402. Doulas, birth plans, and anxiety: How to feel more confident and less overwhelmed in pregnancy and postpartum with Sarah Ludwig

Sarah Ludwig (00:00):

There’s so much in birth and parenting that you cannot control that’s outside of your influence. And so it starts with pregnancy and that’s something that my clients I think struggle with.

Dr. Sarah Bren (00:20):

For new parents, it can sometimes feel like anxiety is one of the symptoms that just comes along with pregnancy. Suddenly you’re responsible for another life and even if you’re not someone who’s predisposed to anxiety, you may still notice that overwhelm and fear just start to creep in. Hi, welcome to Securely Attached. I’m Dr. Sarah Bren, a clinical psychologist and mom of two. In this podcast, I have taken all of my clinical experience, current research on brain science and child psychology, and the insights that I’ve gained in my own parenting journey, and I’ve 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. And this week, I’m joined by doula, childbirth educator and founder of Baby to Go, Sarah Ludwig. Sarah supports families through pregnancy, labor, and the postpartum period, and she meets parents exactly where they are, helping them to feel more prepared, more supportive, and a little less overwhelmed as they move through this transition. In this episode, Sarah and I talk about why pregnancy can bring up so much anxiety, how our desire for control can sometimes backfire, and what it actually looks like to prepare for birth in a way that helps you feel more confident. We get into the role of doulas, how to think about birth plans as flexible preferences, and why building our ability to cope matters more than trying to control every possible outcome.

(01:52):

And as you’re listening, if you realize this anxiety we’re talking about is something you’ve been experiencing, whether it’s during pregnancy, postpartum, or just in your life more broadly, I want you to know you don’t have to manage it on your own. At my group practice, Upshur Bren Psychology Group, we support individuals, parents, families, and children to manage challenging emotions like anxiety and gain a sense of confidence and control again.

(02:19):

If you’d like support, you can schedule a free 30-minute consultation by clicking the link in the episode description wherever you’re streaming this podcast, or visit upsharebren.com to learn more. That’s U-P-S-H-U-R-B-R-E-N.com. Okay. Now here is my conversation with Sarah Ludwig.

(02:35):

Hi, Sarah Ludwig. Thank you so much for joining the podcast. I’m so happy to have you here.

Sarah Ludwig (02:46):

I’m so excited. Thank you for having me.

Dr. Sarah Bren (02:49):

Yes. I’m really looking forward to talking to you because it’s been a little while since we’ve gotten to hang out, but we know each other through the Hudson Valley Birth Network

Sarah Ludwig (03:00):

Yes.

Dr. Sarah Bren (03:00):

And you’ve done incredible work with that organization.

Sarah Ludwig (03:04):

And I’m a party planner. That’s my major role is …

Dr. Sarah Bren (03:08):

That’s how you rally a bunch of birth workers.

Sarah Ludwig (03:12):

I want us to be connected and forming personal relationships. So what better way to do that than to join up and have some margaritas and some tacos and…

Dr. Sarah Bren (03:25):

I look forward to the Hudson Valley Birth Network Margarita Mixer every year. It’s my favorite. Yay. But maybe talk a little bit about how you got involved with the Hudson Valley Birth Network, what your work, the broader work you do with birthing people and supporting them.

Sarah Ludwig (03:45):

So how I became a doula and a childbirth educator was because I really wanted to connect with moms and I wanted to offer support that I felt was a little bit lacking in my own journey. And it tidily fit in with the fact that my job ended at approximately the same time. The school … I’m a former teacher and the school that I was working with closed. And so I really loved my work, but I was not prepared to join a whole new community and try to balance that with two small young children. So I pivoted. And I wanted to find community and find those connections that were so important. And so I looked up local birth workers at the time and Hudson Valley Birth Network came up and we are such an incredibly welcoming group. And I don’t know if you have the same thing as me, but when you find your people, even when you are not in the mood for a meeting or you don’t want to go out, you feel more energized afterwards and just kind of that give and flow of energy and ideas.

(05:00):

And so Hudson Valley Birth Network, we are a consortium of all kinds of different birth workers from people who are doing more psychological work and therapy based work to doulas and childbirth educators and lactation consultants. And so I love it.

Dr. Sarah Bren (05:21):

Yeah. It’s funny because how I ended up getting connected, I first found the Hudson Valley Birth Network when I was pregnant with my daughter and I was looking for a postpartum doula and I found just a wonderful human being through the Hudson Valley Birth Network. And so then I was looking at it and I was like, oh wait, this isn’t just for postpartum support, labor support, like lactation support, all kinds of incredible, just incredible people there. But there was also mental health support. I was like, “Oh, I could be a part of this. ” I could get connected not just as a mother, but as a therapist. And so that was my entry into it was after using its directory to find my postpartum doula. And then I’ve just found it to be such an incredible source for connecting with people who are working with parents and mothers and families and just community.

Sarah Ludwig (06:26):

See, you were ahead of me because I had no idea that postpartum doulas even existed when I was- And now you are one. And now I am one. Yeah.

