>>> Click here to download my FREE Mental Health Postpartum Checklist that walks you through creating a personalized mental health support system and allows you to feel more confident and relaxed, knowing you have a plan for whatever your unique postpartum experience may be. <<<

Joining me this week is clinical psychologist and the author of Rattled: How to Calm New Mom Anxiety with the Power of the Postpartum Brain, Dr. Nicole Pensak. Together we have an enlightening conversation that not only acknowledges the challenges of motherhood but also celebrates the incredible strength and potential it brings. 

In this episode, we explore:

Matrescence: Understanding the profound transition into motherhood and its impact on the brain’s neuroplasticity.

Silent Patients: Recognizing the often-overlooked mental health needs of mothers and advocating for better support systems. (Plus, how to do that for yourself until society catches up.)

Neuroplasticity as a Superpower: How the brain’s adaptability can be harnessed for personal growth and improved cognitive functioning in mothers.

Motherhood as a Normative “Trauma”: Addressing the intense, transformative nature of motherhood and reframing it as a period of growth and strength

Connection, Bonding, and Burnout: Practical tips for navigating the emotional rollercoaster of early motherhood, from bonding with your baby to managing the transition back to work.

Tune in to learn how to navigate motherhood with self compassion, resilience, and empowerment.

LEARN MORE ABOUT NICOLE:

https://www.drnicoleamoyalpensak.com

GET NICOLE’S BOOK:

Rattled: How to Calm New Mom Anxiety with the Power of the Postpartum Brain

INTERESTED IN LEARNING MORE ABOUT THE FIRST YEAR OF PARENTHOOD?

Click HERE to sign up for my FREE workshop, Confident Parenting from the Start, to get tools and strategies that you can put into practice right away to challenge self-doubt, put an end to your panic-Googling, and finally find the ease and enjoyment in early parenthood!

Dr. Nicole (00:00):

I don’t want you to have to go through self-diagnosis. I’m sort of sick of giving mothers self checklists of symptoms. I always advocate for just if you’re feeling off, talk to a specialist in postpartum mental health and they will tell you, I mean, let’s take that off your plate. You shouldn’t have to self-diagnose. You’re not going to self-diagnose your diabetes. So why would you self-diagnose your postpartum depression, or anxiety, OCD or psychosis? I mean, it’s ridiculous.

Dr. Sarah (00:33):

When we go through matresence, which is the developmental period of adapting to motherhood after the birth of a child, we undergo a massive emotional, hormonal, and cognitive transformation during this time. The brain’s neuroplasticity or its ability to change and rewire itself is heightened. So what does that mean? It means that any work that we do on ourselves to heal old wounds or work towards building new, healthier systems are amplified, and we can use this to our advantage. Joining me this week is Dr. Nicole Pensak, a clinical psychologist and researcher specializing in treating postpartum mental health anxiety, OCD and depression, and she’s the author of a new book, Rattled: How to Calm New Mom Anxiety with the Power of the Postpartum Brain. From baby bonding and managing mom rage to returning to work and building a proactive mental health plan, this is such a relatable conversation that is also chockfull of suggestions and really scientifically rooted advice that I cannot wait for you to hear.

(01:51):

Do you find yourself questioning whether you’re doing this whole parenting thing right, second guessing yourself, losing sleep and falling prey to mom guilt. As a clinical psychologist, I have seen so many of the parents I work with deal with these challenges, and as a mom of two, I’ve lived them from time to time myself. But here’s the thing, when you know what to focus on and what to give yourself permission to ignore, it can make parenting feel a whole lot easier. That’s why I created a workshop specifically for new and expecting parents to help you learn these exact things so you can genuinely feel confident in parenthood right from the start. I’ll teach you what I like to call my confidence recipe and equip you with tools and strategies you could put into practice right away to challenge that self-doubt, to put an end to your panic, Googling, and finally find the ease and enjoyment in early parenthood. I believe all new parents should have access to the information and support they need to help them during this messy, chaotic, and often stressful time. So this masterclass is completely free. Just go to drsarahbren.com/confidentparenting to sign up for one of these masterclasses. That’s drsarahbren.com/confidentparenting. Or just grab the link in the episode description on whatever platform you’re streaming this episode. So don’t wait. Secure your free spot and get that boost of support, guidance and science-backed strategies that can transform your parenting experience.

(03:26):

Hi, I’m Dr. Sarah Bren, a clinical psychologist and mom of two. In this podcast, I’ve taken all of my clinical experience, current research on brain science and child psychology and the insights I’ve gained on my own parenting journey and distilled everything down into easy to understand and actionable parenting insights so you can tune out the noise and tune into your own authentic parenting voice with confidence and calm. This is Securely Attached.

(03:55):

Hello, welcome to the Securely Attached podcast. Today we have Dr. Nicole Pensak here. I’m really excited to dive into this conversation with you. How are you doing? Thanks for being here.

Dr. Nicole (04:10):

I’m great. Thanks for having me. I’m so excited to be here.

Dr. Sarah (04:13):

Yes, so you just came out with a new book, Rattled: How to Calm New Mom Anxiety with the Power of the Postpartum Brain, and that title really caught my attention. I am a nerd about brain science and we talk about it a lot on this podcast, and so I was just really excited to get to talk to you about some of the translating some of this sciencey stuff into a really easy way to understand it for new moms and moms who have been momming for a while. And also I feel like even after you become a mom multiple times over this stuff can reemerge, which is interesting.

