Ep 5: PMADS, and Perinatal Anxiety and Depression With Dr. Catherine Birndorf

Today on the show we welcome Dr. Catherine Birndorf, Co-Founder and Medical Director of The Motherhood Center of New York. Dr. Catherine is also co-author of the books, What No One Tells You: A Guide to Your Emotions from Pregnancy to Motherhood and The Nine Rooms of Happiness, and associate professor of psychiatry at New York Presbyterian Hospital and Weill Cornell Medicine. She’s been featured on many national television networks and published in various magazines.

Transcript

spk_0:   0:14
everyone, We're green and era and welcome to fertility. Ford were part of the wellness team at Army of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our fertility for a podcast brings together advice for medical professionals, mental health specialists, wellness experts and patients because knowledge is power and you're your own best advocate. Dr Catherine Byrne Dorf is the cofounder, medical director of the Motherhood Center of New York. She has a reproductive psychiatrist and clinical associate professor of psychiatry at New York Presbyterian Weill Cornell Medical Center, where she founded the Payne Whitney women's program. Dr. Brown Dwarf is a board member of Postpartum Support International, a nonprofit organization for awareness, prevention and treatment of mental health issues related to childbearing worldwide. For 10 years, she was a regular mental health columnist for Self magazine and has appeared on numerous television programs, including the Today Show, Good Morning, America, MSNBC and CNN. Her first book, The Nine Rooms of Happiness, co authored with Lucy Danziger, was published in 2010. In this episode, we talked with Dr Bergdorf about how perinatal mood and anxiety disorders, or P meds, are defined have to know if you're at a higher risk for P Man's and have a seat help and proper treatment if you're suffering from a P mad.

spk_1:   1:34
We are so excited to welcome to fertility for today. Dr. Catherine Byrne Dorthe, the co founder and medical director of the Motherhood Center of New York, a space that provide supportive service is for new and expecting moms, including a range of treatment options for women experiencing Perry Natal mood and anxiety disorders often referred to as postpartum depression. Thank you so much for joining us today. I'm so excited to have you on

spk_2:   1:58
Thanks for having me. So

spk_1:   2:00
let's start by having you tell our listeners what is a mother had

spk_2:   2:04
center. So the Motherhood Center is a warm, kind of cozy treatment center. So those are sort of oxy morons, where we help women who are experiencing things like postpartum depression, anxiety during pregnancy, all the full range of different kinds of anxiety and depressive disorders from before trying to conceive during pregnancy and afterwards. And if you come in the post partum stage, we also have an on site nursery because we like to do a lot of work around attachments, since many women who are struggling with issues related thio, their mental health also struggle in how they feel about being a mom and being with the baby.

spk_1:   2:51
And I can attest to the warm coziness of the center. I've been there myself for a lot of seminars, and it feels like you're just in somebody's living room. It's so callously and nice. It's so lovely. So for listeners for tuning in today, can you tell them a little bit more? What exactly is a perinatal mood or anxiety disorder?

spk_2:   3:11
Okay, so I like to say, When I started doing this work and I was in med school in the nineties, no one was talking about postpartum depression, right? It didn't even I remember. I sort of had to, like, Knock on people's Doors is as a psychiatrist who wanted to understand everything about the emotional health of women during their reproductive years. People like, well, women don't have those problems. What do you mean? I'm gonna be I see these people all the time, but I don't really see that. Or I would say to my own pediatrician, Hey, do you have women who are struggling or on medications, Ford pressure, anxiety. And he was like, No, I said, Do you ask them just like, Well, good point. No. So we weren't talking about it wasn't in the zeitgeist, right? So reproductive psychiatry, which is what I call myself in those of us in the field who do this work, which you know, we're psychiatrists or psychologists or social workers People in the mental health field who study and treat the emotions along the reproductive spectrum, right from Menzies through Perry Natal through peri menopause. Menopause Great. We are this this sub specialty that is just really getting out there. So it started a while back, but it's taken a long time to really get going. So that's a very long way to say before, when no one was talking about it. What? We don't see this it Then we then moved to postpartum depression is something that people Oh, I see. I've heard of that right? The problem waas that postpartum depression is postpartum, so it's a Ziff. It only happens in the postpartum after a baby or is depression. So it's only depression, so with super narrow. So we have pushed the envelope and we're now calling it pairing natal right before, during and after pregnancy. Mood, which is depression, bipolar, other mood disorders and anxiety. So that covers all kinds of things. Panic disorder, generalized anxiety disorder. O C. D. Got kicked out, but we still included PTSD also got kicked out of anxiety disorders, but we still include it, and that includes all kinds of things. So P Mads or perinatal mood and anxiety disorders is just so much more inclusive than P p d postpartum depression, which was the catch all phrase before there was no phrase at all.