Dr. Sarah Bren (06:36):

Yeah. You know it’s funny. So people who are listening probably know Emily Upshur. She’s my partner at our group practice and she’s on the show a lot on Thursdays. She’s always often here to do our Q&A questions, but Emily and I know each other because we used to work at Mount Sinai Beth Israel Hospital for years together. And she’s always been like a few years ahead of me in like babies and life. And so when I was pregnant with my first, we were both still working at the hospital and she was like, “Here’s what you’re going to do. You’re going to get a doula.” And I was like, “A what? ” And she’s like, “You’re going to get a doula.” I’m like, “I don’t think I need that. ” She’s like, “You’re going to get a doula.”

Sarah Ludwig (07:17):

It’s so nice to have a plan.

Dr. Sarah Bren (07:19):

I know. And she is type A. I am a type B. Is there a type B? I don’t know what we call it. I might be a type Z. I’m a type ADHD.

Sarah Ludwig (07:29):

Okay.

Dr. Sarah Bren (07:31):

But she’s definitely a type A. And that was nice to have someone who could be like, “Okay, I’ve already done all the research. This is what you need and this is who…” So it was really helpful. And having a doula with my first was the most, looking back, I’m so grateful that I had that because I think it actually allowed me to have a pregnancy that was not … I think I might have had a much less successful labor and delivery. There was like moments in it where had she not been there to help me kind of understand what was going on and stay kind of calm and focused, I don’t think I would have had the labor that I had.

Sarah Ludwig (08:11):

So we clearly can’t change medical outcomes. And I had my first son before I was in this world and before I really knew that much. And I took a childbirth class because I am type A, and that’s what we do is we like get all our ducks in a row. And the particular class that I took, unfortunately, I believe gave me a really good handle on how to be a great patient in that hospital, but not so much how to have a voice in my care, the ins and outs of my options and things. And so I think that’s an important part of what doulas do is sort of like put a pause and like, “Okay, here’s what’s being recommended to you, but you still have the final decision here.” And I think that when we talk about having a healthy birth, most people are really focused on physical outcomes for mother and baby.

(09:11):

And that is absolutely, truly the most important because without your physical outcomes, you don’t have mental and emotional health. So I’m not downplaying that healthy baby, healthy mommy, but I think it’s a low bar. I think that we can strive for more. And I think that we need to include the mental and emotional wellbeing to have a full picture of those positive outcomes. And I think that’s what has come in. Yeah.

Dr. Sarah Bren (09:41):

Yeah. So for people who are not familiar … I mean, we have a few episodes where we’ve talked about this, but it’s been a while. So if people … Can we give listeners like a little bit of a doula 101 and maybe like what you bring too, like when you’re working with a family, whether it’s first time, sometimes maybe it’s not their first time.

Sarah Ludwig (10:05):

I had a lot of second and third time parents for sure who maybe had an experience that they didn’t love the first time, or maybe they had a doula and were like, “We’re never doing this without someone.” So I touched on it a little bit. I am not in charge of any of the physical health. So doctors and nurses have a role obviously and they are of primary importance, but I think especially first time parents don’t necessarily realize how limited the amount of time that the doctor is in the room. They’re not hanging out with you. And the nurses most of the time have other patients and so that they are not there for the majority of time. And they’re there to make sure your IVs are correct and you’re getting the right medication and you are getting communication from your doctor, but they’re not there to sort of really support you and your partner if you have a partner there with you.

(11:07):

They are not coming to your house during your pregnancy to make sure you feel prepared. They’re not checking in with you afterwards. And so I, as a doula, am a steady presence. I am there, someone who knows you from your pregnancy all the way through that process, so some continuous care and support. And I think that there is a little bit of a stereotype of doulas. And if you are looking for the girl who’s going to whisper incantations from the birth goddess in your ear while waving a crystal over your belly under a full moon, I know that girl, I’m not her. So if that’s who you’re looking for, I am happy to connect you and please all the best wishes for your journey. As I mentioned, I’m a little bit more type A.

(12:03):

My voice doesn’t do that whispery birth goddessy kind of thing. I’m in there. I bring a little humor. I think that this is a milestone, but it doesn’t have to be so serious all the time. So I’m happy when, drop a little F bomb here and there. I bring the sparkle and a little levity to the room. And I also help a lot of the moms that I work with are type A. I joke that we are in the New York metropolitan area and I think we all have an underlayer of anxiety and want a list and there’s so much in birth and parenting that you cannot control that’s outside of your influence. And so it starts with pregnancy and that’s something that my clients I think struggle with. And so giving them, here are the aspects that we can control, here’s the checklist that you can follow, but also there is a whole other lane and welcome to parenting because there is all of this stuff that you just kind of have to go with and you need to let go a little bit of that control for sure.

