a great park. I would go every afternoon with my daughter, and for me, that became just such salve for my loneliness and my desire for some kind of community. I started seeing the same babies, the same nannies, the same moms, the same dads, and I formed little - I planted seeds there that later in life, my daughter's eight now - like, I'll be like, "Oh my gosh, Oscar, we used to hang out at the park with you and your nanny." Like, it's just, it's so cool. And it became the park for me, became like my Cheers. Like everyone was like, "Molly, Bijou" - it's my daughter's name. Like, it was really just nice. And I met some amazing mom friends there, just organically. So that for me, I didn't have like a group that I was really so into, but that was great for me. Or if you don't have a park that's like nice near you, like, finding a local coffee shop that you just frequent every day, you know.

Britta: Yes, I love this. I love both the ritual part and then also, I'll say that I got a little outside of myself when I was in that early postpartum period, in that I would see somebody with a baby, and I became bold in a way that I would not necessarily do like in other parts of my life, and I'd be like, "Hi, oh, you have a baby too. Look here, I have a baby too. Hi. What's your name?" You know, and I totally, like, "Do you want to be friends?" Because I wanted community. And so whether that was in the coffee shop or the library - the library is great - or, you know, wherever it was, it's like starting to actually let myself speak to the longing for friendship. And that in itself was like, oh, little scary.

And one of the things I did was I would actually say to them, "Do you know if there's a baby group? Do you know where there's a this? Do you..." It would be like I was making a request. And pretty soon, I had sort of accosted enough people in my community that I was looking for a baby group that one of them actually, who I'd given a phone number to, called me and said, "Hey, I heard Sue has started a baby group, and you said you were interested in one. Why don't you call Sue?" And I was like, "Great, I'm gonna call Sue." And then various different people started joining this baby group, and it was self structured. There wasn't a, you know, whatever. And our kids grew up together. Amazing. It wasn't that it came knocking at my door. I had to keep going out and asking for it.

Molly: Exactly, same, same, same. I definitely was - I was just saying I would just go up to someone. And I think my kind of icebreaker was, "How old's your baby?" Like, I would just, you know, go right in there. And even if I'm a little more - I'm like a bubbly introvert, but I'm a little more like introvert leaning - but I just, I had to be extroverted in early parenthood, and I still have to be now, because otherwise it's just the choice of just being more isolated, you know?

Britta: Yeah, yeah.

Planning Ahead: Connecting with Practitioners

Britta: Okay, so what else? So the village - we went down a village rabbit hole, which apparently we just did. So what?

Molly: Totally, okay. What else? I would say, you know, ideally while you're pregnant - I know there's like so much admin while you're pregnant, and it's very overwhelming. For me it was, it can be overwhelming - I would say, as many practitioners that you can connect with ahead of time, the better, because you're not going to click with everyone. And if you have a history of any kind of mental health disorder, if you have a history of PMS, or I think it's PMDD, like any kind of sensitivity to hormonal changes, if you've had a fertility journey, these are risk factors for getting PMADs. Even if you don't have these risk factors, it would behoove you to connect with practitioners ahead of time, because when the shit hits the fan, when you have a baby, you're not going to have the time and the capacity. You don't know how you're going to feel, how you're going to be functioning, to do all this stuff.

Britta: To find somebody you want - you want to reduce the hardship of getting support. So like, preemptively create your roster, so you know where to go to get the support you need. Who are those practitioners you mean?

Molly: Yes, yes. Well, I would say, you know, I'll start with therapy, because - I'm not saying I'm the end all be all - I really, that's your wheelhouse. Hi, but it's my warehouse. I will advocate for connecting with a therapist, because like I said, PMADs can develop in pregnancy too. It can be helpful with postpartum planning and everything too. To find a therapist that you connect with, because I get a lot of SOS emails and calls postpartum, and people are like, "Do you take insurance? Do you have an opening?" And it's like, a lot of times I'm like, "No, I don't take insurance. No, I don't have an opening right now." And it's like, I feel terrible, you know? And I try to direct them to proper outlets.