spk_1:   5:34
So now is P p. D. Now under the umbrella of a p magnus. Okay,

spk_2:   5:38
so I could answer that much more concisely if you'd like me to. Sure. Okay, because I just gave you, like, the super long answer to be overly inclusive. But really p Mads Perinatal moon anxiety disorders are the new ppd. Are the new post

spk_1:   5:53
partner trending right Point avenue Black. Yes, right Commander of the new people And I like to say

spk_2:   5:58
because people remember that and when you're thinking of it, the whole idea is just don't get stuck on postpartum and depression like P man's are much more inclusive.

spk_1:   6:09
So I did that so helpful for people because I think a lot of people, as you kind of touched fun, think, Okay, postpartum depression after pregnancy. And they don't understand that these things gonna rise before or dirt correct.

spk_2:   6:21
Right. So that's the That's the big secret. Which is that depression, anxiety and any other kinds of mental health issues exist always. And if they weren't treated before you

spk_0:   6:33
tried to conceive, they're going to

spk_2:   6:35
still be around. So while you're trying to conceive while you're pregnant and in the post partum, if you haven't treated things that really actually require treatment, you're still gonna have Um

spk_1:   6:45
So now if you say you were a teenager, you were diagnosed with depression anxiety. It was treated. Okay. You know, years later, whenever you choose to conceive a child, are you now more at a higher risk for experiencing a P Matt because of a prior history? Okay,

spk_2:   7:00
absolutely. So doesn't mean you will know, but are you at a higher risk? Yes. So

spk_1:   7:04
what can you do to kind of prepare yourself? You know, knowing that you're in a high risk

spk_2:   7:10
acknowledges power, right? So to know, and to not, you know, have your head in the sand and say like, Oh, that was so long ago. It will never happen again is just to acknowledge that you have been through something in the past or there's family history of it. That's also a risk factor for those to develop for people to develop a paranormal motoring side of disorder. So if it's around either in your pastor, your family's past or you're presently struggling, you are more likely than the next person to have trouble during or after pregnancy. So know about it asked somebody. Okay, I don't I don't feel that now. But it was a problem before. What should I do? How do I prepare for this? I see lots of women who will come in and say, I'm fine now, but like in my past, I was on Prozac. Should I go back on so I don't get this or how do I make sure I don't get this because I have this before? And that's a conversation, and just being aware of it puts you ahead of the game.

spk_1:   8:03
Sure, and I always recommend I say, Look, you know, align yourself of the great therapist, a great reproductive psychiatrist. You don't need to see them regularly, but have it in your back pocket so that if you do feel that you're getting these symptoms, you already have this system in place 100%. And I will be totally honest and tell our listeners I also have a history of anxiety, depression. I knew that going into trying to conceive, I had a great psychiatrist on him and that with her, and I put the supports in place. And without that, I think it would have been very different.

spk_2:   8:32
Brilliant. I mean, that's the best you can hope for, right? Because it's not like you can say, you can't will it away. You can't say I don't have this or I don't wanna have it. It can happen to anyone a new and it can also happen to those who had it before. So why not be proactive?

spk_1:   8:48
Right? And that was my other question, too. So even if you if you don't have a history of anxiety, depression, any sort of mood disorder, can you still get a P mad?

spk_2:   8:56
Absolutely. So I would say we see the first presentation of many different kinds of illnesses mental health illnesses both during and after pregnancy. So sometimes you can't find an decedent's in the past like you, Maybe you could find like, Oh, I used to be a little obsessional growing up, but no one ever really thought it was full blown O. C. D didn't get in your way of life. But when you deliver you mate or during pregnancy because it can also come out, then become very obsessional or compulsive or both. And

spk_1:   9:29
what is this? This has to do with the hormone production? Or,

spk_2:   9:32
you know, I wish I could give you a concise answer and tell you yes, it's totally hormonally related. That's we don't know that to be the case. We know it is all happening in the context of hormonal fluctuation. So the way I think about it or talk about it is really if you've struggled at one point of reproductive flux hormonal fluctuations, you're probably more likely to struggle at another time of flux. So if you were a P M SC person or had worked full blown premenstrual dysphoric disorder, P M d d, you may be more likely tohave perinatal issues or peri menopausal issues again, It's not a guarantee, but you may be more likely than someone who's never had issues during times. You know, didn't get Moody Jr period, right? So you may be more likely, but it's not a guarantee.

