TRANSCRIPT EPISODE 51 – All About Pregnancy & Birth With Dr. Nicole C. Rankins

Transcript episode #51: Preparing for Postpartum Life, Relationships, and Mental Health with Dr. Alyssa Berlin

Transcript

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(00:00)

In today's episode of the podcast, I am talking to clinical psychologist, Dr. Alyssa Berlin.

(00:12)

Welcome to the All About Pregnancy & Birth podcast. I'm your host, Dr. Nicole Calloway Rankins, a board certified Ob Gyn physician, certified integrative health coach and creator of The Birth Preparation Course, an online childbirth education class that will leave you feeling knowledgeable, prepared, confident, and empowered going into your birth. Quick note, this podcast is for educational purposes only and it's not a substitute for medical advice. You see the full disclaimer at www.ncrcoaching.com/disclaimer.

(00:44)

Hello, hello, hello. Welcome to another episode of the podcast. This is episode number 51 and as always I'm so grateful that you are spending some time with me today. Okay, so today's episode of the podcast is a good one and I know I say that about like, every episode, and that's because I strive to make sure that's true. But in this case, of course it really is true. This is a great episode today. It's with Dr. Alyssa Berlin. She is a clinical psychologist who specializes in pregnancy, postpartum and parenting. Dr. Berlin is the creator of the Afterbirth Plan Workshop, a program that prepares couples for what to expect after a baby is born and how to prepare for a physically and emotionally healthy postpartum transition for the baby, for each partner and for the evolving relationship. Dr. Berlin is on the board of advisors for the International Cesarean Awareness Network.

(01:43)

She is also a faculty member of Maternal Mental Health Now Training Institute. She has an expertise working with individuals struggling with trauma and you can also read Dr. Alyssa's blogs on the Huffington post where she contributed to PBS's This Emotional Life project. Dr. Alyssa and her husband, prenatal chiropractor, Dr. Elliot Berlin. He was on the podcast actually back in October. They live in Los Angeles and they're the proud parents of four amazing children. Now, Alyssa and I have a really fun, great informative conversation today about reclaiming the word postpartum. A better way to approach the postpartum period, what exactly perinatal mood and anxiety disorders are and how common they are and then what you should do if you're worried you have a perinatal mood and anxiety disorder. Also some tips on how to ease the transition into motherhood and much, much more.

(02:49)

So definitely listen in, lots of great information in this episode. Now before we get into the episode, quick question for you. Have you made your birth wishes yet, also known as a birth plan? If not, it is not too early for you to start. One of the biggest mistakes I see women make is kind of going with the flow when they approach their birth, but you really want to inform yourself so you can be an informed participant in your birth. Now, of course that doesn't mean that you can guarantee a specific outcome for your birth. No one can do that, but you are much more likely to be satisfied with your birth when you go into the process informed. And one of the ways to do that is to make a birth plan. But not make a birth plan just any old kind of way.

(03:35)

There's a way to go about making a birth plan that is so much more effective at helping you be an informed participant in your birth and it'll give you a much better chance of having the birth you want. So there's a process to it and you can learn all about this process in my free online class on how to make a birth plan that works. You will learn questions to ask, tips to get your doctors and nurses to pay attention, what to include and much, much, much more. This is a free online on demand class. It's offered several times a day, so you can go to www.ncrcoaching.com/register to sign up totally free. So check it out. You definitely will not regret it.

(04:22)

All right, so let's get into today's episode with Dr. Alyssa Berlin.

(04:27)

Nicole: Thank you so much, Alyssa, for coming one to the podcast. I am super excited to have you here.

(04:33)

Alyssa: Thanks Nicole. I'm so excited to be here as well.

(04:36)

Nicole: Yeah, so why don't we start off by having you tell us a little bit about yourself and your work and your family.

(04:43)

Alyssa: Sure. I am a perinatal psychologist. And so I've dedicated my professional work to working with individuals, couples, and families who are pregnant and getting ready for that transition to postpartum. I'm very blessed that I get to work with my husband who is a prenatal chiropractor. And together we opened a holistic wellness center together aimed towards helping families at this phase of life. You know, he and I together have four children, which wow.

(05:12)

Nicole: Incredible. So, how old are they?

(05:17)

Alyssa: So they are now 9, 11, 13 and 15. So segwaying into a very different chapter, but each unique and wonderful in their own right. And, it's lovely because it just means that I get to come at this work both from a personal and a professional perspective.

(05:35)

Nicole: Yeah, that is awesome. You know, you mentioned your husband. I will say that he was on the podcast before and it was great to have him on. So you guys are just like a powerhouse dynamic couple.

(05:47)

Alyssa: Yeah, it's really lovely to be able to support families together. You know, coming at it from that mind body experience. He and I joked back in the day when were both in graduate school that one day we would open a practice called a shrink and a quack. So the name didn't stick, but I was just going to say that I've also been really fortunate in the past couple of years to specialize in trauma work, knowing that, you know, for good or for bad, it's a big part of the birth world and how to help families not be stuck in that trauma, but to find ways to work through it so that they could really enjoy this inherently joyous time in life.

(06:36)

Nicole: Oh, wow. Oh, so you focus specifically on birth trauma?