Dr. Sarah Bren (13:24):

Yes. It’s interesting because as we’re talking about type A, I keep thinking like, “Oh, there’s a type.” Right? But I actually think, as we’re discussing this, I’m like, oh, it’s fluid actually because I don’t consider myself a type A person in most aspects of life, but when I feel a lack of control or I feel like I’m in over my head or I feel really overwhelmed, one of the ways, and perhaps I think my less successful strategies with dealing with that is like put my head in the sand and avoid or get a little chaotic and scattered. but I actually think when I turn on my type A parts, I actually handle that overwhelming situation better. I think if I over … It’s like a spectrum, right? And we’re always kind of moving across it, but when I go super type A, it doesn’t help me because then I stress out, I get rigid, I get kind of irritable because I want to control things I can’t control, but when I’m like a little bit type A, like a little more than I usually am, I feel grounded because I’m like, “Oh, okay, I can do this, I can do this and then I can do … ” So I think even parents who maybe don’t identify as type A in pregnancy certainly might wake up those parts.

(14:49):

But also, I think parents who are very much identify as type A can get stuck in that kind of a hyper control mode. And I imagine that’s where working with someone like you could be really helpful because like you said, even just the role you play as a doula, but also just you as Sarah, like it sounds like you’re both able to relate to that desire to have that tight grip on control, but also can say like, “We’re going to turn the volume down on the intensity here. We’re going to lighten things up. We’re going to zoom out. We’re going to remember some context here. We’re going to get a little goofy. We’re going to not make everything so serious.” I think that’s a very good antidote.

Sarah Ludwig (15:36):

1,000%. I think that pregnancy and birth, especially the first time, but every time, because every time is different, is a little overwhelming and a little scary. And so my women who are, or my families who are more on the type A end of that spectrum really clutch onto those plans. And I talk about, we’re going to do some birth preferences and we’re going to create what your priorities and your ideals are. The baby isn’t going to read it. And so this is not a strict agenda, it’s more of an itinerary. So when you’re planning your birth preferences, it’s kind of like you’re planning a trip. We’re going to take a trip to California and maybe you really want to go to the beach and drive up the Pacific Coast Highway in a convertible with the wind in your hair and that’s your whole plan. But if we get there and it starts raining, I want you to know where the best museums and the great restaurants are and we’re not going to sit in our hotel room and cry because we missed out on the beach.

(16:46):

And it can be, it’s totally fine to sort of mourn the loss of that beach vacation that you were dreaming of, but we’re still going to have a good time and we are going to control what we can control and then sort of find a way to let go and be aware that there is a significant part of this that we kind of have to learn to go with the flow. And that’s getting ready for parenting because your kids are certainly not going to be one of those things that you can tightly control all the time.

Dr. Sarah Bren (17:20):

I know. Yes. It’s so funny how like in pregnancy before, the idea of it is like, this is this journey and I have so much say in it and maybe I believe on some level that when I have kids, I won’t have as much say, but I’m like, “Oh, that kid’s inside of you from the beginning and they are going to assert the will on you from the beginning.”

Sarah Ludwig (17:47):

Yes, they are.

Dr. Sarah Bren (17:48):

Yeah. My daughter was breached my second. And I was like, “Well, what do you mean to make her flip?” And they’re like, “Well, we’ll try.” So I mean, I did everything. I was laying upside down on my couch. I did acupuncture. I did chiropractic. My husband was lighting mocha at my feet. He was like lighting incense and lofting smoke at my toes. We did everything, we did a cephalic inversion, everything. So from like the woo to the medical, we tried everything and there was no flipping this child.

Sarah Ludwig (18:26):

And sometimes that’s the way it is. Sometimes there’s some reason, and you may find out, you may find, oh, she had a short cord or she just didn’t have the space and sometimes we just never find out, and that’s unsettling, that’s not fun.

Dr. Sarah Bren (18:43):

I know it is hard. And I think we can assign, this is I think very important because I fell into this trap too. I was like, “Oh, she’s already being stubborn.” She’s refusing to flip. And I had to take a moment and catch that and be like, “I don’t want to project a bunch of stuff onto this child, right?” That’s my stuff. I want her to flip and I don’t have control over that. I can control some of the things that I can try, but ultimately I can. And when my OB ended up delivering her, I had a C-section, planned C-section on Mother’s Day. I walked into the hospital with my bag. I was like, “This is very weird because this is not how I had my first.” I did not carry a suitcase into the hospital with my first jauntily. I was like very, very much in labor. I practically crawled into the hospital the first time, but so my OB, when she delivered her, she said she was so wedged down into your pelvis, there’s just no way that her body was going to be able to flip.

(19:44):

And I was like, “Wow, I’ve been assigning a lot of even volition on her end into this unborn baby.” And I had to be like, she didn’t want that eat. She was probably feeling stuck. So total tangent, but I’m just realizing like we as parents don’t have a lot of control all the time and that’s really hard, but neither do our kids. And sometimes when we feel out of control, we kind of project agency onto our kids or like a sense of like they are thwarting my desire for control right now in some way they are choosing to do that. And I think it is super important to remember like probably not.