spk_1:   10:18
So what are some red flags or symptoms? People? So look for to know. OK, this might be, ah p mad and not just I'm feeling sad today.

spk_2:   10:26
Great question. So there is a wide range of normal, and I think one big problem is that we think there's either bliss like I should be so happy. I look at Instagram and everyone else is happy stuff. Don't get me

spk_1:   10:42
started. Only look at puppies on Instagram.

spk_2:   10:45
And then there's this swath you know, 20% of illness, right? So between bliss and illness blesses like five people and they have their own sort of genetic malfunction that makes them like born on the sunny side of the street, I don't know and then those who have illness you have this wide range of normal, and it's very and so some days are good and some days are bad as long as on the whole you're doing better than not or you're more, well, then ill. You're doing pretty well, But if you're distressed, if there's impairment and you're functioning, if you're not able to get along personally or professionally, or you're struggling in those ways, I don't care what you're experiencing. Get help, right, because that makes it a disorder. What what makes a disorder different from just having a You know, a symptom here or there is the distress that it's causing you and how much impairment it is also causing you. So again I hang out with one person is a, you know, an explosion to another. So it's really one's own experience and how much it's impacting them for us to really consider it to be a problem. And so

spk_1:   11:57
so if it's really affecting your quality of life for and what you consider a good quality of life. If you no longer have that, then does this that helped get help,

spk_2:   12:04
get tell somebody, ask for help. They really like. Bottom line is P. Mads are treatable if you can figure out that you have one. If you are outside that range of quote normal or again, and it's a wide ranch. If you are outside that range, we can help you. It's This is like bread and butter. It's not hard to treat. The hardest part is finding it, recognizing it, finding someone who could help you get There are many, many obstacles. I don't want to be blithe about that, but but I will say super treatable, like everyone can get better. And

spk_1:   12:41
so what would the treatment be? Would it be a medication and talk therapy? Just medication. Just talk there. Be what? Yes, and I look seeking treatment. What would that look like?

spk_2:   12:49
All of the above. So on the milder end of things, sometimes it's a support group. Sometimes it's, you know, just helping someone realize they need to talk to their family, entrusted confidence. And again, that would be more mild illness or just difficulty with adjusting. But then you go to therapy. Talk there be. I'm a huge believer. I do a ton of it, and I think that if you can get away with just that awesome and then there's medication. If things are more moderate to severe and the talk they're being again, there are many kinds of talk therapies right inside or into CBT DBT I Petey. We can name all the acronyms, right? There are a multitude of of ways to address it or to be oriented within talk therapies, and they can all be useful. Some are more helpful than others for the person in question. But if it's not working or in conjunction with, you may need a medication, and that's okay, too.

spk_1:   13:45
And those are safe during pregnancy because a lot of people worry that they're not

spk_2:   13:50
well. That is a very important question, and the way I'd answer it is generally speaking, almost all of the psychiatric medications that we would use with someone are considered relatively safe and pregnancy. The reason I say it so carefully and like that is because I can't guarantee anything. But people get very caught up on the fact that what should take this medication or not, Onda Riel equation is not to take the matter, not take the med. It's what is taking the medication versus not taking it look like. So what are your illness? Symptoms? And so it's comparing symptoms and how much you're struggling and suffering against those of the potential risks of medication. If you were to take one. Does that make sense? Sure. So people get very They're like, Oh, my doctor told me to go off everything like, Okay, Well, what would that be like for you? Well, I'd be hospitalized because I actually have a serious illness and I will become so depressed and potentially suicidal. Okay. Well, then let's think about whether or not you should take your Prozac. What do you think? Right. It's almost like it's not

spk_1:   14:58
as I would cost benefit enough. It's

spk_2:   14:59
absolutely a cost benefit analysis, but people don't think of it like that. They're just like his medication, Safe or not, and honest, like an answer. We have more data on the medication. Particularly antidepressants have been more study than any category of medication out there because they're so scrutinized and marginalized, right? No one's asking about you know, your your diabetes medication, your seizure medication, your high blood pressure medication. Oh, you have to take that because that's really medical illness. That's not true. People are asking, and they should. They should ask their doctors which ones are the considered? Safest. So I don't wanna I don't wanna say that that's not true. On the other hand. If it's psychiatric or psychological, they're like, Oh, that's that's optional. You can write off that.