(06:40)

Alyssa: So I do both. My passion is preparation and mitigating postpartum illnesses, whatever I can, so that, that is my passion, right? Well, I have to step into it to step out of it. If I can help you be prepared and know what to expect from the get go and then just start that entry into parenthood off on the right foot. That is where my heart is. That being said, we know that that's not always, you know, in the cards for everyone. It's just not the path that they take. And so on the other side I have, I do work a lot with that birth, trauma, pregnancy loss, all the different things that happen at that phase of life.

(07:19)

Nicole: Right, right, right. Which is really, really important. I don't think we recognize, especially around pregnancy loss, what the psychological impact can be. So that's great that you have that full spectrum of things that you can offer to folks.

(07:34)

Alyssa: Thank you. You're very kind.

(07:36)

Nicole: Yeah. So why don't we just hop right into it and talk about what exactly are perinatal mood and anxiety disorders if you had to talk about what they are. And that's kind of a big question, but so to give us an overview I guess.

(07:50)

Alyssa: Yeah, sure. And if it's okay, I even want to start one step before that, which is to say, I'd really love to reclaim the word postpartum. Because before we talk about postpartum illnesses a little bit, we need to talk about normal postpartum adjustment or the normal postpartum period. I feel like day to day when you hear people say, Oh, she's so postpartum, they're using it as this catch all phrase for she's anxious or she's depressed. And so first and foremost we really want to recognize that in the same way that any woman who currently has a baby in that uterus is pregnant, any woman who has just delivered a baby is in postpartum period. Right? And it's important to recognize that because if we can recognize that as its own time period, then we can also start to ascribe normal behaviors and expectations. So that time period, rarely do any of us move into a new home or start a new job.

(08:44)

Alyssa: And from day one we've got to go on. We feel like it's the perfect fit and we know where everything is and it's just that that easy fits like a glove kind of experience. Most new takes time. It takes time to find, you know, where the water cooler is or where the bathroom is or where we want to hang the pictures or stuff like that. And the same is true for the normal postpartum period. It's a major adjustment. You've just added a new person to your life, you've added a new role to your life and we want to create the time and space so slowly adjust to that. So that's postpartum.

(09:18)

Nicole: Yeah, that and that's really important. And because we don't, we focus so much on pregnancy, I mean I, I feel like we're getting better, but we definitely do not really help women with that transition. It's certainly, I mean, speaking from the medical side, you know, we do that six week postpartum checkup and then bye, bye, which is, I'm completely insufficient. So yeah, I'm glad you're raising awareness to that. Yeah.

(09:42)

Alyssa: So that's it. You're talking my language because I want to start a new epidemic, a new wave where at 28 weeks of pregnancy we make that our postpartum check-in week, where all obese, all midwives, all medical practitioners are unanimously asking women what's your postpartum, you know, research been like, what have you done to prepare? Have you taken a class yet? Because I want to make sure that I am giving you the most comprehensive, you know, prenatal care and part of that is helping you wrap your minds around what's coming next.

(10:17)

Nicole: I love that. That is an outstanding idea for sure. Like, I mean that's a perfect time to start thinking about it. Why haven't we done this before?

(10:28)

Alyssa: I don't know Nicole, but you and I are going to do that. We're going to, there we go. Let's be honest. You know, as much as we'd like to think we've come a long way in accepting mental health and reducing that stigma and we have, there's still a long way to go. And so if it's the kind of thing where I tell you to prepare, but I don't tell you that flag goes up of why she's telling me why, what does she think that I need to do? Why not that person? But again, if we just do it across the board and we just say, Hey, you know what, this is just healthy, conscious preparing. Well then it's like, of course like who doesn't want to be the best, you know, parents and partner they could possibly be. And you're telling me this will help. Sure. I'm into that.

(11:09)

Nicole: That makes sense. I mean, just perfect sense. Perfect, perfect sense. So reclaiming postpartum and sort of redefining that, taking that step back, I think that is really important. So then what would you say then are those perinatal mood and anxiety disorders?

(11:27)

Alyssa: Oh, for sure. So perinatal mood and anxiety disorders a little bit replaced. What used to be a postpartum depression, right? We now understand that postpartum depression is a piece of a much bigger puzzle. And so perinatal means from conception through that first year, you know, post-delivery. And then mood and anxiety disorders because we know that, like I said, it's more than just, and we're actually seeing a constellation of a number of different mood and anxiety disorders that can crop up both starting during pregnancy and continuing in that postpartum period. Depression, anxiety. I probably see obsessive compulsive disorder postpartum more than anything else in my practice. Bipolar disorder, post traumatic stress disorder. It's a much bigger picture than we used to know. Or than it used to be. And honestly, for a lot of women, their postpartum illness will look more anxious than depressed.

(12:29)

Nicole: I notice that a lot too. Yeah, yeah. Yeah.

(12:33)

Alyssa: And it's important that we acknowledge that because if in our mindset postpartum is synonymous specifically with postpartum depression and the woman says to herself, or the guy says to himself, well, I'm not depressed, so I guess I can't be struggling with a postpartum illness. We want them to know that that's not true. That anxiety is a part of that constellation. And honestly, more than anything, I'm a big proponent that if anyone feels like they're struggling, we want them to get the help. And support that they need.

(12:58)

Nicole: Sure, absolutely. Yep. For sure. So how common are perinatal mood and anxiety disorders?

