Dr. Rubin worked in women's reproductive behavioral health during her time on the east coast, and continues to treat these struggles on the west coast. In this episode, Dr. Pete and Dr. Rubin discuss the many challenges women may face postpartum, specifically with regards to symptoms on the anxiety spectrum given that these have generally received less public attention than depressive symptoms. Tune in to learn more about postpartum challenges and how fantasy narratives about pregnancy and new motherhood may exacerbate them.

Transcript:

Nikki: So, thankfully, over the past, I don't know, I guess it's maybe it's been 20 years since Brooke Shields wrote her book about postpartum depression. there's been a lot more awareness about struggles new mothers may face, particularly with regards to depressive symptoms. And today, Pete and I really want to talk about just sort of more broadly, some of the other things that can show up for new moms. So it's not just postpartum depression, there's also postpartum anxiety disorders are fairly common. but also just sort of the struggles that new moms can face with regards to mental well being and mental health, because this is something unfortunately, extends beyond Parenthood. but there's a lot of as I like to call them, like fantasy narratives out there about what having a new baby is supposed to be like and I think it really messes with people's heads.

Pete: I think, for me, as a man, I can never have a baby. I can't carry a baby and I have such strong empathy for women that have a new baby, because I can't imagine what that's like in terms of like, if you can't sleep, I mean, really, your life is no longer yours. And everyone you talk to will be like, oh, but that was the greatest thing that ever happened to me and it also is one of the worst things I've ever, but I don’t really mean that.

Nikki: One of the hardest things.

Pete: It’s a lot of struggles. And Brooke Shields book was in 2006. And so you're right it’s 15 years ago. Yeah. So that was like a big deal and yet, postpartum depression is like super, super common. It's more than half of women will experience some symptoms, postpartum depression. But I'm glad that you said that, because we're going to talk more about anxiety, because it's something that really doesn't get nearly enough attention but that's also just as common.

Nikki: Yeah. And I think that's something that maybe gets missed quite a bit because I think new parents can often, I would say, accurately assume like, they're going to be anxious, right, especially if it's a first kid, right? They don't know what they're doing so, yeah, it's normative to feel

Pete: You mean there’s no good book at how to be a parent?

Nikki: Well, interestingly enough, a lot of people think that there are right, there's tons of books that you can read.

Pete: There are apps, books and people have all this shit and I’m like no.

Nikki:  Yeah, we can get into that in a minute, I would say like, this is just another example of where the information overload of the current era, you know, tips into like, too much information is actually not helpful.

Pete: That's right. But another part about it like when they're pregnant, they go for these tests. I remember my sister was going for these tests about whether or not your child has Down syndrome. You know, it's like they do that it's like one of the first test and she was so anxious. And of course, she was anxious, because they're so worried about what the outcome or what they may or may not find.

Nikki: Absolutely. And so, we're talking about like the disadvantage of knowing so much right, or having the opportunity to potentially know that most of us operate from the assumption that the more information we have, the better. And unfortunately, that's not the case, this, again, extends beyond issues related to pregnancy and postpartum because we can't know everything. Right. And that's like one of the biggest things that you know, we talked about on this podcast is like tolerating uncertainty, letting go of control. But kind of moving us back to talk here about postpartum anxiety specifically, I would say, because there's this awareness that yeah, if like you're a new parent, like there's going to be some level of anxiety. I think a lot of times, women that are actually struggling with postpartum anxiety, which is really like clinically significant anxiety. So this could be actually postpartum (OCD), obsessive compulsive disorder, postpartum, generalized anxiety disorder, (GAD), postpartum panic disorder, right. So these are things that can happen outside of pregnancy but basically, maybe somebody never even had a presentation like this prior to having a kid. not all the time so sometimes they have and it worsens after but it shows up and they and they think it's to be expected and so it never get recorded.

Pete: Nikki, this is a big piece of your practice, I don't know is it still? I know it was in New York it was a big piece of your practice.

Nikki: It was, I don't treat it as much here in LA, only because, we'll have her on the podcast at some point in the future. But my dear colleague and amazing reproductive psychiatrist, Dr. Jennifer Rhoades.

Pete: She's wonderful.

Nikki: Yeah, she's amazing, amazing physician. She was in New York and actually has since moved to Colorado. So we shared a lot of cases and I've learned just an immense amount from her as well. But yeah, I worked a lot with postpartum and perinatal as well.

Pete: You did, I remember that.

Nikki: So perinatal meaning like during pregnancy.

Pete: By the way, Like women on the subway when their belly is that big, I've always so anxious for them. Of course, I”m going to give you my seat and I can't believe that you're like, so calmly just chilling on the subway.