spk_1:   15:43
Well, that's what I was gonna say. I think perhaps part of it is they're still, unfortunately, a stigma in our country around mental health, which is horrible, you know, mental health. It's a disease. It's a

spk_2:   15:52
brain illness. It is the same medical illness as cancer, right? Anything

spk_1:   15:58
that imbalance in your brain, it's chemical, that's it, have to be taken seriously. And I think that's part of the problem. And it's actually you know, it postpartum and any P mad. You know, I know we were speaking briefly before we started this podcast, and I found you have my patients, you know, protect me after they give birth and send me pictures. And it's so exciting. And I always respond to them with words of congratulations. And I always say, you know, if you're not feeling so excited, if you're feeling sad, that's totally normal. It's OK. Please ask for help. You're not alone, and I can't even tell you how many people come back to me and say, Thank goodness you said that. I don't feel that I don't feel like myself. I didn't know who to ask for help. I was so ashamed. And I think there's so much shame that goes with this and it breaks my heart, you know, especially in a community. You know, as I work in the fertility film, people working very hard to conceive, they feel like they have to feel happy because they work so hard and that there suddenly they're not allowed to feel anything less than pure bliss. That's not reality.

spk_2:   16:59
And it's not normal, no. Either way,

spk_1:   17:01
ladies are hard, baby, huh?

spk_2:   17:03
And if you, if you didn't have a normal up and down in your daily life again, it's not normal to be blissed out all the time.

spk_1:   17:13
No. And babies are hard and lack of sleep is a huge factor and postpartum future. Why Sleep is so important. And babies take all that away from you.

spk_0:   17:21
Yeah, and you're a judge, and it's an enormous

spk_2:   17:23
adjustments. So not just physiologically and physically, like you're changing in terms of sleep and appetite and energy. All of that's normal stuff to change. But your entire identity, boo right is completely shifting. So becoming a mother and I think there is no more profound change in a woman's life. Should she choose to become a mother? I mean, you've gone from one person you'd like made you created this a person inside of you like that. All right, slow down to think of it, I lied, right? Blows your mind right? And then you have to get them out of you. Another mind blowing experience. And then how do you lied to them? And who are they? Are they a part of you? And is that like people say, like it's your heart walking on a piece of your heart, walking around outside in the world? I mean, of course, in Darwinian terms, you should be anxious about that person out there who has to fend for themselves without you and go through life. And it is a certain level of anxiety is normal or stress, whatever you want to call it. But it's when you're unable to kind of process that transition or be able to tolerate all that. It brings up that we get into potential trouble, right? So women who have had have struggled with our own mothers or who don't have a mother because she's passed away or because she was ill and unavailable or whatever it is when they become mothers. I mean, it's really hard. There's no template.

spk_1:   18:51
It's so complex It And how do you, you know, compassionate, wearing all the hats you wear in a normal life, is it? You know, do you have a partner, right? You know, do you have other Children? Are you a daughter, a sister, a friend of professional? How do you retain your own sense of identity? It's incredibly difficult, right?

spk_2:   19:07
And if you're if you recognize that it's gonna happen and you don't fight it and just know that on some level you're gonna have to deal with this identity transition, you will struggle. But you will be able to do it. I mean, everyone ultimately does hopefully. But I think if you fight it and you're like, I should be just just blossoming here, what's wrong with me or I'm not in love with my baby right away is a big people. Be like I don't even really like what? What what's going on here? And you thought you were gonna feel really in love with this baby because that's what everybody says and it takes time for those relationships to build

spk_1:   19:46
its so hard. Yeah, I think my friends, I saw they appreciate it. I kept it pretty real of them. This is hard because it's hard. This baby is hard, it's very hard.

spk_2:   19:55
And it doesn't mean you don't love the

spk_1:   19:57
baby that you

spk_2:   19:57
didn't want the baby that you wish you could give the baby back. Although sometimes you know I

spk_1:   20:02
still do Which man four tantrum, right? Like a taker.

spk_2:   20:07
But I think that the idea that it's always supposed to be natural, easy and blissful it has really screwed us up.