(13:07)

Alyssa: It's a great question. And you know, the statistics vary based on a number of different parameters and distinctions. For perinatal major depression, you're looking at about 20 to 24% of the population, our statistics with anxiety and OCD and some of the other illnesses really need a lot more research. But looking anywhere from like the 6 to 15% is pretty common right now. And that's for women or the birthing partner. For men, oftentimes what we're seeing is that about 10% struggle with the postpartum depression, perinatal depression. And interestingly enough though, their statistic goes up to about 50% if their partner is struggling themselves.

(13:56)

Nicole: Interesting. I had never even, I don't even think that, I feel like this is the first time I'm like babbling here because I am like, I've heard men being discussed in this conversation about, you know, these disorders.

(14:12)

Alyssa: Yeah. Well, and you know, men again are much less likely to endorse it. You know, I think in general, you know, in our culture and men typically like to distance themselves from anything that feels too girly and you don't get more girly than a postpartum illness. But, but they do, you know, we now know that this is an experience that impacts and affects everybody. And our very sweet supportive partners on the side are also impacted by the enormity of what it means to be a parent and to take on that new role

(14:45)

Nicole: For sure. Absolutely. So then how about what are some signs or symptoms, I guess, what are some things that that should raise alarm bells for women that they may be having trouble with, with mood or anxiety? I feel like that's a long thing to say. Like perinatal mood and anxiety disorders.

(15:07)

Alyssa: We shorten it to PMADS.

(15:07)

Nicole: Okay. Let's say PMADS. So what are some signs and symptoms that women should be on the lookout for for PMADS?

(15:15)

Alyssa: Sure. And so, you know, again, maybe we could add one other element before we even go into that. Let's say let's add in the baby blues and let's recognize that the baby blues are, you know, something that starts two to three days after a woman has a baby and lasts for about two to three weeks and that is something that impacts about 80 to 85% of the population. And I'm a big believer that anything that 80 or 85% of people are experiencing is normal, right? It's this normal recalibration that's happening as your body is adjusting to some of those major shifts in hormones. And so the baby blues, some of the signs and symptoms are feeling overwhelmed, feeling down, feeling like your mood is a little bit erratic crying for no reason. Maybe you're laughing for no reason, although that's usually less bothersome to people.

(16:08)

Alyssa: It's this feeling of just not being grounded within yourself. I just, I don't feel like me. But it's important to recognize that for the majority of women, the baby blues will, will go away on their own. There are definitely things that we can do to help. First and foremost, anything you're going to do to take care of your physical self is going to help your emotional, your emotional wellbeing. So eating healthy nutritious foods, taking a shower.

(16:37)

Nicole: Yes, that makes a big difference. Huge difference.

(16:40)

Alyssa: And that's true for all of us across the board. You know, maybe going outside and getting some fresh air or you know, maybe sitting outside or taking a few steps or if you feel up to it walking around the block. So anything you're going to do to your help with your physical self is going to really help your emotional and your cognitive wellbeing. Talk is huge, but you know, at our core we're social beings and that connection and that communication is, it's just life altering sometimes and knowing, Oh, you're in this with me, I'm not all on my own. That could be huge, you know? Touch is tremendous.

(17:19)

Nicole: And those are all like fairly easy, straight forward things like not, you know, not like huge, you know?

(17:27)

Alyssa: And you want to keep that in mind that although when someone is struggling they can feel bigger. But ostensibly we want us to do small things in the right direction, break things down so they don't feel too big and that they can have a really nice bigger impact along the way. And support support is massive. You know, it's funny cause you hear people saying that our village disappeared and I don't like to think about our village disappearing as much as the face of the village has changed. You know, we're now much more focused on the virtual village and what I call village 2.0, which maybe it wasn't the family in the way that it used to be back in the day, but maybe now it's surrogate family or really great friends that are like family or hired help. Doulas are a tremendous source of support.

(18:15)

Nicole: Absolutely. For sure. For sure. So those baby blues, which are normal first couple weeks, but then if things kind of extend is where we're getting or when you start to get concerned...

(18:31)

Alyssa: That's right. And so for some, they will be some signs of depression or anxiety creeping up in that period. But like you said, for many, it's when we crossed that three week mark, that two to three week mark and we see that people are still struggling or struggling in a deeper way instead of things improving, that we tend to be more in the realm of those PMADS. And a lot of the signs for depression or anxiety are similar to what those disorders might look like, you know, in the, not the postpartum period, but they tend to take on somewhat of a different feel and become much more focused around baby. So for example, with depression, we know that with normal depression, you know, a change in sleep and a change in appetite are super common either over or under. In the postpartum period, it tends to usually be more under women who are, are not really eating very much, losing their birth weight really quickly. Women who are struggling to sleep and having a really hard time settling down their minds and being able to, you know, get some rest, a lot of thoughts or concerns about their adequacy as a parent that starts to crop up. And then for anxiety, you know, anxiety has this internal experience of almost like this live wire. Like I just can't settle down, thoughts, you know, or, or sources of concern kind of seem to get stuck in our minds and you know, instead of some normal concerns where maybe someone will offer you some information of why that might not be an issue. Like let's say for example, we're concerned that baby's not eating enough and maybe someone would say to you, Oh, but look like that was such a great poopy diaper.

(20:13)

Alyssa: And I was like, Oh, okay. Yeah, I guess then that must mean they're taking in good calories. When someone's struggling with anxiety, you know, I talk about the yes thoughts kind of kicking in and it's like, yes, that, you know, or it's like, but what if? And it's that notion that they're not as calmed by that information, but that next concerning thought is like on the heels of the one before. Right? But how do you know? You know, yes, but what about this? Yes, but what about that? And then usually when one issue is satisfied, it just tends to jump to that next piece.