Dr. Nicole (04:56):

One hundred percent.

Dr. Sarah (04:57):

Yeah. So maybe could you just start by introducing a little bit about yourself and your work and why this book?

Dr. Nicole (05:06):

Yeah, sure. So I’m a clinical psychologist and I spent years working in medical hospitals working with different types of patients with medical problems such as cancer and transplant, and I sort of prided myself on working with the sickest of the sick. And then over time I became fascinated with a different type of patient, the silent patient in the room, the caregiver. And so I spent time in academia developing these interventions that would help caregivers of patients with medical problems manage their stress because it’s just overwhelming that they have to take care of their loved ones 24/7 and manage all of their care. Fast forward in academia, I’m sort of set in my career and then I become a mother and I’m like, wait a minute, mothers are the silent patients in the room. So they give birth and everyone focuses on the baby, and I really felt like mothers needed more science-based information and support, and I wanted to translate all of my expertise in working with caregivers to working with the ultimate caregiver, the mother.

(06:17):

And so I am a mom of two. I have a 6-year-old and a 4-year-old, and my second was born right before Covid, so he was in the NICU for five weeks and then two weeks later we were on lockdown and I suffered from really severe postpartum OCD and anxiety and I was able to feel better in a relatively short period of time. And I did go through mild postpartum with my first, but after my second I realized I went from rock bottom to sort of thriving, feeling better than ever in a short period of time. And I wanted to understand what was going on here. And so as an academic, as a researcher and an expert in treating patients with depression, anxiety, OCD and postpartum, I went back and I was looking at the research and I was like, wait a minute. There’s a story here that no one’s talking about.

(07:12):

So the first is, is that we have a maternal mental health crisis in the United States, and we really we’re one in five mothers. Now I’ve seen rates a size one in three after covid where we’re not catching enough mothers, we’re not getting them enough postpartum mental health care, so our system is not working and failing them. So we need to figure out a way to get treatment more accessible to mothers. And I provide a proactive postpartum mental health care plan in the book. And so that’s one of my main goals was to solve the postpartum mental health crisis. And then the second part was getting into mires, the transition to becoming a mother. And I realized no one’s talking about mires. It’s a huge seismic transformation. Every system in your body changes, your brain changes rapidly fine tuning and priming itself for new learning to really orient, to give moms a leg up in caregiving.

(08:12):

I always say it’s like Marie Kondo-ing the mind, right? To give yourself benefits and become more attuned to caregiving for the baby. So I thought, wait a minute, this is huge. And no one talks about this transformation and turns out there’s a lot of maternal brain plasticity. So you’re synaptic pruning, getting rid of useless neural networks while also developing nuance. It’s all new learning when you become a mom. So you’re just building these incredible brain resources. And I’m like, wait a minute. So if we’re learning about tending to the baby, can we also learn about tending to yourself and figuring out and supporting all of these different processes that are happening? The relationship changes, the mom shame the mom, guilt mom rage, baby bonding, back to work transitions, all of that is part of this mires besides the hormonal, the biological, the neurological, the psychological identity changes.

(09:19):

And so it’s just incredible how everything changes. And so I really wanted to help moms nurture that process and get to the other side of thriving and really help them take advantage of this transformation. And I feel like there are so many barriers that get in the way culturally with not parental unpaid parental leave and just lack of resources, support for parents, financial strain, all of this. So I really wanted to acknowledge how challenging it is motherhood in the us, but also give mothers a really practical guide and roadmap to how to manage that all and what they do have control of at the time. And then the third piece is right, so I talk about this heightened period of neuroplasticity and self-directed neuroplasticity and post-traumatic growth that can happen. So going from rock bottom, 13% of mothers experience a birth trauma, one in three women experience a sexual assault.

(10:27):

You come into motherhood and it’s like your kid will just trigger you in ways you couldn’t imagine. And then you’re working through your own maybe childhood trauma or just I call motherhood a normative trauma because it assaults every system on your body. And so I think there’s just tremendous potential to better support mothers and empower them to really understand how much their brain and systems are actually going to get better if we do it right, if we nurture them along the way. And not to mention the whole stigma of mommy brain. So mommy brain is this label that mothers are dysfunctional or that their brain’s not working, right? And I’m like, wait a minute, that’s not true. Because when we actually look at the science and the research, there’s really weak support for significant differences in memory functioning between mothers and non mothers. And so there was a great article in JAMA recently about rebranding Mommy Brain and a lot of great maternal neuroplasticity researchers out there are shedding light on this.

(11:38):

And mince is now labeled a neurocognitive developmental phase because of the profound transformations that go on. And so mommy brain actually comes with cognitive boost. So we see that mothers have some benefits in cognitive functioning, but there’s so many roadblocks and landmines in the way. So how do we get past them so that moms can reach their full potential? And that’s really the story behind Rattled, because I personally experienced that I treat mothers every day, I treat this every day and I see how good treatment and removing these roadblocks and nurturing all of these components really can get mothers feeling better than ever and taking advantage of this opportunity.

Dr. Sarah (12:21):

And I think that’s such an incredible way to reframe things because when you locate all of these changes that are happening and all of these stressors and like you said, normative trauma, it is traumatizing, but not in a capital T trauma if you will. It’s that your body is going through something incredible physically, hormonally, emotionally, psychologically. It is incredible. And that profound hugeness of it shakes you.