spk_1:   20:14
It's so tough that I myself, people hate social media. You know, I think I'm blessed with my work to know kind of the rial what's really going on in people's lives. And if I see them on Instagram or Facebook, well, no, that's not what they're putting out. There is not really what's going on. And you know, I think it's kind of a disservice kind of a big dessert, because

spk_2:   20:33
we we look at it and we think we aspire. Oh, she looks so greater. She's doing so great and it's like we have women who will say to us, Do you see me in that picture? I was actually suicidal,

spk_1:   20:45
right? And they're not putting it at that, are putting it out there. Look, it's hard to be a parent. It's very hard

spk_2:   20:50
and talking. It's hard to be real. So kudos to you and those who are in the many women who are putting it out there notes. It's changed so much in the course of my doing. This work is so much more real now, and it's still we have a long way to go. But it's so much more real than

spk_1:   21:05
it is today. I think, you know, as you touched upon before two Senate, I think the hardest thing is asking for help and get in the support. And, you know, I always tell people, Look, I feel really blessed that I first experienced depression when I was 14 years old. I was living at home. My parents recognised I wasn't acting like myself. They brought me to help, so they did everything for me. If I've been over 18 and adult, I don't know that I would have known what to do. Had the tools had the wherewithal. I think asking for help in being vulnerable is one of the hardest things to D'Oh. And so is someone who, you know, assuming they're over 18 and adult having a child, you know, asking for help, I think, is the hardest thing. You know, people don't know where to go, and they also are afraid to do that. And so that's why I love that the motherhood center is there as a resource. You. So what do you tell people about asking for help? What does that look like? Is it picking up the phone Isn't reaching out to a loved one?

spk_2:   22:02
Yes, yes, yes, it's anything you can possibly muster. And so if you know something's wrong or not right with you, don't let that go. And and that's a lot to ask of someone who's not feeling while or a themselves. So sometimes it is more observed by family, and they don't know what to do there, like we get calls from desperate family members who say things like, I don't even know what's going on. All I know is she just had a baby, or all I know is she's pregnant and I can tell you she's not herself great. Bring her in. Let's see what's going on. We'll try and help you figure this out. We will. We will figure this out together with information from you so we can understand who she really is and what is so different now. So families are super important to keep families have evolved. If you have a family, not

spk_1:   22:49
everybody dies. What if you don't

spk_2:   22:50
or or doesn't have a partner? So you know, hopefully there's a friend or someone you know. It's so important that there's just someone you can turn to. And the really important piece, I think, is that nobody has to have the answer right. None of us have the answers to everything. But fortunately, we have people who are experts in all kinds of things, so we can find help. If if I don't have the answer, I know how to find the answer

spk_1:   23:16
it. I think it is building a team. Sometimes that's what it takes. It takes a lot of people,

spk_2:   23:21
right, so, you know, and I'll just say, even as a physician, you know, we don't like to not know. So physicians really like to have the answers, and I can tell you that a lot of doctors won't ask you how you are because they don't know what to do with what you're gonna tell them, right? So it's a really it's a Catch 22. That's really unfortunate. So I spent a lot of time also educating physicians, fellow physicians and say to them, You don't have to know. You just have to recognize that something's not right. And if you can't even recognize it, just ask So screening sh meaning like we need to be doing it. But really, if you look a person, a new mom or a pregnant woman who in the eye and just say and hold the gays in sort of a socially awkward way just gets so we're gonna break first, right? You just look at them and you say, How are you? And you don't do the social

spk_1:   24:15
a going for like, it's two seconds. Just wait. But

spk_2:   24:21
almost invariably, someone who's struggling is gonna start crying right and that you're trying to make them cry. But you're trying to give them the space and say to them with your with your gaze, I see you and I'm willing to hear what you have to say, you don't have to know. The answer doesn't matter. You will help them get to help.

spk_1:   24:41
I feel like that's also kind of bigger picture, maybe political conversation about since state of health care in our in our country, which is okay, number one. You know, the screening for a postmortem, right? I remember. Was it at the hospital or the pediatrician or my Jew? And whatever it was, you know, they give you a piece of paper, you check some boxes, they're like, OK, great. You're fine. So what kind of screening is that? And then also by acid and physician to sit down, hold the gays, ask someone how they are requires more of their time,

spk_2:   25:08
right in the Anyway, we we went, spoke to the labor and delivery nurse, is recently at the hospital and said, Listen, you're gonna hand out the Edinburgh Post Natal Depression scale. It's great. Listen, screening was a very important first step. The problem is that if the way you handed out is like, hey, just fill this out quickly so you can go. You think someone's gonna write down? They're not feeling well. They want to get the heck out of the hospital, or they're worried that if they are feeling really bad,

spk_0:   25:33
they're gonna take their bread

spk_1:   25:34
and their baby. So

spk_2:   25:35
so how truthful can women really be if someone is handing out a screen now, if we all had the time, whether it's, you know, from whoever on the floor is part of your treatment team could say, Listen, here's a piece of paper that we'd like you to really be as honest as possible. Don't worry. Many women feel these ways. They feel depressed. They feel anxious. They sometimes feel like they'd rather not have had this baby. It's not uncommon to feel these ways, so please be as honest as you can and we will help you. Our goal is not to hurt your to take the baby away, but to help you. Me? How long did that take? Right? Right. And that would change. Screening is just It's so hard.