Sarah Ludwig (20:32):

They’re probably filling out of control. We all can sometimes imagine that we can research our way into the best outcomes and the best things and there is no one best. So we talked about zooming out. I tell my clients, because they’re like, “Oh, do you like take a look at my registry?” And I’m like, “Okay, I’m happy to look at it. ” I am of the opinion that a lot of products for especially pregnant families and new parents are very predatory in their marketing and they imagine like, “We need this because I mean, we’ll spend all the money because we want the best for our baby.” And if you take a step back and you’re like, “Okay, maybe you want that little egg that changes color based on the temperature of the room, but remember that not everybody lives in a perfect climate controlled bubble.” And the families that live in Sub-Saharan Africa or in Northern Canada with wildly different climates, they still have babies and they still have happy, healthy babies and you don’t necessarily need to be within that half a degree window for your child to be healthy and to have a great life.

(21:44):

And so there are things that we can do that we can control and I try to kind of help them focus on those aspects and then just know that there are things that we can’t and we don’t have to. And there is no one best. If someone asks, if people ask me all the time, like, “What’s the best car seat, for example?” And it depends on your vehicle, it depends on your family makeup, it depends on where you’re driving, it depends on a lot of different things. There is no one best. It’s sort of like asking someone what’s the best dinner. I mean, I don’t know, are you gluten free? Are you vegetarian? What are you in the mood for? Because my best dinner certainly varies from day to day. Sometimes I want all you can eat sushi and sometimes I’m like maybe just a salad. I’m not that hungry.

Dr. Sarah Bren (22:40):

Right. But that makes me think about, because when we’re talking about type A and we’re talking about control, we’re also talking about anxiety, right? And I think an important thing to recognize is that there’s kind of like an optimal zone of seeking control and there’s a point of diminishing returns. Sure. So like when you have anxiety, it can be helpful to find the things that we have control over or the things that we can have some visibility into. Because a lot of times with anxiety, I’ll give like an equation that I like to use to sort of describe the factors that increase and decrease anxiety. So think about like a formula, like a numerator and a denominator. So the number on top with a line and a number on the bottom. On top is unknown plus lack of control. The higher the numerator, the higher the anxiety, right?

(23:41):

The more that’s unknown and the more we don’t feel we have control over, the higher our anxiety. However, underneath that, divided by our confidence in our ability to cope. And so we have these three variables and they equal anxiety. So when the numerators…

Sarah Ludwig (23:59):

Can we add in the denominator, maybe the things that we can have some say in, like…

Dr. Sarah Bren (24:06):

Well, that’s the thing. Confidence in my ability to cope might mean I can cope with whatever comes or I can cope by focusing my attention on what I can control. There’s so many things, but we can tweak the numerators a little bit, right? Right. If the unknown is really high, I can do some research. I can find out some things.

Sarah Ludwig (24:30):

Yeah, I love that.

Dr. Sarah Bren (24:33):

If the lack of control is really high, I can find some things that I can control in the situation, make that numerator go down. It’s just that I can’t completely wipe it off. I can’t make it zero. I can make it smaller, but I usually can’t make it zero. And so that bottom piece is like what my confidence in my ability to cope, that we have a lot more control over in the sense of I can expand that. I have the capacity to expand that denominator more than I might be able to reduce the numerators if we’re getting kind of too numbered.

Sarah Ludwig (25:10):

I love that. I love a good analogy. That’s so good. I talk to my clients too, that there is a certain amount of normal anxiety that comes with having a baby. This is a little life that you have put in charge of, and like there is a lot. And so if you are driving around a parking lot for the first time with your baby and all of a sudden you’re noticing like there’s all these cars and you’re a little bit worried about getting into a car accident, then that is kind of a normal leveling anxiety. It is a livable and there are solutions to that. You can go on off hours, you can park closer or leave the baby at home with someone while you go or Instacart or whatever. There are solutions there. If what you’re worried about is like wild horses coming and trampling you in the parking lot, that’s not a level of reality within where we live. Maybe there are places in rural America or in the world that wild horses in a parking lot are a concern, but if you’re telling me…

Dr. Sarah Bren (26:13):

Probability versus possibility.

Sarah Ludwig (26:16):

If you’re going to like the White Plain or like the Montvale Wegmans and you’re concerned about wild horses, then I’m going to tell you that that is a level of anxiety that’s a little extra and let’s work on that and let’s help you find the strategies and bring up that denominator so that we can cope and not feel that way in a regular basis.

Dr. Sarah Bren (26:39):

Right. And that’s actually, it’s so funny that you bring that up because I think it’s really valid. I think that there is, I mean, obviously there’s postpartum anxiety and postpartum OCD that where we have like intrusive thoughts and worries.

Sarah Ludwig (26:53):

For sure.

Dr. Sarah Bren (26:53):

But there’s also just normative, like non-subclinical anxiety and intrusive thinking when you have a baby.