Nikki: I know, I know. I mean, being from LA again, just when I would see anybody with children or someone pregnant going into the subway or someone you know, carrying the stroller down here. I was like, you just get in the car. I was like, that's hard enough getting them all in the car.

Pete: When I had to take my niece's somewhere or like the other day was leaving going, where the heck was I going? but it's such a thing when you have all these people. And so I think for for moms, especially if you have an underlying perfectionism, which a lot of us do, you know, like this type A personality, and then all of a sudden that your life is literally turned upside down. How do you not develop anxiety? And we know from the research that about 6% to 27% of women within six months of birth, will develop postpartum anxiety, you know, some aspect of it.

Nikki: Which is really high.

Pete: That’s too high.

Nikki: I mean, up to 27%. It's like we're talking about a little bit more than a quarter of women, right.

Pete: Yeah.

Nikki: That's the thing. I don't think that that part is talked about enough. Right. So again, I'm really grateful to Brooke Shields for having brought that into the cultural awareness in the United States. And I want people to be aware that postpartum anxiety can happen to that if you are just feeling like you are just not hanging on.

Pete: Like you are hang on by a thread.

Nikki: Yeah. Hang on by a thread you deserve support, like you deserve help. Right. But I think it's important too because, obviously, in this podcast, I'm not going to kind of go through all the diagnostic criteria. there are a lot of wonderful resources out there, like ada.org. For example, if women want to learn more about postpartum disorders, right, and kind of going through the criteria. And not just women, you know, if there are other partners out

Pete: Partners, their working through it too. Because I think that's a good point, too. I'm glad you brought that up.

Nikki: We have people like if we have, you know, any transgender men or non binary listeners, right, that might be going through pregnancy as well. That's also important to acknowledge. Right?

Pete: Absolutely, and partners in general.

Nikki: And partners in general, that if your partner is struggling in some way.

Pete: Yeah, it's hard to just watch that. Some resources there, that's a good one.

Nikki: So, I think what I want to maybe talk a little bit more about here, Pete, is that just in addition to somebody being aware of like, am I struggling too much? Am I too anxious? I think we want to kind of come back to this idea of sometimes I think people don't want to acknowledge it, because there's this story that exists in our culture.

Pete: That fantasy too, I love that, yeah.

Nikki: The fantasy that being a new parent, and I've heard this word frequently, and I have such a reaction to actually set you're supposed to be experiencing bliss. Right?

Pete: Yeah, I’ve heard that word.

Nikki: I will say, obviously, there's probably people listening saying like, ‘well, I felt bliss or I fell in love with my baby the second that my baby was born.’ And that's certainly possible so I'm not trying to take that away from anybody. So what I want to say to people, what I say to patients all the time is look, number one. This is a very stressful experience on the body. Right? very stressful experience on the body, however your labor went, right? Maybe it was like a natural birth. Maybe you had a vaginal delivery. Maybe you had a C section, but like, whatever it is, this is hard on the body.

Pete:  Well, I was just gonna say that too, because you talked about with Dr. Rhodes with as a reproductive psychiatrist. So one article was looking at PTSD, which I think that's also an anxiety diagnosis, these days.

9:24 Unknown Speaker: five I think,

Pete: pretty soon Where are you? Oh, wait didn't exist. It

Nikki: was for a long time considering the anxieties. I would say it is. I'm gonna say clinically, yes, PTSD is in the exam.

Pete: Exactly. So like, if you think about what some people go through from, you know, conception to birth, there's a lot of trauma that people experience. So to me, it's validating and make sense of that. This, this article, Elena alley, looked at about, you know, almost 2500 patients, you know, like 800 articles that you reviewed, and it's been analysis And found that PTSD was also common. And so I think I wanted to bring that up because I think that's also a big piece of the anxiety because your body goes through trauma. And and my my sister in law had Irish twins. So Oh, wow, delivering two babies in the same year, when baby was in January, the second baby was in December. And during her second pregnancy, she's like, Oh, I just got an orthopedic because my hip hurts. And I'm like, sister, you've been pregnant for two years, right? I know, for sure hip hurts.

Nikki: Absolutely. Well, and by the way, that's not even including, like, sometimes there is actual trauma, right? Like that. If you know that there's like an emergency c section, right, baby? That's just moms in distress. Right? I

Pete: got it. I was talking to my best friend when she gave birth to the twins. And then they she had a C section. And then like afterwards, they don't feel your legs for a while because of however,

Unknown Speaker: yes. Uh huh.

Pete: That would be great with like, I was like, Oh, my God, you're so your legs. What is that?