But if you can do a little bit ahead of time, if you're trying to use insurance, do the annoying thing, make the calls, or, you know, find a sliding scale therapist. Or, you know, I know like myself and my associates, we take like FSA and HSA cards, and we provide superbills. You can get potential reimbursement for out of network. So do all that legwork ahead of time, because when you're not feeling good postpartum, you're not going to have the capacity. You want to set yourself up for success. And you could offload some of this to your partner, or you guys can be a team about it, some of the legwork.

And then just sticking with the mental health piece before I go on to some of the other branches, I wanted to mention this earlier, but I forgot. I'm a big fan of reproductive psychiatrists, so they have a specialty in the whole umbrella of preconception through parenthood. They really are specialists in hormonal shifts for women, and they know a lot about the research and the medication that's safe for pregnancy and breastfeeding. So I would say reproductive psychiatrists are great to connect with if you're worried about PMADs or you have a history of mental health stuff, or you're experiencing stuff in pregnancy. Definitely, you know, connect with someone ahead of time, get all that admin out of the way.

And then I think, you know, the biggest things I hear about that first year post birth - and I experience - is like, sleep and feeding. It's like we're just primarily wired to want our babies to eat and sleep, and us, we need to eat and sleep too. We are animals. We are mammals. And I would say, you know, if you are able to breastfeed and you choose to, to connect with a lactation person ahead of time. A lot of them take insurance. And all these practitioners I mentioned, I think most, if not all, do like complimentary consults, you know, just to make sure you like, connect with them, you like their vibe. Again, it's like you just have to vet some people and connect ahead of time. So lactation is huge, and sleep you may want to connect to like a sleep consultant, because you may want to just kind of get some things in a row beforehand.

Britta: Support to support the sleep in one way or another, in line with your values and beliefs about sleep, so that you have that ahead of time. I love that, for sure.

One of the things that I find that people are sometimes surprised about is that it can be tricky to get diagnosed because you go from seeing your care provider so frequently during pregnancy to your checkup at six weeks, bye bye. And now you're seeing a pediatrician. And your pediatrician - pediatricians should be trained in identifying PMADs. They are the doctors who are seeing the dyadic unit. But they're looking at the baby, and so it can be tricky to even know what it is that's going on. And it's one of the places where partners can also be really helpful.

And I know that Postpartum Support International has a great page for helping to understand, like, what are the symptoms, and what is this and all of that. And one of the things which bringing up partners makes me realize - partners are susceptible to perinatal mood disorders as well, which is something that is also not talked about and is still kind of stigmatized in an unfortunate way.

Molly: Yep, definitely, definitely, yes. Okay. I want to touch on that and also go back really quick to the kind of prevention, call it postpartum planning or preferences, whatever you want. In addition to connecting with some of those top practitioners - there's like myriad other ones, but I won't go to every single person - but I would also say discussing with your partner, if you have one, ahead of time, about maternity leave, paternity leave, who's doing the night feedings, how are we figuring out self care? What's our support system look like? What resources, if any, can we allocate to these support people? What family members can we bring in? To have these uncomfortable conversations ahead of time, not, you know, two days post birth when you're recovering and you're all tired and you're like, you know. So if you can have these conversations ahead of time, great.

And yes, fathers or like the support person - the statistic recently as of 2025, one in 10 fathers get PMADs, whereas one in five mothers do. But one in 10 is still pretty big figure.

Britta: It is, you know.

Molly: And it is, like you said, there is the stigma, and there's still, you know, paternity leave is still kind of, I mean, way less fleshed out than maternity, you know. But yet, we're seeing statistics of like millennial and now Gen Z dads being much more involved than previous generations. So you know, these conversations are important to have, and there is support.

Britta: And yes.

Closing Wisdom

Britta: Oh, gosh, okay, I know - I knew this was going to happen. We've just talked and talked and talked, and I don't feel close to done.

Molly: Me either. I know.

Britta: Oh, there's that. And we have to start wrapping up. So I want to just ask, is there anything else you want to make sure that our listeners know before we wrap up? And also, can you share where folks can find you and what your offerings are?