(12:56):

And I think sometimes we tend to sort of have a narrative sometimes that we’re weak because we got shook. And the reality is, or rattled if you will, you can’t not get rattled. You can’t not get shook by this. It’s big, and it’s not a sign that there’s something wrong with us or that we aren’t handling this well. It’s that no, it’s an earthquake and you’re going to shake. And how do we look at that as, alright, so how do we move through this with grace for ourselves? But also to kind of put it in a context, I like this idea of mires essence as a developmental stage, which I think is very helpful. I mean people, maybe we should talk a little bit more about matresence because I think it is a term that’s kind of just starting to emerge in the kind of real world, speak the vernacular. People are starting to have heard this word a few times now. Oh, I’ve read an article, I saw a headline, that word in it, what does it mean and how do we contextualize it as part of a developmental process that exists along the lifespan that we’re just starting to actually name and understand better? But it’s always been there, right? It’s not a new concept, it’s just a new name for a concept we didn’t really identify or give attention to. But it’s very similar kind of to adolescence

Dr. Nicole (14:22):

It is.

Dr. Sarah (14:23):

In that the brain goes through a construction, it’s a huge evolution in sense of self in orientation from adolescence. You’re moving from an orientation to the family to an orientation to the outside world, and your sense of self gets reshaped as a result of that. And in mires essence, we’re moving from an orientation to the outside world into our child, and the relationship of the parent child relationship becomes the center focus. And that informs our sense of self.

Dr. Nicole (14:58):

And I love the way that you put that. Exactly. So adolescence is, if you think about the timeline for adolescence, right? It lasts until age 26. I mean, your brain is not fully formed until 26, so it’s a much longer period of time than when we compare the changes that happen in mires, at least the peak of changes. And mothers go through changes throughout their lifetime, and there’s maternal brain plasticity even when they’re raising adolescence because think about all the challenges you have to go through with your kid, it’s just an entirely new also developmental phase in that sense. But with matresence early on, you’ve got the biological changes, you’re becoming a mother for the first time. There’s this psychological preoccupation of having a baby and being completely responsible for it. That’s a huge identity shift. And so not to mention all of the neuroplasticity that’s going on both in environmental and biological. So with every new challenge that mothers are forced to rise to that are relentless 24/7, figuring out why is my baby crying? How do I soothe my baby? How do I bond with my baby? How do I engage my baby feeding, breastfeeding, all the challenges that come up and working through them.

Dr. Sarah (16:17):

How do I keep it alive?

Dr. Nicole (16:19):

Exactly. And so that is just fine tuning your, but you’re just developing at such an exponential rate. And so I think it’s just incredible. And I think more credit needs to go to mothers who are going through, well, obviously all mothers go through this, but we need to have that recognition and understanding and also validation that like, wow, this is huge. It feels huge because it is huge. And so we need to allow the process to happen with compassion, like you said, with grace, but also there are scientifically supported ways that we can better facilitate this process and help mothers do better.

Dr. Sarah (17:02):

Yes. So can we talk a little bit about some of those ways, obviously being able to identify with a story that makes sense. I was just talking about this today actually with one of my patients, but when we ask the question, why is this happening? Or why am I doing this? Or why am I feeling this or why something inherently behind that, why is a struggle, a conflict around acceptance? And if we are able to say, not just why is this happening? Because anyone who’s experienced postpartum depression or postpartum OCD or any sort of maternal mental health challenge after having a baby, the question, why is this happening to me or why am I struggling with this is certainly a question that comes up. And if we can answer that question with something that makes sense and is the thought this makes sense, is the most safety creating thought one can have?

(18:06):

It’s so settling and so grounding to be like, oh, this is happening because of this and this makes sense. It moves it out of this doubt of, is there something wrong with me? Am I doing something wrong? Is something broken here to, oh, I have an explanation for this and that makes sense and I can rest, my nervous system can move back into a sense of safety and I can proceed. That I think alone is very, very helpful. But I imagine there are very specific things that you also can talk to that actually help support mothers mental health so that they can move through mince with the least amount of residual impact.

Dr. Nicole (18:51):

Right, exactly. So I always recommend, in order to do the greatest amount of good for the most number of people, I say set up a proactive postpartum mental health treatment plan. So once you pee on that stick, establish care with a prescriber and a therapist that specialize in postpartum mental health. So by setting this up proactively, whether you think you’ll need it or not, hopefully you won’t, but it’s there if you do. And it’s common, so one in five, one in three, but you establish care early on and rapport and a relationship, sometimes it takes a little while or a couple different therapists to figure out who you want to work with. So by going through that process early on and not scrambling last minute, it helps you figure out who’s going to be in your village, who’s going to be in your support team, right?

(19:50):

And so also they can do a full history intake, see you at baseline, and give you information on your unique risk factors for potentially experiencing postpartum. So we know that there are established risk factors. Moms don’t have to guess, and so let the doctors do their job. We want to take care of you. And by understanding your personal risk factors as well as just having that in place early on means that first of all, you’ll have regular follow-ups, and once you give birth, you have someone that will check in with you, you establish your follow-up appointments early on, check-ins within two weeks of birth. Right now, the standard of care is six weeks. Typically in the field with experts, they know that they need to check in around two weeks. So by that time, the baby blues will, and even sooner if there are symptoms and depending on your history, but the baby blues will subside and they can start getting a more accurate picture of what your mood is postpartum and be able to intervene. And so we typically see upticks in postpartum early on if the mother does not breastfeed, and then later on if they do breastfeed and then they start to wean because the hormonal changes from weaning and not breastfeeding can really drastically impact postpartum.