Nikki: Absolutely, absolutely. So it's like, there's actual trauma. And then I'm even thinking in the science, there's even trauma like with the medical system, like for example, for, you know, there's a lot of, there's been some articles recently, and there's research about, you know, black women's experience, you know, with with maternal care, you know, that, that they're at higher risk for, I think, like, I think there's like a higher risk for, like, you know, like, I don't know if it's like, fetal death or, like, maternal death as well. I mean, really scary. Scary stuff. So there's,
there's so much that can happen. Right? And, and the story, though, again, around labor and delivery, right is this is like, this is the best day of your life.

Pete: This is beautiful fantasy.

Nikki: fantasy, that it's so beautiful. And so, again, I'm not trying to say that you you're not going to or can't experience moments of love and connection and enjoy, right. It's just we do a real disservice. To to new parents, you know, in here, obviously, we've been talking a lot about women specifically. Because they're

Pete: the ones that give the kid birth.

Nikki: Yes, exactly. Yeah, correct. Okay, for this episode. Okay. So, yes. So, uh, so, so with, you know, with women, when we tell them, like, it's going to be this amazing thing, so that when, if they have a hard time, even if you don't go through trauma, but it's just really hard or scary, that then there starts to be, you know, a secondary reaction of like, What's wrong with me? That's right, right. What's wrong? There's, there's a questioning of that. And then that starts to feed into and I see this a lot with I work a lot. I still do work a lot with new moms, where they'll they'll say, I'm not in love with the baby. Right? Right. Do you hear that? I mean, I'll say I'm not and I'll say to them, first thing you say go Guess what? You don't know this little person. I'm like, I'm like, dude, but but also I'll what I'll do is I'll focus on actually the biological aspect. I'll say, Well, are you experiencing? There's also sometimes as a way I'm assessing for for postpartum depression, I'll say, Are you experiencing like, you know, a sense of maybe like protection or like just even going through the motions of like, you can tell like, I want to take care of or protect this little being and a lot of them still say yes, if they say no, sometimes that can be an indication that there is actually postpartum depression, there's really like, even an aversion sometimes can, can happen, which again, that's something a lot of women feel shame about, right?

Pete: Shame is a big piece. And I just think from an empathy perspective, like, I if I don't, if I have, I sleep really well. And if I have one night, like a year that I don't sleep well, I'm miserable. And so like, these new moms are like, not sleeping. I know

Nikki: what's like this baby is like up every hour, whatever. Right? So yeah, so then it's like, so there's a story like, well, you should be experiencing bliss. You should love with this baby. We can then start to go into like, you should lose the baby weight. Right. breastfeed should breastfeed. That's a big one. That's a big one. Ooh, do I have that conversation? Right? You hear the story? The old like, breast is best. Yeah. And that's sort of all all around.

Pete: If the baby doesn't latch the baby Don't laugh.

Nikki: Yeah. Right. Yeah. So there's, I have to recommend, and I recommend this to patients. There's a great show, and I've talked to you about it for Pete called Adam ruins everything. Have

Unknown Speaker: you heard of Oh

Nikki: larious It's a Adam Conover is his name. He's a comedian. And I would say it's really like a CBT show because he's all about myth busting. He loves facts. And it's done in this very cute way. And every episode is titled something like Adam ruins sex Adam ruins Adam ruins college, whatever. It's really what he's doing. It's it sounds negative. But the whole point is that he's helping people to like, see things as they are, which is the end you feel relieved, right? One of the episode is Adam ruins having a baby. Yeah. And I've given it as homework for a lot of patients. I want

Pete: to watch it now.

Nikki: Oh, it's fantastic. He goes through all of these things like statistics about you know, fantasies that people have about pregnancy and postpartum and what the actual statistics are. And like a anyway, just there's some some some great nuggets in there, but one of them they talk about breastfeeding. And, you know, those he'll say, it's like, I think those statistics something like you know, it's like 15% of Women like campus, he's like, what if you don't produce milk? Like what do you think they did? 100 years ago?

Pete: That happens to a bad person. Yeah, exactly. There was an episode to about that, where there's no now there's like a market for breast milk. Which is interesting. Yes, you know, conversation because we don't know enough about it. And I think most endocrinologist say that that's like, it's actually just, it's got to be like, the baby's mom's milk. Like, it's, if it's someone else's, it's not. Yeah, but I, I think it will be helpful for people just to hear, because I think if I talk, I know, we're not gonna go into like the differential diagnosis between but I think just listen to some of the symptoms. Because the other truth is, as we talked about six to 27%, that's for those that report and actually seek treatment. And you and I both know that the numbers are likely higher, I think of just as an overall sad mood, a loss of interest, you know, decreased fatigue, or loss of energy changes in your appetite, changes in sleep issues. I mean, these are all things that are going to occur, you have a baby, no matter, right, you know, guilt, shame, like just about,