(20:46)

Nicole: Got it. Okay. Okay. So when a woman is concerned that she's having trouble either, I guess during pregnancy or after pregnancy, I don't know if the response is similar, but what, what should she do?

(21:01)

Alyssa: That's a great question. And we want to tap into the resources around us. So you know, first and foremost, Nicole, when I do a workshop, the afterbirth plan workshop, which is a workshop that I encourage couples to do when they're pregnant. And in that workshop, you know, one of the three components that we go through are signs and symptoms of baby blues and PMADS, and helping them walk through exactly that question. What if I do, what do I do if I'm struggling? And I always want people to know that I'm a resource for them, that they can call and check it out, you know, and we can talk it through together. But reaching out to any doctor or practitioner or a therapist that you already have an established relationship with is great, ideally, right. If we've done that preparation during pregnancy, we've also created some space and created some permission for women or men to talk to their partners about it.

(21:58)

Alyssa: And you know, if they're lucky enough to have a partner in the picture. And so having permission to have that conversation means being able to go to their partner and say, Hey, you know, some of those things that we talked to, you know, Dr. Alyssa about, I dunno, I'm kind of, you know, struggling or wondering if that's happening for me. Or maybe it's the partner who notices that their partner is struggling and for them to broach the subject. But Ob's are great. Postpartum doulas are great, therapists are great. Again, reach out, let someone know that you're having a hard time. It is a tremendously helpful piece. And again, we want to make sure that we're talking to the right people who don't kind of poo poo it, if you will, are saying, no, no, no, you're fine. It's normal. But someone who's going to take any concern that you have seriously and want to check it out and explore it with you. And that's really important.

(22:50)

Nicole: Really crucial points. I think the points that I, and I, you know, that Alyssa and I think or would agree on number one, please just tell someone like bring it to someone's attention so you can get help. Don't hold this inside. And then number two, find the right person. What Alyssa said is just so critical. If you, if you encounter someone who's like, Oh, that's just normal, or Oh, you'll get over it, then please find someone else who takes your concerns seriously.

(23:20)

Alyssa: Yeah, absolutely. And here's where postpartum support international does a really wonderful job of bringing that message home, right? They have their universal message, which really talks about this notion that it's not the woman's fault, right? So that she's not alone first and foremost. So there are other people who have walked that path and there are definitely people who can help, who understand what's going on, you know, so you're not alone. You're not to blame. It's not your fault. There's nothing that you did to make this happen. It's just sometimes this happens or this is how your body responds.

(23:52)

Nicole: Right? And there's nothing wrong with you. It doesn't mean that you're not happy about having a baby, you know, or that you have these bad feelings towards, you know, I don't know if I'm saying it the right way, but you could probably say it much better than I can.

(24:06)

Alyssa: No, you're doing amazing and really what you're saying that it's not a function of being a good parent or it's not a function of how much you love your baby, right? And that will help you will get well, that this is super treatable and so we want, you know, women and men alike to come forward knowing all of these things, that they're not alone and it's not their fault. And that with help they will get well. It's so, so important.

(24:30)

Nicole: So important. So speaking of treatment then, how do you approach caring for women in this arena and where do medications fit into that?

(24:39)

Alyssa: It's a great question. So first and foremost, you know, I do the therapeutic piece and I work very closely with wonderful maternal mental health psychiatrists.

(24:51)

Nicole: And I think, I'm sorry, I don't mean to interrupt, but I think therapy is totally underutilized.

(24:56)

Alyssa: Nicole. I agree.

(25:00)

Nicole: It is completely under utilized. I think because it takes a bit more effort. You know, it's not as easy as popping a pill, but it can be very effective, especially if you have a, a great therapist and it has some more longterm benefits I think than just a medication can. So I really think that therapy is underutilized.

(25:25)

Alyssa: Yeah. And you know, like my experience of postpartum and it's very interesting is I think that postpartum shines a spotlight on whatever bumps or bruises or relative concerns we had before. And it tends to bring them center stage and it makes them kind of more, more of the focus where we can't sidestep it the way that we used to because there's just no additional energy in the system to cope with them the way that we used to. And so for a lot of people, you know, it's having a baby that brings them into therapy for the first time because this thing that maybe wasn't so bothersome, now again, if it's just insurmountable in that same way. And therapy is huge, it's a huge, wonderful resource to have to come to a place that's solely geared towards nurturing and supporting and helping you to feel more integrated within yourself and help to feel or to make life more doable day to day.

(26:29)

Nicole: For sure. So how long, and I don't want to say that I'm like against medications because I'm certainly not because some women or people need medication. That's just the reality of it.

(26:40)

Alyssa: And it's important for people to know that the conversation around medication is changing dramatically. You know, it used to be that the conversation was, you know, am I exposing baby to the medication, right? Either through pregnancy or through breast milk or is there no exposure at all? And the truth is, is that's not the case. That's not really what the choices are that really what we're deciding between is exposure to an untreated mental illness, which we know impacts baby, or medication. And although medication is not a first line defense for me, I'm a firm believer that no one should suffer, you know, in the pregnancy or postpartum period. And that it's an important component in the larger picture.

(27:25)

Nicole: Absolutely. So what is the typical like therapeutic relationship in the sense for how frequent, how long before folks can seem to feel better? That may be hard to to say, but how do things typically go?