Dr. Sarah (21:19):

Because specifically you’re dealing with a really rapid drop in hormones, is that why?

Dr. Nicole (21:24):

Yes. And so that’s really important to pay attention to, and your provider will be able to talk to you about those. And that’s why you also need someone that specializes in perinatal mental health or postpartum mental health so that they know what they’re looking at. Because so many times mothers walk into the doctor’s offices and their providers, their primary care, well-intentioned great medical providers will potentially, their symptoms will get dismissed. Oh, that’s just being a new mom. How many times have you heard that? Or This is what it is, it’s just really hard and oh, you’ll sleep eventually. It’s like, wait a minute. Moms are suffering for lots of reasons and more than they should. And also if you’re experiencing postpartum anxiety and depression, you’re not going to be able to problem solve and figure out scheduling a provider. And I don’t want you to have to go through self-diagnosis. I’m sort of sick of giving mothers self checklists of symptoms. I always advocate for just if you’re feeling off, talk to a specialist in postpartum mental health and they will tell you, I mean, let’s take that off your plate. You shouldn’t have to self-diagnose.

Dr. Sarah (22:39):

No, we don’t ask anyone to self-diagnose in any other kind of field.

Dr. Nicole (22:44):

Exactly, right. You’re not going to self-diagnose your diabetes. So why would you self-diagnose your depression, or anxiety, OCD or psychosis? I mean, it’s ridiculous. And then sometimes it can take months to get in with a provider. If you’re in crisis, you don’t want to wait months to feel better. I know that when I was suffering the second time, I was in really worst place and I was able to feel relief in nine days. And that’s because, look, we can’t prevent postpartum from happening. I always say, my brain likes to do this thing postpartum. So if I had another baby, I would know that my brain likes to do this thing, and I would have my treatment team in place and I would have little control over whether it does it or not. However, I would have control over having my proactive postpartum mental health team in place, being able to take the second time I needed medication, and I was just able to feel so quickly and get to the other side of that within a really short period of time.

Dr. Sarah (23:50):

So right. And I imagine though there is, I am a psychologist. I am in my own therapy. I understand that it is a privilege to be able to access mental health care in our world. And so I’m also thinking about the parents or parents to be who are maybe thinking, I want to be proactive about this. I want to have a proactive mental health plan, but I can’t necessarily just go to therapy in anticipation of a potential problem for financial reasons or maybe access to care is hard. I think telehealth has made it a lot easier in certain states to get, because if you live in a therapy desert, for example, you can still find somebody, but if you can’t find someone in network or you have to pay out of pocket for therapy and that’s a prohibitive thing, what would you say might be a tiered approach if you can’t do obviously the ideal, and I’m complete agreement with you, I actually promote this same concept as well of before you.

(25:06):

Let’s not wait for there to be a problem to solve a problem, because like you said, when you’re in crisis, it’s not a very good time. Two, if you’re in it, it’s hard to see it. I had postpartum depression with my second, and I even, it was my husband who was like, something’s wrong. I couldn’t see it. As soon as he said it, I was like, you’re right. But I couldn’t see it in it. And so it’s like when you’re in it, it’s very hard to know you’re in it sometimes. And so I am a huge advocate for anticipating this, even if it’s just identifying who you’ll call or doing your research ahead of time to find that therapist or a couple different therapists that you could reach out to or have a partner know these are the people to call should we need some help? Even if I don’t engage Carol, although I do think your point is very well taken that if you can already have an established relationship, the ability for that person to perceive subtle shifts and to already know your baseline is critically valuable. But what are some tiered approaches like support groups or other ways to tap into support anticipatorily?

Dr. Nicole (26:15):

Sure. So I mean, I always recommend Postpartum Support International‘s website because they have a support group for everything, for every.

Dr. Sarah (26:25):

They do. For dads, for every member of the family. It’s amazing.

Dr. Nicole (26:31):

And I think it’s free if not very low cost.

Dr. Sarah (26:35):

Yeah. It’s peer led.

Dr. Nicole (26:36):

Also providers that specialize in postpartum that are all different levels from PhD, social worker that would’ve potentially take insurance. So I would start there as sort of a cost effective approach. Also, The Motherhood Center in New York does same day screening, so for postpartum, which I think is incredible resource. And I’m sure they triage you after that to figure that out. Yeah, I mean, look, you can always go to your OB and your primary as well, and hopefully they will recognize and not dismiss your symptoms, but I would really encourage you to advocate for yourself, make sure you’re feeling heard. And in different places there are different resources locally. So just searching online for that postpartum or perinatal support specific.

Dr. Sarah (27:44):

And even one thing that you could do too is have an intake with a clinician and just leave it there so that they have a baseline, they’ve established some type of diagnostic picture of you. And then maybe you say, I’m imagining someone who is like, this is something that feels like a financial reach maybe, but I want to do it anyway, but I need to be sort of thoughtful about how I do it mean if a mother called me and was like, I just want an intake and I don’t want to have ongoing treatment unless I have the baby and realize I need it, would you still see me? I would totally take them on as a client, and most people probably would too.