spk_1:   26:13
Right? And change Anything change has to happen. Yeah, So now what If you're listening and you're not in New York? Because the mother attenders based in New York What if you're not in your where can you go? If you're feeling symptoms.

spk_2:   26:25
Yep. So we are in New York and we have because we have this sort of specialized a program for women who are more sort of moderately to severely depressed or anxious or psychotic or having you know, really impairing symptoms. Not that they need the hospital, but that they need to really be in treatment during the day, every day we did five days a week, five hours a day with your baby. That's really what we do specially, you know, there are a handful of other programs like ours that exist in hospitals were the only one of its kind that exists outside of a hospital. In this, Like

spk_1:   26:56
Lena, I want a copy of every state of the country. We would

spk_2:   27:00
love Thio. So they there some in other places around the country. So I want to give a nod to those. And I also want to say that I'm a board member of Postpartum Support International, which is an amazing grassroots nonprofit organization with coordinators and support in every city and state, around the country and internationally so you can call them. There's a great postpartum dot net is the website, and you can reach out that the most wonderful people involved who will help you find help. That's a huge part of Yes, I does.

spk_1:   27:34
And asking for help. It's is the hardest part. But that's you do that everything else will come to place. Yeah,

spk_2:   27:40
And you can call the mother and Senator. We were very specific, you know, in choosing one phone number where we have a human being, answers the phone and says, you know, my name is so and so you're kind Mother said the mother had centre. How can I help you? So even if we can't, our goal is to help find your help. Just to find you not to let you go, but id like Okay, You're in another state, another city, or we can't figure out how to work with this insurance or we don't know what to do. We're gonna find it out. We're not gonna just let you go.

spk_1:   28:09
I think, as you said, doctors like to find answers. Yeah, I know. For myself, of patients, they ask me something. I never just let anybody go, right. You can send somebody right as a caring profession. You do that?

spk_2:   28:21
I don't know. Which is a problem because I never sleep, and I don't think you do either. Obviously,

spk_1:   28:26
you sleep on your bed

spk_2:   28:30
time What you know. But yes, it's

spk_0:   28:33
like we wanted to know if someone's

spk_2:   28:34
asking for help. It is our duty and responsibility to figure out howto

spk_1:   28:38
also period. Well, I think the world is so lucky to have somebody like you, you know, bee so human and mindful and caring. You know, I think, unfortunately, that's it's few and far between are few and far between People get so caught up in their daily staff and that I have a big believer in mindfulness and meditating and and taking time to be present and just be where you are.

spk_2:   28:59
Yeah, it's easier said than done right, but it's hashtag goals.

spk_1:   29:05
It is. So what are some of the favorite parts of your job?

spk_2:   29:08
Oh my God, I love I just want to say I feel blessed and lucky every day, and I like to tell the story. When my daughter milestones four and I was going to the hospital. My husband's also physician and we've both on call all the time. We were residents when we had kids

spk_1:   29:26
sleep in that

spk_2:   29:27
sleeping, whatever. So I remember she was in the bathtub and I was walking out to go take call at the hospital. And I was like, Oh, honey, I'm sorry. I have to the hospital, and she looked at me and said, Why are you sorry? Why are you apologizing? I said, Well, I'm sorry I'm leaving you because I have to go to work shows. Okay, But you like your job. I was like, Hello, four year old. You know, you're good. And I remember thinking I'm never gonna apologize again. Like I will apologize for many things. But it was false. It was a false Apollo, like right? She picked it up. And she's like, Wait, I need you to be straightforward and honest here. Yes, you're leaving me and you love your job.

spk_1:   30:06
I love that. But a great model figure, kid. Right?