(27:41)

Alyssa: It's a great question. And where it's challenging is, you know, from a combination of different factors is what's coming up more a function of being overwhelmed with what's happening as well as the hormonal changes in the body. But perhaps there's no bigger traumas in the system. Or has this, you know, chapter in life or the process of having a baby triggered or exacerbated a prior trauma or was this experience in its own right? Traumatic trauma is one of those things that it's in the eye of the beholder, right? If a woman had a birth, that to her felt traumatic. Even if someone else around might have said, oh that was beautiful, you want to go with where mom is. So that makes it really hard. And frequency will oftentimes be based on how, how much mom or dad are struggling or how much partners are struggling.

(28:40)

Alyssa: You know, and I come at it from two different perspectives. I like to use, you know, what I call bandaids, which are more like cognitive behavioral methods to really create some nice behavioral change as immediate as possible so that day, day to day doesn't feel as daunting or overwhelming. At the same time. I like to work with the underlying stuff. That's maybe fueling it from within in an effort to deal with the larger problem or whatever trauma may have been triggered. And to do that, I use a lot of somatic experiencing and movement desensitization reprocessing, EMDR, which are both really helpful. So, it really depends where mom is or where dad or where the couple is and and what we want to address. First and foremost is returning her to a more comfortable level of functioning. That's first and foremost and probably one of the first things that I'll intervene with is how much sleep is mom or dad getting or how much sleep are the partners getting? How much support do they have around them day to day and how do we help them access levels of support and that's going to be that first line and then when some of those things have stabilized, then we look at potentially working on those deeper things.

(29:56)

Nicole: Got it. That yeah, that that's kids like if you can't get the basics down then my goodness you, it's hard to even tackle any of the rest.

(30:04)

Alyssa: That's it. All bets are off and we don't want to add fuel to the fire. We want to first contain and stabilize. That's always going to be number one.

(30:13)

Nicole: Yeah. Now, do you recommend that women seek out psychologists who have special training or interest or expertise in treating pregnant and postpartum women?

(30:27)

Alyssa: I do, having someone who has an expertise with maternal mental health or paternal mental health around this time period is really important because those are going to be the practitioners who understand the nuances in the differences from how they might look in a non pregnancy postpartum period and the changes that occur in this phase of life. And to that end, there are some wonderful resources that can help connect you with a therapist, you know, with that expertise. I've had lots of people who come who might have a regular therapist and just want to work on this one piece before they go back to their other therapist. So maternal mental health now is something right here in California that has a wonderful resource directory that will help people connect with psychologists and psychiatrists that run the gamut of low fee, no fee, regular fee, all of that postpartum support international, um, has coordinators, I believe nationally and internationally. I'm one of the local coordinators here in LA and those are people who are there to help anyone who is struggling, connect with the appropriate resources or referrals that they need.

(31:40)

Nicole: Oh, well I have never heard of postpartum support international. I am embarrassed that I've never heard of this, but we will for sure link it in the show notes so everybody can have access to it.

(31:50)

Alyssa: That's amazing. Yeah. Nicole, and I know how much you like those acronyms. So PSI, postpartum support international.

(31:56)

Nicole: There we go. There we go. Okay, so does a lot of most or a lot or most of your work focus on women in that transition to the postpartum period or do you see women during pregnancy as well? What's the kind of balance? What do you see?

(32:14)

Alyssa: And I do both, you know, knowing that such a deep passion is prevention. I'll work with a lot of women or couples or men, right? Birthing and non birthing partners alike during pregnancy. Because oftentimes getting pregnant or being pregnant will already start to bring up some of those ghosts in the nursery or old relationships that maybe are not sitting as well with us. Especially if there was a loss of a parent historically. Oftentimes that's something that kind of gets called back up. And so a question for the woman who is now birthing and getting ready to segue into parenthood themselves. Couples who maybe are struggling and noticing some contention will come in during pregnancy to get on top of that and address that before the baby comes. And then I'll get a number of people who come in and it's even just from this perspective of prevention and wanting to safeguard the relationship, and prepare for what's coming next. So I do a lot of that. And then on the other side, anyone who is struggling, I want them to reach out and, and we work on whatever it is that they need to do. Like we said, to return them to a really happy, you know, level of functioning so that they can enjoy that little person in their lives.

(33:29)

Nicole: Right. And I guess I brought that up to to say that yes, we have more attention on postpartum depression and PMADS, but some women do struggle during pregnancy as well for sure. And it's okay to seek help during that and you should during that time as well.

(33:47)

Alyssa: Not only is it okay, we want you to, why would we want you to wait until baby's on the outside to figure out a plan? Because like we said, perinatal, we know that for a lot of women those symptoms will start during pregnancy, oftentimes in that third trimester. And if that's the case, we want to get on top of it knowing that that's a risk factor to struggling in that postpartum period. So we want to do whatever we can to help you know, whoever's struggling in that place, whether it's the birthing or the non birthing partner and use that opportunity to plan more extensively for making sure that we have resources and different things in place for after.

(34:27)

Nicole: Got it. So if you could, do you have any suggestions or advice about things women can do during their pregnancy to help ease that transition into motherhood?

(34:41)

Alyssa: For sure. First thing I want you to do is take a workshop, find something around you that helps you to wrap your mind around what to expect.