Dr. Nicole (28:31):

And I do that too with patients. If they just want the postpartum intake with treatment planning, that’s what I would do. It would be a full intake, and then it’s sort of, okay, these are your unique risk factors. This is the timeline, and you would stay in communication and you’d be checking in, but you have that in place so that the clinician takes that off your plate in terms of I know what to think about. If my patient has a history of bipolar disorder and there have been medication changes or whatever she wanted to ease up, it could be anything, but we know that that’s a risk factor for postpartum psychosis. So I’m going to be checking in with that patient immediately after birth and monitoring in a different way than I would for someone with no history and just wants to be proactive and cover all their bases. That’s someone that I’m going to approach a little differently still with the same amount of, well, maybe not talking to them that day right after birth or a couple days later, but at least in communication early on and having a check-in within two weeks.

Dr. Sarah (29:41):

Weeks. Yes. I think that that’s really helpful. I don’t want someone to write this off because they’re like, oh, I can’t do this, so I’m not going to do it. It’s like, no, there’s so many, there’s so much gray. It’s not a do or it’s so many ways to do this. And so look into what works for you, but don’t write it off because it feels like intimidating or big, especially if you’re new to therapy, that can feel kind of like a big leap. But I couldn’t agree more with you on that.

Dr. Nicole (30:16):

I mean, I do think in the future we are going to have this sort of seamless standard of care with mental health and really part of that just warm handoff transition. It’s part of the medical team. We’re not there yet. So unfortunately the onus still falls on mothers to set up their own postpartum mental health care as everything else. But I say that to put them in a place of empowerment, don’t wait for your medical team to do this for you. You do this. We’ll get there eventually, but it’s going to take a really long time. And mothers need help like yesterday.

Dr. Sarah (30:50):

Yeah. Yes. So I will also have some questions for you about, you were talking about we have all these changes postpartum in our brain, and historically it’s been sort of couched as this negative achilles heel of motherhood, and you are reframing it as actually an asset, a strength, and maybe something we can, if we approach it with a lot of knowledge, we can even kind of hack this to our advantage. What is some of the benefits to this increased neuroplasticity that women experience after having a baby?

Dr. Nicole (31:31):

So I feel like mothers know this, right? Mothers know that they’re smarter and how much they’re capable of in terms of after they have kids and they’re like, wow, I just did a million things in a half hour and I figured out how to soothe my baby, and how great does that feel when you sort of problem solve? And it’s like, I was right. And so I feel like mothers sort of inherently know this, but they get confused when they can’t keep up with adult conversation and they’re like, I can’t even remember what I did yesterday, and that happens, still happens to me. But I’m like, really? It’s about the lack of sleep that’s a major contributor to the fogginess and the forgetfulness and the feeling interrupted. I mean, these are all very real subjective feelings of mommy brain. That is a real phenomenon. However, the research and the brain changes don’t really support that.

(32:25):

There is significant differences in terms of memory, cognitive functioning between mothers and non mothers. So it’s really this lack of sleep and it’s the increased mental load. Your brain is adapting to thinking about a million more things that have to do with the baby. You’ve never done this before or you’ve never done it with two children before, or two children in different developmental phases. So it’s just an incredible amount of learning and things to figure out. And so you have to give yourself time to adjust to that. So that’s what I think of it. It’s like an adaptation, and this is what research says. It’s an adaptation, and it doesn’t happen overnight. Even though you physically become a mom overnight, you give birth there, you’re psychologically, the process takes a lot longer. Baby bonding takes a lot longer than we think for a lot of mothers.

(33:17):

It’s very common, and I hear that from a lot of my patients. I went through this myself. I was sort of wondering what was wrong with me, where I knew I loved my baby, but I wasn’t sure do I feel it? I was like, I don’t know. It’s not really doing anything for me right now yet. I was just going to be in love and consumed by this overwhelming feeling, and I sort of wasn’t. And that was something I wanted to learn a lot more about. And so I did, and the research supports this. We know that it typically takes months for this relationship to develop. And right in the beginning it’s really projection anyway in any relationship. And so we have to frame that in the same way in terms of…

Dr. Sarah (34:03):

Can you explain that? Because a really interesting way to think about bonding as a sort evolution of initially it may be projection, and then as you get to know this person more, the projection gives way to a more mutual shared experience. But if people aren’t familiar with this concept of projection, could you explain what that might kind of mean for what that looks like in the mother’s mind and in the early stages?

Dr. Nicole (34:36):

Yeah, I mean, whatever it manifests in terms of the baby, whatever that represents for the mother in terms of you have these feelings of fulfillment or just pride and it’s all wonderful, but it’s a baby and you’re projecting all of these images and hopes and dreams onto this thing, but it’s really, that’s internal for you. It has nothing to do with the baby. So you’re putting that all on this new baby. And so that’s really the projection of it instead of with a more genuine relationship, takes time to build, and the baby’s not really doing much in the beginning anyway, and so it’s going to become way more gratifying over time, and there’s going to be more opportunities for you to connect and to soothe and to go through the challenges together. I think that’s really what builds that bonding. Now, look, this is not to minimize women mothers who have that immediate love for their baby and are overwhelmed with emotion. I think that that’s great also. So I don’t want to minimize that experience either, but I just want to validate that bonding takes time. It’s a relationship with another genuine person.