spk_2:   30:09
And they both say to because I'll tell you, my husband and I, you know, we weren't at many school functions were always working, but my kids were like, No, I'm so glad you didn't have to be part of the like P t a. That's okay. We're glad you guys do what you D'oh! Because we are so proud of you. These are my kids or 17 and 20 left and they're like, we're so proud of you. We wouldn't have had it any other way. I'm like, Okay, good, because I don't know if we could have had it any other way, but But I'm so glad that it worked and that we were home. We were there for the important things and we were always there psychologically. And it was quality. And there's plenty of quantity, too. But it's relieving when you're a full time working person who's got a mission. My house cancer surgeon. So he's also of similar mind like he's gonna help you, Tonto, where you need to be. It's like our kids, they got it and they're friends. Got it. They'll come over and be like, Can we talk to you about what you do? We love what you did, you know, it's just interesting. Thio find that, like, you know, people can they really get it? And that you can love what you d'oh and still, you know, be a parent and have friends and do other things in the world. But, um, yeah, until the after

spk_1:   31:19
now I love that guy comes back and says that 2017.

spk_2:   31:23
Listen, it was a gift. And then don't worry that one of them had a tantrum this morning. So, you know, at 17 I don't sit. Threw a tantrum in Answer everything wrong.

spk_1:   31:32
17. It's hard, really hard,

spk_2:   31:33
so hard, so hard, but, um, using one of the parts that you love, so wanna answer that? So I love what I d'oh for a 1,000,000 reasons, but I really love working with patients with people I love. I love stories, and I could listen endlessly to what people have to say. Like there's no such thing when I teach about psychotherapy and doing it and being in a room with a patient one on one, people be like, How do you sit through that like you listen to people like talk or wine or complaining like, if I'm bored, they're not telling me something. Something isn't being said because I am never bored in a room while I'm with a patient. Everyone has a story. Every story has meaning, and if they're struggling, then I want to know when I want to understand,

spk_1:   32:16
right, unravel and

spk_2:   32:18
unravel it. So I find it like, endlessly fascinating to be ableto. It's like a privilege for people to share with you their inner workings.

spk_1:   32:29
Oh, yeah, and try

spk_2:   32:29
to figure that out. It is Alana Total Honor. It is always interesting. I it's just a privilege. So it jazz is Mia's, you can tell. And since I'm someone who's like always on the move doing things, there is something so incredibly replenishing for me to sit one on one with a patient because I have to sit still and pay attention to nothing else except the person in the room and what they're saying and how they're feeling and how it makes me feelings like counter transference. It'll all the other dynamic techniques, right? Like it is a singular experience. And there are so few of those these days, right? So that is that's another thing. I just love about it. I get to be in the moment with no other distractions and and when I help people and they come back and say, my life is different because of our work together so powerful. I mean,

spk_1:   33:22
they have a greater number than that.

spk_2:   33:23
So good. So yes, I like everything about it. And I I really also love this period of time for women. You know, I'm very interested in was at Smith College Underground. I've always been a seven is, you know, and all my work and medical soldier was a lot around reproductive rights. You know, I'm very interested in helping women make choices that they otherwise feel like they don't have so so born when I you know, a lot of the work I do is, you know, helping women decide. Do I stay on my medication or not? You know, should I suffer with this illness like, How bad is it? How do I How do I think about this? And I love that way of doing those kinds of consultations because women think they only that the doctor said to either Stay on, that's fine. And they're like, but I isn't or they say, go off because they're like, No, no, no. Any medication like that is a problem, and you could go off of it. I love to be able to sit and talk to them and say, Let's like, step back and look at your who you are and your life context and what you need and tow walk through that kind of consultation with someone is, is just It's so powerful and it lends people make choices that they thought they would never be able to make. They would just have to go along with whatever this person said or that person thinks, or you know, what they found on Google. But really, if I could empower people, too, you know what the latest Dina is and help them make a choice within their context, like that's collaborative medicine. And I love that and I could I mean, I do it all day long.

spk_1:   34:54
I think as you said, knowledge is power and I always tell my patients that knowledge is power and you're your own best advocate

spk_2:   35:01
told. And you have to be your

spk_1:   35:03
have today if you have to speak up for yourself totally. And so what are the hardest parts of your job?

spk_2:   35:10
The hardest part's are helping people tolerate when things were taking a long time to get better, right? So I think it's really hard to sit with a patient day after day or, you know, week after week, who's like, but I'm not getting better. And to have to really tolerate is the word right. You're on the right path. We're on a path, but it can take time. It isn't just instantaneous, and the longer you wait and the more entrenched an illness is, the further behind the eight ball you can be so it can take a while. You know, women who struggle with moderate and particular severe post partum are dancing partum depression, anxiety and otherwise, I mean, you can you can lose time and there's this feeling of like, I'm I'm not bonding. I'm not attached. I'm not back at work. I'm I'm not doing anything and I feel so horrible. So it's really disempowering. And three people feel so ashamed and guilty that they can't get better faster. But so that's the hard part.