Sarah Ludwig (27:03):

If you’re worried about germs and you make the people who come to your home, wash their hands before holding the baby, that’s a normal thing. If you won’t let anybody else hold your baby, if you won’t let your partner or your mother-in-law have a relationship with the baby because you’re worried about their germs coming home from work, then that’s interfering with your relationships. That’s interfering with your ability to live your life. And so that’s where I think the relative normal concern, which we have to have. I mean, like they say pain is learning. If you put your hand on a hot stove, that pain is telling you, “Don’t put your hand there because you’re going to damage yourself.” So there is a level of anxiety that is helpful that helps us do live our lives in a way that is healthy, in a way that’s protective.

(28:02):

But when it gets to be a level where it’s interfering with your relationships, where it’s interfering with your ability to sort of go through your life, then that’s where I recommend reaching out to someone that helps with your mental health and seeing how we can increase that denominator. I love that. I’m going to use that forever now. I love that analogy. And so that numerator and denominator thing is exciting.

Dr. Sarah Bren (28:27):

Yeah. And it’s true that in pregnancy, the brain changes, our nervous system changes, we are going to have more fight or flight response. We are going to have more intrusive thinking. We’re going to have more worry thoughts. That’s all kind of our biological evolution towards making sure our child survives. It’s part. We are way more on high alert and more hypervigilant and more worried postpartum than we usually are.

Sarah Ludwig (28:59):

Well, even sensory information, you get pregnancy nose where you can smell more and food aversions are thought to be partially to avoid foods that could be unsafe and so yeah.

Dr. Sarah Bren (29:17):

Yeah. And so I think it’s important for us to just kind of like, again, like zoom out and say, why am I more worried about everything right now? Why am I starting to get like extra, extra nervous around people, like germs or being out in traffic? It really is one, we want to notice it. We want to give ourselves some grace. We want to normalize that that is part of our system adapting to having a little life that we have to like keep alive, but also it’s like we have to stay tethered to, like you were saying, we have to stay tethered to reality Is this probable or possible? It might be possible, but it’s not probable. Is it getting in the way of my ability to move through the day? Is it interfering with relationships? Is it taking a toll on my mental health?

(30:14):

If those things are happening, it is really important to get some support because postpartum anxiety is very real. Postpartum OCD is very real. There’s a lot more than just postpartum depression that can happen. And people who are type A, generally speaking, are more likely to experience anxiety. And if you have a predisposition to anxiety, you may be more vulnerable to having kind of a postpartum anxiety kind of intense to your symptoms.

Sarah Ludwig (30:49):

And it’s so treatable. And so being aware that that’s something that can happen and keeping an eye out for the signs and even having your partner aware of like, here’s what it could look like if there’s difficulty and like who are we going to reach out to? And that’s part of, I think a lot of people plan birth plans or that’s part of the cultural vernacular is making a birth plan. And I call them birth preferences because like I said, that baby’s not reading that and sometimes your body is not cooperative. But I also give my clients a postpartum workbook because sometimes I think we forget that after the birth, there’s a whole change in what our lives look like. And it’s hard to build a boat while you’re drowning.

(31:43):

And so to be aware, “Hey, I’m headed into the ocean. I am a pretty strong swimmer and I think I’m ready for what to expect, but like let’s know where the lifeguards are. Let’s know where the boats are in case we need them.” And so I have a postpartum workbook where people fill in like, “What are you going to do in terms of like meal planning? Whose job is that going to be? And what safeguards do you have in place?” And if you have a history of anxiety or depression or are concerned about that possibility, who do you reach out to? What is the plan for if you feel yourself kind of sliding into that space, how can we help you? Where are your lifelines? Where is your life preserver? And so knowing that ahead of time can even decrease the possibility of you needing them because you have them in place.

Dr. Sarah Bren (32:41):

And I think any type A parent is going to be so appreciative because a true type A parent is going to do all the research, but they are only going to research what they know to research. They’re only going to make the lists of what they know to make lists of. They’re only going to make the plans for what they know to make plans of. And I think it is so important as anyone working with parents and people planning for pregnancy, planning for parenthood is to broaden their sight lines and say, “We need to move beyond the birth plan. We need to move even beyond the postpartum.” You need to be thinking about that stuff too, thinking about a parenting plan, like thinking about … And again, I think it’s also important not to get too far.

Sarah Ludwig (33:31):

Oh yeah. No, we’re not detailing how this child is going to get their driver’s license.

Dr. Sarah Bren (33:38):

But understanding, like you talk about controlling the controllables and I think that’s even a spectrum, right? There’s a sweet spot. We want to be able to feel not completely unmoored and not completely out of control. So we want to control what we can control, but I think we also have to watch for when we’re hyper controlling all the minutiae because that’s a good little bell to let ring to say, “Ooh.”

Sarah Ludwig (34:08):

That’s like Google. Google will tell you you’re dying with anything.

Dr. Sarah Bren (34:11):

I know.