Dr. Sarah (36:03):

Yeah, I think that’s a very important point. Not to say there’s something wrong with projection. I think it is appropriate and natural to project onto this infant our own experience. And the problem I think lies not with that, oh, it’s projection, therefore it’s not real. So shouldn’t a false sense of connection. It’s not. It’s just that if you have your own stuff that gets stirred up from your relationship with your own parents to early childhood to anything really, anything that motherhood, the entrance into motherhood awakens from our past, if that’s part of what’s getting projected, it can actually make bonding with the child really difficult and complicated if we don’t carry that stuff or if we have a way of separating that stuff out from the emotions we project onto our baby, I think more women who are able to have that experience don’t have the same difficulty with the bonding it. Everybody’s projecting, what are we projecting, right? If we’ve got stuff that gets mixed in with the projections that make the bonding complex and maybe even painful, and this could be happening completely unconsciously, completely unconsciously, then we might have ambivalence about pursuing that line of projecting and that eventual evolution of that projection turning into that more mutual dance of, oh, wait, you’re giving me a smile or a coup in exchange for my gaze, and now we’re having two person exchange that’s based in reality. That’s not a projection that’s happening. Right?

Dr. Nicole (38:10):

Right. Exactly.

Dr. Sarah (38:11):

Yeah.

Dr. Nicole (38:13):

And so this is why I also say that becoming a mother is an opportune time to be in therapy because of all of that neuroplasticity. We know therapy rewires the brain. So imagine your brain is sort of primed for changing and development. Well, if you’re in therapy at the same time, I feel like your therapy can go that much further if you are going into some of these core issues that may come out in motherhood. And so I feel like that’s another way to sort of say, again, you can be better than ever if you nurture this process. Therapy is one way to do that and sort of ride that tide of neuroplasticity.

Dr. Sarah (38:54):

Yes, yes. And it’s so empowering, like, oh, hey, instead of thinking of this as my kryptonite, it’s my superpower.

Dr. Nicole (39:03):

Exactly. And it’s like, what greater motivation is there when you have a baby? It’s like you want to be the best version of yourself. You want to do your best. You want to take care of this kid. You don’t want to pass on intergenerational trauma. You want to make it better for your kids. So that’s why I also think that’s a great motivator to work on all of these things.

Dr. Sarah (39:29):

Yeah. I wonder too, that makes me think of mom guilt, and I work with lots of people who do have stuff in their background. They have trauma experiences, they have challenges with their attachment relationships and early childhood. They know they’re going into motherhood with some things that could potentially impact the ease with which they transition into motherhood and could even impact their relationship with their child, their ability to bond the way that they attune to their child, the way they develop that secure attachment relationship. And so much of my work with those parents who have their forethought, who are in that proactive stance, a lot of it is saying, this is not that fragile. It’s you aren’t a wrecking ball and flying through a glass window here. There’s some resilience just deeply rooted in our species that says this biological drive to attach and our ability to, even if we have really tough stuff coming into motherhood, our ability to persevere and be an attuned parent most of the time, enough of the time, the good enough mother, we don’t have to be perfectly healed to have a very healthy relationship with our kid.

Dr. Nicole (41:08):

No, no. Right. Exactly. And so I think of it as, I love, that’s who rattled is geared for introspective parent. And so yeah, you’re going to constantly be developing. It’s not like, oh, you go to therapy for a little while and then you’re ready to be a mom or ready to be a parent, or you solve that issue because your kids, as they get older and are in developmental phases, will bring more stuff out of you. It’s be aware, compassionate, and know how to manage it. It’s not the absence of those feelings. It’s being able to manage that and not project it, not put it on your kids, not pass it on to the next generation. And so of course, with therapy and treatment, you’re going to be triggered less, but it’s not the absence of having these tough emotions or these challenges or this awareness of what you’ve been through. It’s an acknowledgement and it’s a choice. It’s a space where you’re like, okay, so this is what’s happening and can either, this is how I can move forward with it. This is how I can cope with it in the moment and not put it on my kid. I’m aware I have that space to make choice a conscious choice.

Dr. Sarah (42:36):

And I think it’s funny. I am a huge proponent of therapy. Obviously I’m biased as we both are. We know that world and we know what it can do. And I think that therapy is so potentially valuable, but I think what’s really important is it’s not the therapy, it’s the consciousness, it’s the awareness. It’s the elevating consciousness. It’s becoming more compassionate towards ourselves for our ups and downs in our regulation, more compassionate towards our child for their ups and downs in their regulation. That therapy can facilitate that. But what the ultimate goal is, is that elevation and consciousness, that ability to have compassion for ourselves, that ability to accept what’s going on in a way that doesn’t keep us shaken, that doesn’t rattle us, that allows us to be sort of, I can weather this with my child for my child. If you get there through therapy, if you get there through, there’s other ways to get there.

(43:45):

And I think you made a very good point earlier too. The greater the risk factors, the greater the strain on somebody’s mental health in their history, the more support might be needed to do this. And just because you don’t have a history of trauma or a history of maybe mental illness or challenges with your mental health, doesn’t mean you can’t have postpartum depression or postpartum anxiety or a perinatal mood and anxiety disorder, of course. But sometimes working with a professional really helps you establish what your risk level is and what level of support you need. Not everybody is going to require therapy in order to be able to do this. I don’t know the work of becoming an attuned, compassionate, aware human being, but it’s not going to hurt you.