spk_1:   36:11
That's hard to like, a journey like that it

spk_2:   36:13
is, But it's also again. The flip side is it's a privilege, and I'll say to people, Let me hold your hope for you like

spk_1:   36:19
I write

spk_2:   36:19
like I know you can't feel it right now and that's part of what this illnesses. But I am hopeful for you and everyone can get better, so it will happen. We just have to take our time.

spk_1:   36:31
I love it. So how do you not take work home with you? You know, it could be very difficult.

spk_2:   36:36
Yeah. You know, my husband and I both we do a lot of referring out. We've been in our respective fields for a long time, so we spend a lot of time at night on the phone with people like my cousins. So and so are my best friend. And I have this or that. Like, what would you do? Can you just talk to him for a minute? Can you review the case?

spk_1:   36:52
Seems to Netflix and chill right

spk_2:   36:54
and matches. It's hard. I wouldn't say I've gotten much better not taking home like the crisis of the day because you know, much more senior in the field now. And I can not that I Don't worry because I say if I can't sleep and I value sleep tremendously, if I can't sleep, then something's not right like them. Then we I don't feel good enough about whatever the treatment plan is to sleep through the night, you know? Well, then we need to do something else. So, generally speaking, when I leave, I can leave the crazies at work as long as I know people are quote tucked in. But like it's that we often go home and are answering. These other questions are were out at a cocktail party or dinner party and people like I just picked him bringing Yes, of course. And you know that I'm fine with that. But I also whatever, it's hard not to, but I love my Netflix. I started playing tennis again after all these years. I played as a kid, and I'm like, I was like, Why not my doubles group on? Suddenly we're into it. Roll these 50 year old ladies like back on the course

spk_1:   38:00
hombre that outlet zoo so much you have? Yeah,

spk_2:   38:03
and walking and having an in love. Just I love my friends. I just really good friends that I've had for years and years who just nourish me and talking, injuring him. You know, I do. I preference those 61 amount of work

spk_1:   38:19
that you have to take care of yourself, you know, south care. Otherwise you're gonna do what you do. Yeah. So this has been so amazing and wonderful. I know still helpful for listeners. Is there anything else you want to tell them before we wrap up?

spk_2:   38:31
Just ask for help to your one of your many points. Great points do like just don't suffer in silence. Don't be ashamed. Shame is a silent killer like there's no need for it, even though easier said than done. But, like just tell somebody asked for help. Majors push, Don't let it go. Treatment is out there. These illnesses, these perinatal mornings. I just sort of czar just so treatable. It's just a shame when people show up many years out and they lost years of of of, you know,

spk_1:   39:05
God like

spk_2:   39:06
quality of life, offenses, breaks that breaks my heart. So ask, push, don't accept less than you know you deserve. Get out there and get help on Don't take no for an answer.

spk_1:   39:18
Yeah, I think that's a whole other conversation that you don't get into it, which is driving herself, you know, enough to know you deserve it and ask for help. So we'll get all the information about the mother of center on our channels and everyone concert. You know how to get tactical and then I like to end the podcast by doing the gratitude with positive note. So I ask you, what is one thing you were grateful for today?

spk_2:   39:41
I would say my health made me personally

spk_1:   39:44
ask your gratitude for today. So

spk_2:   39:46
my gratitude for today is that I feel good that I can walk across the park to get here, that my legs work and my mind is working that I feel healthy. I don't take that for granted. Very grateful for for my health.

spk_1:   39:59
I love that embezzlement. And I ask Mayan will be today that I got to meet you Another amazing empowering woman. You know, I said what My daughter grows up in a day and age where she thinks she knows she can't do anything until I love meeting other people like you, who I think are, you know, paving the way for my daughter. So I'm so grateful to you for coming on all the work that you d'oh! I love that he was a referral source for my patients. And I'm hoping that you know what time the dialogue and our country will change And mental health pea Mads will be just a part of our lexicon and the shame will go away.

spk_2:   40:33
Excellent. I could give you a

spk_0:   40:35
little match. Thank you so much for listening today. And always remember, practice gratitude. Give a little love to someone else and yourself. And remember, you are not alone. Find us on Instagram at fertility. Underscore forward. And if you're looking for more support, visit us at www dot r m a n y dot com and tune in next week for more fertility forward.