Sarah Ludwig (34:11):

Google is not your friend you can put in, “I have a headache.” And I say to my clients, I say, “Look, sometimes you have a headache and you take a Tylenol and you lie down with a cool claf on your eyes.” And sometimes you have a headache and you think, “This is different and this feels wrong.” And you go to your doctor, you go to the urgent care. And so if you type in that same headache to Google, it will tell you you could have a brain tumor every time. And that’s not indicative of like you could, but the likelihood of that without other symptoms. And so let me be your Google. Here’s what I think that would be helpful to plan for. Here are the systems that it would be great to have in place, but also if something comes up that you’re not ready for, I will have the answer for you or I will know six people that do because as you know, I’m in the Hudson Valley Birth Network.

(35:12):

I have such a close group of people that if I’m not sure of something, boy, do I have a great resource for you and it’s not some fear mongering kind of avenue of the biggest…

Dr. Sarah Bren (35:28):

The wild, wild west of the internet. Or now with AI, I can’t even like…

Sarah Ludwig (35:33):

Oh my gosh.

Dr. Sarah Bren (35:34):

Oh my God, I’m so glad I was not pregnant with AI. If you are pregnant and you are ChatGPT-ing, please ask ChatGPT how to prompt it so that you are getting only research back information and not too much of it. Tell it to … Don’t overwhelm me. Don’t inundate me with every possible thing. Give me the key information and let me know when there’s something I need to do to escalate it to my doctor or my doula or support system, because if you are sitting there using ChatGPT or whatever, an AI companion for your pregnancy, be aware.

Sarah Ludwig (36:21):

Well, they are also- There are ways to do it.

Dr. Sarah Bren (36:23):

There’s ways not to do it.

Sarah Ludwig (36:24):

It has learned the history of human knowledge and a lot of that human knowledge is A, defunct or B, outdated, or maybe a little overconfident, right? And so something.

Dr. Sarah Bren (36:43):

Or a hallucination because it’s not all accurate.

Sarah Ludwig (36:47):

The way that ChatGPT functions is it wants to give you the answer. And so it has been proven and research backed that if it doesn’t know the answer, it will lie to you. And so you want to make sure that you’re getting accurate information and so accurate and not overwhelming, for sure.

Dr. Sarah Bren (37:11):

Yeah, because that’s the other thing is it wants to not only give you the information, but it wants to be very thorough. And so it will give you, not only will it give you too much information, most and many of the time, it will also then prompt you to be like, “Want me to do this now? Want me to do this now?” It will take you down a rabbit hole that like that’s the last thing you need and I…

Sarah Ludwig (37:36):

I didn’t need a next step. I just needed a quick yes or no answer.

Dr. Sarah Bren (37:39):

And the next step should be, why don’t you talk to your doctor or why don’t you talk to your doula or why don’t you talk to a human please and it’s not going to do that.

Sarah Ludwig (37:48):

No.

Dr. Sarah Bren (37:50):

So be careful with that. I’ll just say that. It’s still very, very … It might be very good at some things. It is not good at that.

Sarah Ludwig (38:00):

Right. I think that AI has a place. I use it as a tool, full disclosure.

Dr. Sarah Bren (38:06):

Me too.

Sarah Ludwig (38:08):

I am very happy with the functionality that it provides, but it’s not taking the place of human interaction anytime soon because also it will back you up. So if it thinks that what you … If it perceives bias on your part, it will be like, “Yes, you are absolutely right.” And sometimes you’re not just for the record.

Dr. Sarah Bren (38:34):

Right. It’s also, it’s a good tool and the best tools, especially really powerful ones, are best used when you are very clear on what you’re trying to do, why you’re trying to do it, and you’re very grounded and centered and non-reactive and emotional, that tends not to be when a lot of people will turn to AI. We use AI as a tool when we are panicking or when we’re really anxious. And when we’re using that tool, that very powerful tool in our own heightened emotional state, it’s like operating heavy machinery while panicking, no.

Sarah Ludwig (39:16):

Or when you feel like you can’t, like if I can call a person, I’m going to call a person, but if it’s two in the morning and I don’t have a person to talk to, then it’s easy to go to ChatGPT, but then you don’t have someone else you’re bouncing that off of.

Dr. Sarah Bren (39:31):

So even something like before you start prompting it, like I need this to be a very simple, straightforward conversation. And if at any point you feel like it needs to get escalated to my OB or my midwife or my doula, please identify that point and stop. You can tell it to do things like that.

Sarah Ludwig (39:54):

For sure. And you can put it in your settings, depending on your system, you can put in a protocol that says, “Only offer me evidence-based information.” Do not give unverified claims at any point.

Dr. Sarah Bren (40:06):

Yes, highly recommend that too for everything.