(34:52)

Nicole: Now is your workshop available online at all?

(34:56)

Alyssa: So it is, I do the workshop locally live or I'll do it, you know, live via Skype or zoom meeting or things like that. And actually over the holiday weekends coming up, we're getting ready to film it. So it'll be a self paced class that you can do online from the comfort of your own home.

(35:16)

Nicole: Yeah, we will be sure to link to that in the show notes for sure. So folks, you can, you can check that out now. So first thing you said, do some sort of workshop or preparation to ease that transition. Are there specific other like things you should look for like a postpartum class or...

(35:34)

Alyssa: Yeah, you'll hear, you know, so mine's the afterbirth plan. You'll hear ones that talk about how to safeguard the relationship and baby proofing the relationship has become a very popular, you know, kind of moniker for that. And whatever it is that we can do to help inform or educate you about, about what's coming, about the importance of nurturing that romantic relationship, recognizing that that feeds, you know, our, our relationship with our children. There are some wonderful books out there that you could read that are amazing that also help you to wrap your mind around that. John and Julie Gottman have And Baby Makes Three which is a great read. It was, I'm trying to remember which came first. I don't remember if the workshop came first or the book came first, but it was the basis for their, you know, transition to parenthood work. David Code has a wonderful book. The title is something to the effect of to raise, you know, healthy children. Put your marriage first and anything along that line that really helps give a couple permission that the time that they take to nurture their relationship with their partner is not something that they're doing to baby. That's something that they're doing for baby and informs baby's sense of attachment and sense of safety and just informs, you know, a healthy child development.

(36:59)

Nicole: Got it. So first thing is take some sort of workshop or class or read a book during your pregnancy so that you are prepared.

(37:11)

Alyssa: Yeah, it makes a difference. Listen, expectations we know can be our saving grace or our ends. And so if we come into having a baby and we're expecting unicorns and puppies and rainbows and butterflies and it doesn't live up to that expectation, then we're likely to struggle and feel like we were fed a false bill of goods. If on the other hand, right, we have someone who's telling us, Hey, there are going to be incredible moments of love and connection like you've never experienced, but it's challenging, right? It's stressful and there are things that you can do to address that and there are things that you could do during pregnancy to start practicing those skills. Why would we not want people to know that and to be availing themselves of that?

(38:00)

Nicole: Yeah, for sure. Absolutely. So what other things, if you had one or two other things that folks could do?

(38:08)

Alyssa: So I'm a big believer in certain anchors within the relationship that really just inform our connection in general. You know, again, if a person is lucky enough to have a partner in their lives and they're doing this together, then I want them to know that it was remiss of them if at any point they thought that being in a committed relationship means that they stop dating. Cause it doesn't, it does not. So it's okay. And if that's you, you can quietly say, okay, now let's get back on track. Because dating is a lifelong process. And so one thing I like for, you know, families and couples to do is to make sure that, that no more than seven days ever go by without having what I call a date moment.

(38:54)

Nicole: Ohhh, I'm like, seven days? Can we stretch it out to ten?

(39:04)

Alyssa: Well, here's the thing. I'm not a big fan of date night when it comes to being pregnant or postpartum. And here's why... Anything that has to compete with sleep is doomed to fail. So don't, don't go up against the sleep gods. Right? We want to, we want to really honor sleep as an important component in this bigger picture. Right. So but a day moments and a the moment is really lovely in that it doesn't have to require you to leave the house. It doesn't have to require you to spend money. A date moment is any hour or two that you set aside for no other purpose than to charge the batteries of your relationship with each other.

(39:38)

Nicole: I like that.

(39:40)

Alyssa: Yeah. Have a picnic in the living room, get canvases and paint at the kitchen table. It doesn't matter. The only goal is to sit together and charge the batteries of that relationship and that's huge. Think about it. When we feel like we're a team and we feel connected to our partner, the world becomes a lot easier. Things that felt insurmountable feel ever so slightly if not magnanimously more possible.

(40:09)

Nicole: I think that's great that you frame it as a date moment. See that feels much lighter and easier because you always feel like date night, whether it's during your pregnancy or definitely once a baby's born is like this production and you got to get a sitter and you got to do this and you got to do that. But when you just make it a moment and the added piece of it's about recharging your relationship, then that makes it a lot. A lot more doable.

(40:37)

Alyssa: Yeah, and that's what we want. We want small steps in the right direction. So here, I'll give you my analogy of relationships. Ready? When I think about relationships, I think about walking up a down escalator, right? Think about it. If you put in a little bit of effort, you'll make some headway. If you put in more effort, you'll make more headway. But the second you stop actively climbing that escalator, life just naturally brings you down. The same is true with our relationships with our partner, right? If we put in efforts, it helps to facilitate that closest. But the second you stop actively investing in that relationship, the more life and stress and responsibility just naturally brings us down. And farther apart and having a baby speeds up that escalator. So we requires us knocks to pull back on our efforts, but to double our efforts of what we do to nurture that relationship. Yes. This is all, go ahead. Yes, no. And the last piece of clothes, bat, think about it. It's just one step at a time and that one little step and then one extra moment could be a game changer because small things in the right direction make a big difference in the long run.

(41:45)

Nicole: Oh my God. Alyssa girl, you are over here dropping so much knowledge. I love this analogy. Yes. That is so perfect. Yes!

(41:54)

Alyssa: Nicole, you're awesome. You're so much fun. I love it. You got it.