Nikki: yes. Well, so I think, I guess my wall throw in some sort of, like non diagnostic indicators that you know, somebody might look for as an addition to some diagnostic ones. I would say, if somebody is really not feeling like themselves, I know that sounds very general. But and look, to be clear, having a new baby, like everything's upside down, so it's not like you're gonna feel settled. Yeah, it's right. Like, you're gonna kind of, you know, especially like, the first month after it's sort of like, what's up? Where am I? Right? So when I say like, not feeling like yourself, it's like, feeling very disconnected from yourself very disconnected from, from the baby, feeling very disconnected, you know, from your partner, right. So I think that's a really important one, to be aware of. If anyone's experiencing extremely intense anxiety, so not just like, I'm kind of, you know, I'm feeling a little anxious in my body, like my test chest is a little tight. You know, it's like, you're feeling panic, you know, it's like sense like a loss of control, right? Maybe like intense physiological symptoms, like, you know, your there's an elephant sitting on your chest. Right? Or, like, you know, constant nausea extreme, like, extremely intense heart rate. Extreme obsessive thoughts, right. So, you know, everybody's going to do checking is the baby breathing, right? Yeah. Everyone does that. Right? But if you cannot get yourself to sleep, right, if you're like, you know, they always say a lot of times like when baby naps Mom, Mom and Dad snap, you know, if you can't find yourself being able to do that, because you're so terrified that something's gonna happen. It's like

Pete: cleaning too much or things like that. Let Yeah, got an Apple Maps. Yeah, exactly like that. You said the ADA just for our listeners, anxiety, depression Association of America. I will say, though, don't be looking too much stuff up, I think so for me, like a critical intervention is going to be like, do things that feel good. So invite, like, a family member over who might be able to give you a little bit of a break, maybe go get your nails done, maybe get a massage, maybe buy like a, you know, put hot water in your bathtub, and just sit there for a couple minutes. And you're, you know, do some things that you can really just care for yourself. Try not to look ups too much stuff until you get into like a place where maybe it feels desperate, you know, but I would say get away from the Google.

Nikki: I mean Absolutely. Well, and you know, it's again, I keep coming back to this but actually was just feeling sad when you were saying the part about like recommending self care because that's what I always see people say like, but I can't, but that goes back to the fantasy of like, being a good mom means I have no identity. Right? Like my identity is the baby My baby's everything and it's like, you know, this I would say like it's being a parent is additive and you're right it's not about like replacing who you are.

Pete: What I had a client I had a dad recently say that in session where he was like, I realized that I'm not going to stop growing after baby gets here because he feels like unsure of whether or not he's ready to be a dad. It's like, okay, it's too late. It's coming. And you're not gonna stop growing once a baby?

Nikki: No, you're not.

Pete: And I love you. So I love that you said that too. Because I think with my sister in law, for example, for like some of the baby's first present day birthdays. I also got her president which was like a spa package because I felt like frankly, that's that's where it should be like go take a day away from your child like that. I think that fantasies like I'm supposed to want to be there all the time. Right?

Nikki: Well and social media exacerbates that right everybody the birth of like, the, you know, the gender reveal the birth announces all of these things. And, and again, if any listeners out there are are engaging that I don't say that as a judgement that does something bad. It's more just I want there to be an increased awareness around that this contributes to this broader story about, you know, bees around the early period of of a new parents life, the new baby's life as it should be blessed. And it's like, it's hard. And you know, people talk about all the time like that, you know, we said in a previous episode, I can't remember which one actually, but like, I always joke like that it's like a secret of the universe, though it's not really a secret of the universe that actually in order to connect with these more pleasant emotions, like joy and love and, and connection itself, we actually first have to be willing to come into contact with what we don't want and what's uncomfortable. And what we're how that applies with this is knowing that having a new baby is hard, right? And there might be times when, when you're struggling more than you thought that you would be.

Pete: I'm so glad you shared your expertise. And I think it was, you know, the people you were able to work with and with Dr. Rhodes, I think are so lucky to be able to have you and i think you know, these, these are really critical periods of their time. And so, you know, I think you you've really shed some light on that. So I wonder if we can have some just parting words. What do you think about this idea of how postpartum anxiety and postpartum struggles are natural?

Nikki: I think just with that, just I I want people to just really remember that. It is not only okay to struggle postpartum. That's what's normative, not the fantasy. This has been when east meets west. I'm Dr. Nikki Rubin.

Pete: And I'm Dr. Pete economo. Be present. Be brave. This has been when East meets West all material is based on opinion and educational training of doctors, pt economo, and Nicky Rubin.

Nikki: Content is for informational and educational purposes only

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