(40:08):

Hey, jumping in real quick to tell you about a free resource that I offer for expecting parents. In this episode, we’ve been talking a lot about how pregnancy can bring up feelings of uncertainty and anxiety and how easy it is to focus all of our energy on preparing for the birth itself, but not always so much for what comes after. And that’s exactly why I created a free postpartum mental health workbook, because once your baby arrives and you’re in it, it could be really hard to step back and figure out what you need in that moment. This guide helps you think through all of that ahead of time and walks you through what to expect emotionally, how to set up support systems, and how to identify your non-negotiables so you’re not trying to make those decisions when you are exhausted and overwhelmed.

(40:59):

The goal is to help you feel more prepared, more confident, and more supported, so when you are in the thick of it, you already have a plan to lean on. So if you are expecting or you know someone else who is, just go to the episode description wherever you’re streaming this podcast to get a link to begin your free download and now let’s get back to my conversation with doula Sarah Ludwig.

(41:28):

Let’s go back just to ground this conversation because I think some of the most important things we really touched on here is that anyone can feel a little anxious and out of control in the context of pregnancy. It’s just because of the nature. There’s a tremendous amount. Remember those numerators? There’s a lot of unknown and there’s a lot of things outside of our control. So anxiety’s going to feel high. When we can control what we can control and we can find out more information and make things more known, that can help, but don’t underestimate the value of working that denominator, working that confidence in my ability to cope. And that comes with a lot of the things that having support with someone like a doula can really, in the stressful moments, but also in the calm moments, the planning moments, the what’s important to have a plan for?

(42:22):

What can I say? I don’t have to worry about that. That lives in the hyper control land that might actually maintain or amplify my anxiety because if I’m micro measuring every decimal of degree of temperature in my child’s bedroom, I actually, there’s a pretty good chance that that tool is going to amplify my anxiety and reinforce it, not reduce it.

Sarah Ludwig (42:49):

There’s out there that can count your child’s every breath while they’re sleeping. And I pretty much wholeheartedly recommend against them, as does the AAP, for example.

Dr. Sarah Bren (43:02):

As does the mental health community.

Sarah Ludwig (43:03):

Because A, they’re basically toys. These are not medical devices and your child, unless they do, unless they are one of the outliers who requires a medical device, in which case your doctor will prescribe a true medical alert system, but if you have an average developing, typically developing child, those kind of promote the idea that you have to watch them breathe every moment, and you have to be aware of every heartbeat they take. And if you think about during pregnancy, you’re not thinking, “Oh, I really make sure that you’re developing every fingernail.” We kind of just trust that they are. And so if you are using, I will say, “Here’s what a safe sleep space looks like. Here’s what you can prevent in terms of tragedies and how you can best give your child that safe space.” And then once they are in that safe space, they are safe.

(44:14):

That’s good. You don’t need to watch them sleep, you don’t need to watch them breathe because you have provided them an environment where they are able to do that.

Dr. Sarah Bren (44:28):

Yeah. And I think I work with a lot of anxiety just postpartum and just in life and with kids. And one of the things that’s really common in anxiety and OCD is compulsive checking as a mechanism to reduce the anxious feeling, right? I have a worry thought, I’m hit with a wave of discomfort and anxiety and panic. I check. I have an urge to check. I act on that urge. I see that everything’s okay. I feel relief and the anxiety dissipates. The problem is, is that the checking is like hitting the snooze button. It’s not actually turning off the alarm clock, it’s just a snooze button. And so as soon as I have another worry though, the anxiety will return, I go to check, I feel relief and we can get stuck in this checking loop and these gadgets that kind of really make checking kind of not only really easy, but wired in now to our routines, to our systems, it can really hijack us and create this perpetual loop of checking, which we think it’s going to help manage anxiety, but in a counterintuitive way, it is maintaining or increasing anxiety.

Sarah Ludwig (45:47):

I think that mother, baby, unintentionally, sometimes the hospital sets us up in those systems because they give us a checklist at the very beginning of like, when did they pee? When did they poop? How long did you feed? Set a timer. And yes, filling diapers within that first week, very important. We want to make sure that all our systems are go and we’re functional and all of that stuff. But if you are still marking off pee and poo diapers and your child is six months old, a year old, like…

Dr. Sarah Bren (46:19):

Then it’s compulsive, right? It’s managing anxiety, not your child’s development.

Sarah Ludwig (46:22):

Notice that. Notice if your child hasn’t pooped in several days, but if they are not … It’s also giving us an idea that there is one normal. When I talk to clients who are trying to get more sleep, a lot of times it’s because we are set up with expectations that babies are going to sleep longer or they’re going to do this or they’re going to have one way. And first of all, sleep development is not one line in the increase. It is all sorts of like twisty, turnie.

Dr. Sarah Bren (46:51):

There’s a roller coaster of ups and downs.