(41:59)

Nicole: Yeah. I mean, if you could see me over here like shaking my head like yes. Yes. That makes perfect sense. So, wow, look, I'm going to have to talk to my husband after this.

(42:12)

Alyssa: For sure. Yeah, we'll talk pointers, you know, online.

(42:19)

Nicole: Alrighty. So you talked about preparing with a class or a book. You talked about date moments, um, anything else that women can do to help to sort of ease that transition?

(42:30)

Alyssa: I mean, I think sex always helps. Let's go for it. Right. You know, it's again, it's hard. Sex is one of those things that we're really shy and vulnerable about. That being said, you know, again, we all know that there's a different pep in our step or a different electricity within the household when our physical relationship is on is on target or on task.

(43:06)

Nicole: Yeah, that is true. You have a little more spring in your steps and things are kind of connected if physically so. Okay. Okay. All right. So as we wrap up, is there anything else you'd like to add about this, about the PMADS or anything you'd like women to know before I ask you if you, how you feel about your work?

(43:27)

Alyssa: Sure. You know, more than anything I feel like sometimes we segway into having a baby and we never go into it. Thinking like, I'm going to have this new relationship with my baby at the exclusion of my partner. And yet we know that two thirds of couples experience a decline in their relationship satisfaction when they have a baby. And so although we don't go in anticipating or you know, wanting to kind of shift or replace one for the next, so often it happens where one relationship struggles as a result of adding this new relationship or adding baby. And so what I really want couples to know, or what I really want people to know is that you can have it all. You can have an incredible relationship with baby. You could have an awesome relationship with your partner and a flourishing life overall that you don't have to choose or one doesn't have to fall to the wayside. It takes an effort, it takes a whole lot of work, but it's doable. And I go back to small steps in the right direction. I guess if I were to leave you with one last thing, it's that I believe that every new baby comes with new best friends, creativity and flexibility.

(44:34)

Nicole: Oh yes. Yes. You can. I'm like just thinking about my own experiences. Absolutely. Yes, for sure. Creativity and flexibility. Love that. Love that. I love that. So some questions that I ask all guests who come on, what is the most rewarding part of your work?

(44:52)

Alyssa: It's helping to return people who are struggling to an inherently happy phase of life and to know that you are not impacting just an individual, but you're impacting a family and generations to come, that you know are going to flow from that couple that you're working with.

(45:11)

Nicole: That's really beautiful. I'm sure that feels great.

(45:14)

Alyssa: It is. It's really special. I always tell individuals that I'm really honored to be a part of their journey and I mean it wholeheartedly, right? For someone to let you in at such a vulnerable time in their life and to help make a difference or seeing them being able to enjoy this baby that they've worked so hard to bring into their world. There's nothing like that.

(45:37)

Nicole: Yeah, for sure. Now on the flip side, what's the most frustrating part of your work?

(45:43)

Alyssa: When people leave too early and we don't get to see it all the way through, if I were to be honest. Yeah. Or, or, or sometimes not even knowing what happens, right. People leave because, because people need to leave sometimes. Right. But you can't help but wonder, you know, are they okay? Where are they, what do they need? So that's definitely the hardest part.

(46:03)

Nicole: Yeah. Yeah. I think people don't necessarily understand that when the emotional connection that sometimes, you as a healthcare provider, you still wonder about people you see even after they leave your care.

(46:19)

Alyssa: Oh, absolutely. And again, like most rewarding are the families. I'll just stop by and just be like, Hey, I wanted to reach out. Or you get those holiday cards and you're like, Oh my gosh, you look amazing. Like this is very exciting. Yeah. But the ones that stay in touch are always lovely.

(46:33)

Nicole: Yeah. Yeah. And then how have your personal experiences with pregnancy and birth influenced your work?

(46:42)

Alyssa: It's huge because, you know, when I, so 15 years ago or 16 years ago when my son was born, there was very little that I was aware of that existed to prepare for postpartum. It was actually one of the biggest incentives or impetuses to really embark on this work was that was after baby number two, feeling like there's gotta be more out there. And so I've used my experience navigating relationships or those early days postpartum to inform the information that I teach. It was, you know, the catalyst to do some of that research to help other people not have to step in those pitfalls. If I can help you avoid those pitfalls now knowing that they're there, how amazing. And so often that's an informed by our own personal experiences.

(47:34)

Nicole: Yeah. And not that people who don't have children, you know, people who don't have children can certainly help pregnant women and during birth. But there is something that transforms you when you are a healthcare provider and then you go through pregnancy and birth yourself and then continue to take care of pregnant women. It changes you.

(47:58)

Alyssa: It does, it changes you. And I feel like the, like the proof is in the pudding from the perspective of how many people don't start in this birth space but find themselves segwaying into it after they've become a parent themselves. Very true. So of course not a prerequisite by any means to support someone as they go through this process. But I do think it says a lot that many of us after we've had kids that feel the passion and the call to support other families.

(48:28)

Nicole: Yeah, for sure. Well, thank you so much Alyssa. This has been a great interview. Where can people find you and find out more information about the things that you do?

(48:38)

Alyssa: Thanks Nicole. And you're amazing. Definitely one of my most enjoyable podcasts that I've done. So you are absolutely, you can find me online, www.doctorberlin.com and we made it, we made it fun for you guys. So doctor is spelled out, so it's D O C T O R Berlin dot com. You can also find me on Instagram, @dralyssaberlin. And I really, I hope to hear from you soon.