Dr. Nicole (44:47):

And I’m sure you’re aware of the latest research that we know that was before thought that it was really the relationship between the therapist and patient that was really improving outcomes. But we know now that that’s important when you have sort of mild symptoms. So that might fall into a patient who maybe doesn’t meet criteria for postpartum, but is struggling and still wants to talk about things work, have a thought partner sort of bounce things off of, adjust the motherhood in that sense. But if you’re having very real clinical symptoms like postpartum OCD or depression or anxiety, actually the modality really matters. And so we want to go for more the evidence-based treatment, and someone more skilled in providing that kind of treatment. And so a support group may not be as effective for someone with postpartum OCD. You need a higher dose of treatment. And so it’s important that when you set this up proactively, you’ll be able to understand what your risk factors are, but also your provider can educate you on the different levels, the different, and okay, here’s what I would recommend now, and especially if it’s a financial strain, when I talk about treatment planning with my patients, if I’m aware of the financial strain, I’ll think about different options. I want to get them the best support that matches their level of symptoms or level of risk.

Dr. Sarah (46:12):

Right? And this is a big problem I think, across our country, but mental health care shouldn’t be limited to financial access. And I think there are, it’s not easy, but there are ways definitely to get appropriate mental health care that matches the level of clinical acuity that matches the symptoms, demands for treatment in many different ways if you need it. There are ways to find it. And I think postpartum support international is a very good resource to start. And then in your local areas, there’s also usually something, and actually PSI is a good web because they have a database of every clinician in the entire country and actually world that is trained in their criteria for treating maternal mental health, which is the gold standard of treating maternal mental health. And so usually you can find somebody who is able to see you, their database.

Dr. Nicole (47:30):

Right, exactly. And reach out. I mean, I’m happy to connect you with, I’ll find, I love vetting providers and sending it to people that contact me and say they can’t really join my practice. I will give them resources as well to turn to and specific ones I’m happy to vet them for.

Dr. Sarah (47:48):

Yeah, we do that at my group practice too all the time. If we can’t work with you, we will help you find someone who can, because at the end of the day, that’s our mandate. Getting someone care when needed is always the primary goal.

Dr. Nicole (48:07):

Right? Exactly. Yeah.

Dr. Sarah (48:10):

I’m so excited for this book to be out. I feel like the more that people are writing about this and talking about this and reading about this, the more it’s going to become even more embedded in our sort of just cultural language and just being able to say, oh, this makes sense. What is happening makes sense.

Dr. Nicole (48:31):

I completely agree. I mean, this is why I wrote the book. So I mean, being an academic, I was used to publishing in academic journals, but nobody, moms aren’t perusing PubMed. They’re not reading these original articles. So it was really, I got frustrated because even the interventions I’ve developed are sitting on the shelf somewhere in academia, and I was like, wait a minute. The people that need the information is everyone out there in society and the lay person, and how are they going to engage with this mean, especially with social media nowadays and filtered images, but also the lack of science being portrayed. I really felt like, okay, I’m sort of a medium. I can translate the academic research in an easily digestible way as well as I walk the walk, I talk the talk, I’ve been through it. I’ve been to rock bottom through the worst of it, and out on the other side and put the pieces together in a science-based way. And I think that’s really my mission is to reduce the postpartum mental health crisis, empower mothers to thrive in early motherhood, to understand the brilliance of the maternal brain so that they know that mothers are a good return on investment and that they can feel confident going back to work and understanding their brain power behind that as an asset.

Dr. Sarah (49:54):

Yeah. Yeah. That’s a whole nother thing we haven’t even touched on, which is this idea of, so we’ve talked about using this understanding of the power of the changes that happen in motherhood and matrescence as a way of coping with our negative thoughts or fears or shame or guilt, which is super important. That’s the first step. But what you’re talking about is not just doesn’t stop within our internal work, it’s about what are we projecting out into the world? What’s the narrative around motherhood that we are speaking out as mothers, as women who go through this, right? When we’re not apologetic about what we are prioritizing, what our brains are doing, what our brains have decided as the priority in the moment not, and to be able to say, this is a huge strength that is going to benefit everyone. It is a collective benefit to society to honor the power of the mother’s brain.

Dr. Nicole (50:59):

Yeah, I mean, I spoke about this in my TED Talk where I was like, motherhood is the ultimate employee development program. It teaches you leadership and creativity and client satisfaction and time management and multitasking, or getting a million things done in really stressful situations. And so all of this is fine tuning your brain even more. And that’s why I say it’s not just about getting mothers to a place where, alright, we treat their postpartum and they’re adjusting to motherhood, but I’m like, wait a minute. This is an opportunity for exponential growth and development to be better than ever to use your brain power and your assets and to feel confident in that it may be different. Before you had a baby, you were able to work in stretches of several hours of time. I know that I could sit at my desk for hours and be writing and doing research and whatnot or seeing patients uninterrupted all day.

(51:57):

And then after having kids, I’m like, okay, the way that I work is a little different. And to be aware of that, but also that it’s an asset in a lot of ways, and I’m bringing a lot of cognitive strengths to the equation. And I think that mothers feel really guilty when they go back to work and they feel like, oh, their brain has turned to mush and they can’t function. When really, again, it’s an adaptation. It’s like, no, how’s this going to work for me now? And so in the book, I provide a lot of ways on how to think about that. And my last chapter is called Up the Ante because I want to think about ways to even further develop your maternal brain further, bring out its brilliance. And I really think that mothers understand this inherently, and I sort of want to help them get out of their own way and to recognize the gifts and to empower them.