Molly: Okay, sounds good. Let's see. So I will say just one of the North Stars for me as a mother and a clinician has been spirituality, and Buddhism has been huge for me. I feel like even if you're not into Buddhism, my favorite book of all time on parenting is called Buddhism for Mothers, and I'm like, afraid it's gonna go out of print. I worry every day because it's, it's like, I just want to like buy up all the books. You can get it on Audible too, of course. But it's not the same as like, holding a book. But that book really was a game changer for me as a parent, because, in short, it reframes motherhood as a spiritual practice, and talks about how motherhood itself can be a meditation.

And you know, as we touched on, you and I have our yoga background of teaching and practicing, and that's really been a grounding foundation for me, just to kind of, you know, the endless things - like you said, with your 22 year old, you're still worrying about him, especially when he's in your orbit. And you know, I have an eight year old, and the worry, there's no end in sight for that. You know, she's in the throes of not middle school, but just grade school. And so I just go back again to my roots of, you know, spirituality, meditation, Buddhism. I just feel like that, and if that doesn't resonate with you, if you have other spiritual practices or religious practices or rituals, I just feel like that's really anchored me.

Britta: So I just want to kind of - that's protective too.

Molly: Yes, yes, definitely. And I think, you know, I see some religious communities really thriving in parenthood. They have some really great setups for ritual, you know, and so that's huge.

And then in terms of where to find me and offerings, you can find me on Instagram, if you're on social media. If you're taking a break, I get it. We all kind of come back at one time.

Britta: What are your handles?

Molly: Oh, my handle is life_after_birth_la. You can also find me and my associates - my website is yourlifeafterbirth.com. And I would say offerings wise, I work one on one and do groups, and my associates do one on one and couples. And yeah, I think I'll just keep it at that. I won't overwhelm with too much more information.

Britta: All of that will be in the show notes as well. And Molly, maybe you can share with us some links for where folks can go on PSI's website if they're looking for some support in their neighborhood, or in regard to what it is that they're doing. Postpartum Support International is a great resource for that.

Molly: Yes.

Britta: So as we begin to bring our conversation to a close, I like to end with one question. So that question is, what's one thing you feel passionately about that you want new or expectant parents to see, feel, hear, or know during this profound period of their lives that maybe isn't, you know, the big flashing light that everybody always talks about? Is there - I know it's hard to bring it down to one - what's on your mind today?

Molly: Yes, yes. I will say, when you're in the thick of grieving your old identity, I would say, just know - I would argue there's a better version of yourself on the other side of it. And I will say I was recently in Paris with my family. We were there for a wedding, and I'm in my early to mid 40s, and the last two times I was there, I was in my early and late 20s, and I wasn't a mom yet. And I was just like, I really like this version of myself better than my last few times I was here. I was just kind of reflecting. And I think motherhood has a lot to do with it, and I think aging has a lot to do with it. But it's definitely, you know, like any other kind of rite of passage or spiritual quest, it's not pretty when you're in the throes of the muck, as you know. But it's, I think it's really good on the other side. It's even better. So I would just say the best is yet to come if you're in the muck or in the goo, as you would say, Britta, of the metamorphosis. It's better on the other side.

Britta: Oh, beautiful. If you're in the muck, keep mucking, because you're rebuilding and reforming and wings are being built. And on the other side you get to fly.

Thank you so much, Molly. This has been such a rich conversation. We could have kept going. I really appreciate being with you. Thank you listeners for sharing this time with us. If something shared today impacted, supported or moved you, please share this episode with a friend. I produce this podcast myself, and your support makes it possible. To show a little love for the podcast and these conversations, please follow, rate and review. If you'd like to continue the conversation, please join us on Instagram at Transformed by Birth. I look forward to being with you again on the next episode of Transformed by Birth. Now let's gather what we want to take with us from this episode and draw it in on an inhale. Grab your candle and on an exhale, let's blow it out.

Until next time, bye, friends.