Sarah Ludwig (46:54):

And there’s such, especially within the first three months, we are in such a period of rapid development that if you get caught up in, well, the time that they slept longer, they were wearing their striped pajamas and they were on this bed at a 30 degree north by northwest angle and we had this shade closed, but this shade opened and it’s just coincidental. It becomes kind of these superstitions and these things. And you might get your baby at two weeks old into a routine, but that routine’s going to last approximately two days because then they’re going to be in the next growth spurt and they’re going to be off in a different phase. And so there is an amount that you can control. You can set up a safe sleep space, you can set up a space for good sleep hygiene where it’s dark and they’re warm enough and all of that stuff. But other than that, it’s…

Dr. Sarah Bren (47:57):

It’s coping with, it’s trusting our ability to cope that they will get this, but we also can handle it when they don’t. It’s going to be tough when they wake up. It’s going to be tough when it’s not going according to plan, and I can handle that because it’s … I think that in general, with the type A end of the spectrum, the skillset that really helps is perspective taking, cognitive flexibility, and distress tolerance, right? And really being able to say like, “This is hard and I can handle it, ” versus, “This is hard, I have to fix it.”

Sarah Ludwig (48:40):

My kids are teenagers. I can tell them when to go to bed, I can make sure that they’re not using devices in the hours before bedtime, but I can’t make them go to sleep. You can’t make anyone go to sleep unless you’re tired.

Dr. Sarah Bren (48:57):

You can’t make a human being pee, poop, breathe, eat, not spit. Those are the … Or sleep. There are certain things that we just will not be able to … We can control the environment, we can set … And another thing that I think you said that’s really important is there’s scaffolding. It is important that hospitals teach brand new parents the basics of what to track in the beginning.

Sarah Ludwig (49:22):

Of course.

Dr. Sarah Bren (49:23):

But if we think of that as scaffolding, that good scaffolding gets peeled back as the skillset becomes more intuitive, right? As the habits get built, as the deeper skills emerge. And so as a parent, trusting in your ability to read your child’s cues also requires you to rely … Don’t get me wrong, devices are great and there’s room for tech and apps and stuff and parenting, but be willing to look at that as scaffolding, not a replacement for. The whole goal is to build your skills and your confidence as a parent in your ability to read those sleep cues, to read those hunger cues, to hold the larger rhythm of the day for your child because you know where their ups and downs are. If you’re over relying on an app to tell you all these things, it’s really hard to learn those cues. And so we can use them. Please use them. It’s okay to you. I don’t want anyone to feel guilt or shame or fear on using them, but use them for what they are, a tool, a piece of scaffolding, and be ready to find ways to pull the scaffolding away as you deepen your skillset as a parent, because you got this.

Sarah Ludwig (50:39):

My laptop that I’m talking into is my screen that is on my living room wall that has my calendar, my meal plan, the to- do list, and that is my son is autistic and ADHD and he needs to come in and check in and know there’s a plan and know … My daughter knows when she has dance. It’s on the calendar because my son needs to know where everybody is for his own self, but I don’t have to remind my daughter, “Hey, it’s Monday, you have dance at 5:30.” She knows. My son needs to see it. And so whatever your system is that’s comfortable for you and works for you, great. But if it’s becoming intrusive, that’s where the line is that you don’t just let it go. Let’s take a break.

Dr. Sarah Bren (51:33):

This was so great talking with you. If people are listening and they want to connect with you or they want to learn more about the work that you do as a doula, as a postpartum doula, or as a childbirth educator, how can they connect with you?

Sarah Ludwig (51:47):

So easiest because it doesn’t have any hyphens or dashes or anything is baby to go on Facebook. When I set up my website, it’s baby to go, but it’s got hyphens in between the words. So it’s B-A-B-Y hyphen T-O hyphen G-O.com. And now it’s been so long that I don’t feel comfortable changing it, but it’s not fun to tell people. And I’m on Instagram as well. It’s @baby_to_go. So I’m everywhere.

Dr. Sarah Bren (52:23):

Amazing. Well, we’ll put links to all of that, including your website with the hyphens in the show notes so people can just go to the show description or the show notes page and click and you’ll get right to Sarah’s website because young wealth of information on there and this was so wonderful talking with you.

Sarah Ludwig (52:40):

It was so great. It was so much fun. And I’m going to use your numerator denominator anxiety calculator now forever. That is fantastic. I love it. Thanks.

Dr. Sarah Bren (52:49):

All right. I’ll talk to you soon.

Sarah Ludwig (52:51):

Bye-bye.

Dr. Sarah Bren (52:58):

Thank you so much for listening. I really hope this conversation about how anxiety shows up in pregnancy, the limits of control and what it really means to prepare for birth and postpartum has left you feeling a little more grounded and a little more confident and really better able to trust your ability to handle what comes next.

(53:15):

And if you’re interested in additional support for yourself, your child or your family, I’ve also linked my group practice, Upshur Bren Psychology Group in the episode description. With both virtual and in- person services designed to be effective and convenient, we offer support with everything from anxiety, burnout, emotional overwhelm, to parenting challenges, relationship dynamics, and child development concerns all in one place. You can find a direct link to my group practice in the episode description or visit upsharebren.com to learn more about the supportive resources that we offer. I will be back again on Thursday, answering one of your questions in our Beyond the Sessions Q&A episode. Until then, don’t be a stranger.