(49:04)

Nicole: Okay. Awesome. Well thank you so much and you take care and we will be in touch for sure.

(49:10)

Alyssa: Absolutely. We're going to have to grab coffee soon.

(49:13)

Nicole: Yes, yes. All right. Okay. Take care. Bye. Bye. Bye bye.

(49:17)

All right. Wasn't that a fun episode? I really enjoy talking to Alyssa. She's all the way on the West coast and I'm on the East coast, but if I am ever on the West coast I will certainly look her up so we can grab that cup of coffee and it's the same invitation for her if she's ever on the East coast in Virginia. All right. So you know that after every episode where I have a guest on, I do something called Nicole's notes where I go through my top three or four takeaways from the episode. And these are my takeaways from this interview with Dr. Alyssa Berlin.

(49:49)

All right. Number one, I love how she talked about reclaiming the term postpartum. We talk a lot in our society about postpartum, particularly as it relates to postpartum depression. And that is certainly really important, but we need to expand the conversation to talk about other things that are normal and just really create that time and space to adjust to that postpartum transition and she is spot on that it needs to start during pregnancy. It's not something that is really a part of the way Ob Gyn's are trained, so we need to really, really make that a routine and part of of prenatal care. Now, one of the things that I am super excited about is that I am going to start adding more live sessions in my online childbirth education class, private group, The Birth Preparation Course, the private group for the course, more talks about the postpartum period. So some of it of course will be fun stuff like nursery diaper bags. I'll also talk about things like childcare, how to choose a breast pump. So I'm super excited to add that as a component for members of The Birth Preparation Course. So stay tuned for that. If you are not part of The Birth Preparation Course, you can check it out at www.ncrcoaching.com/enroll.

(51:10)

Okay. The next thing that kind of grabbed my attention was recognizing how anxiety can actually be an issue for a lot of women and not necessarily depression. I think that I probably experienced this with my first daughter, especially if you've listened to the podcast then you know that my first daughter was born eight weeks premature. She had an intestinal malformation called duodenal atrisia. She had surgery three days after she was born. She spent a month in the NICU. She's totally healthy now, but when she came home I was very anxious. In fact, I remember one day she threw up and it seemed like a lot to me and I was terrified that she had like somehow messed up or something happened. Not that she messed up, but that something happened with her surgery in her intestines. So we drove to an appointment at the pediatrician's office and it was like in the beginning of a snow storm. The office was getting ready to close, but it was like I had to get her in to see somebody cause I was just so worried that it was kind of a extra level of worried. And then in looking back like the amount of vomit it was, it really wasn't a ton anyway. So I can see how anxiety can be an issue as well and how she talked about the yes, but where people reassure you that yes, it's okay and you come around with a, but afterwards because you're just, it's hard for you to let go of that anxiety. So if you have issues with anxiety, then that may also be a reason for you to seek help.

(52:51)

All right. The third thing that stuck out with me is that how she talked about we are social beings at our core, we are absolutely social beings and so it's important to connect with other people. So I liked how she talked about the village 2.0 where maybe it's a little bit different than just family. It may be extended friends, it may be mom groups in town. It may be hired help, even it may be a virtual community with online groups. That's one of the things that I've done with my Facebook group All About Pregnancy and Birth. You can check that out. Totally free for you to join where pregnant and postpartum women can connect with one another. So do make that effort to make some sort of a connection because it can most certainly ease that transition in the postpartum period.

(53:43)

And then the final comment I'll say is her comment of working on your relationship is something that you are doing for your baby. Like that's a outstanding way to think of it. I think very often when you have a new baby, it's going to change your relationship literally forever. But a lot of times it can be easy to get sucked into the relationship with the baby and not remember the importance of nurturing your relationship with your partner. And if that goes on for years, which it does for some folks, where it lasts a long time, then it's hard to reconnect when you do have more time together. So spending that time to focus on relationships is important.

(54:26)

Okay, so that's it for this episode of the podcast. I would love to hear your thoughts in the All About Pregnancy and Birth Facebook group. If you're not a member of the group, just search for it on Facebook. It's called All About Pregnancy and Birth and there'll be a link to join the group in the show notes. Also, be sure to subscribe to the podcast in Apple podcast or Spotify or wherever you get your podcasts and if you feel so inclined, I would love for you to leave an honest review in Apple podcast. Number one, I just love reading it. It warms my heart to hear what you guys have have to say about how the podcast affects you. It also helps other women find this show and it helps the show to grow. So I really appreciate them when you take the time to do that.

(55:05)

Now, next week on the podcast, it's a birth story episode and this one is a really special episode as it's a birth story from someone who's a member of The Birth Preparation Course. It's the first time I've had a course member on the show and I am super excited to have her on the podcast. You're going to enjoy our conversation. Miranda and I had a great chat, so come on back next week, and until then, I wish you a healthy and happy pregnancy and birth.

(55:36)

Today's episode is brought to you by Women's Wellness Coaching by Dr. Nicole Calloway Rankins. Head to www.ncrcoaching.com to check out my free one hour mini course on how to make your birth plan as well as my comprehensive online childbirth education class, The Birth Preparation Course with over eight hours of content and a private course community. The Birth Preparation Course will leave you knowledgeable, prepared, confident, and empowered going into your birth. Head to www.ncrcoaching.com to learn more.

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