Dr. Sarah (52:52):

And it’s interesting if we can recognize the gifts and we can start to amplify them and center them in the way we move through the world, what hopefully will happen. And I think sometimes I’ll even work with companies on coming up with a better parental programming for their employees. Because if the larger world can start to see these strengths as true strengths, how many moms have gone back to work? And they’re like, well, I remember when I first went back to work after my second, I was like, I used to work nine to five, and I was like, I need to do eight to four because I have to be at pickup for, I have to be able to have without any question and ability to be there on time to get my kid from daycare. And my boss at the time was like, that’s fine.

(53:51):

But there are a lot of people who would be like, no, you can’t do that. That’s not fair to somebody else. So that’s not how we do it. And it’s like if companies you sort of industrial world could sort of recognize, which I think is part of your point, these are strengths, but they don’t look the same the way the mother brain works needs to be. Sometimes looks different. The schedule might look different, the productivity isn’t likely to change, but you might need to have flexibility. You might need to be open to a different way of doing something to see a greater return on your investment.

Dr. Nicole (54:28):

Absolutely. And I think productivity may not look the same, but it could look better. So when we think of the nine to five typical workday schedule, I mean that was geared, that’s archaic, and it was geared to single family households, single working parent households, and now just with our economy, most households are two income earners. And so our policies need to adapt so that companies and the government see mothers as a great return on investment. And I think they’re starting to, we have great advocates out there, but in the book, I sort of focus on not the policy change because postpartum mothers and mothers in the thick of it with young kids under four are not really going to be able to advocate for policy change that’s sort of outside the wheel.

Dr. Sarah (55:15):

That’s our job as the people who are outside of that window.

Dr. Nicole (55:19):

Exactly. So I acknowledge it, I validate that how hard it is and the cultural changes that need to happen and the shifts in policies and whatnot. But I really want to give mothers tangible things that they can do and how they can think about things right now, what they have control over right now because you tell, oh, well, we talk about how bad things are and how much more support we need, that doesn’t really help mothers. It’s sort of like, okay, great. Yeah, really it sucks, but we really need to empower them to understand the things that they can do day to day to make things better and to feel empowered and to feel confident and to adapt to all of these changes in motherhood and mince.

Dr. Sarah (56:02):

Yes, I love that. And I think that your proactive health plan is a really good example, and I’m sure there’s lots more very tangible strategies in your book. So if people want to read it, if they want to connect with you or learn more about what you’re doing, where can we send them?

Dr. Nicole (56:18):

So definitely follow me on Instagram. I’m most active there @drnikkipensak. And then you can get the book at all major bookstore. It’s on Amazon, it’s on Barnes and Nobles, it’s all over the place. Z’s bookshop as well. It was just named by Zibby Owens on her official summer reading list. So I’m really so thrilled that it was recognized in that way. And if you do read it, please let me know what you think. Please leave a review on Amazon and Goodreads. It really helps to get the book out there. And again, the science backed information in a world full of noise. This is a really strong signal, so yeah.

Dr. Sarah (57:04):

Yeah. And if you give it to your pregnant friends, oh, it’s a good baby shower gift.

Dr. Nicole (57:11):

I actually tell Mothers and I’m just trying to get baby lists to work with me in terms of can, we can take on maternal mental health care. This book should be on every mother’s registry. But also, I posted a video because I wanted mothers to sort of like how you would set up a honey fund for your honeymoon on a registry, set up a mental health component to your registry so that your people who are gifting to you can add money to the fund and it can contribute to your postpartum mental health care support. And so there’s a way to do that. I did post the video on that, and you can do that with babylist.

Dr. Sarah (57:53):

Oh my gosh, that’s awesome.

Dr. Nicole (57:56):

You can just go to a therapist’s website and tag it for your registry, or you can check any item and just name a monetary amount and label it as mental health support postpartum. And I think that should be more widespread and sort of an automatic.

Dr. Sarah (58:13):

And normalized and not like…

Dr. Nicole (58:15):

Normalized, right? Like, oh, okay, so what are you doing for your postpartum? Who’s your postpartum mental health care therapist? Or who’s on your team? But I do recommend prescriber and therapist just as safeguards.

Dr. Sarah (58:27):

I love that. Thank you so much for coming on. This was so, so fun talking to you.

Dr. Nicole (58:32):

Great conversation. Thank you so much for having me. It’s great speaking with you.

Dr. Sarah (58:40):As you just heard us talk about having a preventative proactive, or prophylactic action plan is an essential part of establishing your postpartum routine that is quite often overlooked, and that is exactly why I created a Mental Health Postpartum Checklist and made it completely free because I want all new and expecting parents to have access to it. This interactive checklist and workbook will walk you through everything you need for establishing your personalized, physical, and emotional support systems throughout your postpartum. You can feel more confident and relaxed knowing you have all your ducks in a row and have a game plan for whatever your new little duckling brings. To download my mental health postpartum checklist, just go to the episode description, wherever you’re streaming this podcast to pull up the link. Or you can go to my website, drsarahbren.com, and click the resources tab. That’s drsarahbren.com/resources. Thanks for listening, and don’t be a stranger.