I think that's a huge fear that gets in the way of people reaching out for help from anyone. You know, if you're seeing a pelvic floor PT, if you're going to your OB, say something. Because even if you don't have a mental health provider, those are the people that are going to help connect you. But, yeah, don't be afraid to reach out to anybody who will listen. Millions of women are living with pain, discomfort, and silence. Told that it is just a part of life. It doesn't have to be. This is Healing at Your Core, where pelvic floor physical therapist Brie Allred brings more than 20 years of clinical expertise to the conversations women deserve to have. Real answers, real healing, no shame. And now your host, Brie Allred. Welcome to Healing at Your Core, where we're going to talk about all things core and pelvic floor. Today, I'm so excited for our guest. We have Hannah Sawitzki, and she is here with Nova Therapy. And we're so excited to have this discussion. We're really going to be talking a lot about the fourth trimester. So this time frame after we've delivered our baby, really talking about the first three months, we would kind of argue is the fourth trimester. I would even say it's longer than that because we're forever changed afterwards. I say once postpartum, always postpartum. Postpartum is forever. Yes. So Hannah, if you'll just tell our guests a little bit about yourself and then we'll kind of get into our discussion here. Okay. My name is Hannah Sawitsky. I'm a mental health counselor here in Utah. I'm licensed in a few other states as well. So I can see clients in Montana and Idaho and Texas. Nice. For telehealth type stuff. Yes, for telehealth. So kind of a spread. I do doula services as well here in Cache Valley. And I've been a mental health therapist for 10 years this year. And I've had my own practice for five. So Nova, Nova's been around for five years and was born out of my own postpartum experience. And I have now, I've been in private practice alone for a long time. And now I have a really awesome team of other therapists and peer support specialists that work with me as well. So great. Okay, I'm going to take a little detour from what we talked about. I just want to talk about a little bit of why did you open your own clinic? I was working in residential care. Which means for those of us that aren't in therapy talk. Oh, yeah, mental health world. I was working in a residential facility for adolescents and adults with eating disorders. So a place where they live there for a little bit. So they come for, it's not as high as inpatient treatment, but like one step down. Got it. From the medical inpatient. And I had my first baby while I was doing that job and went back to work for about a year after she was born. and unbeknownst to me was going through my own postpartum anxiety experience and when I realized that that was what was happening and how lonely it was I wanted to be part of making sure that other women didn't go through that same experience feeling so isolated and thought I was going to go just the doula route and got trained as a doula and in the midst of that thought maternal mental health would build perfectly on top of what I already did. So it all just combined into one and Nova was born. Yes. Tell me why the name Nova. Okay. It's hard. It's kind of hard to explain because I have this picture on my daughter's wall and it's this mountainscape with just like amazing Milky Way stars. It's watercolor. And I just had that in my head and from like a celestial perspective nova stars are like the birth of a new star and I thought that went really well with like parents kind of are born when our children are born and also this idea of just the therapeutic process is a lot of rebirth and a lot of growing and I thought it was a nice metaphor. I love it. I love everything about it. So fun. So we kind of covered already a little bit about like, what is the fourth trimester? So let's talk your definition then. What would you say the fourth trimester is? Yes, I was thinking about this coming in today and I've kind of heard it explained that our babies really truly need more time in the womb, but there's not enough space for them to stay longer. like compared to other animals our babies are born especially helpless like giraffes kind of like plop to the ground and stand up and immediately right and we are not in that position with our babies so I think of it as they really should be gestating a little bit longer and we're still kind of gestating these very dependent little beings and so it's this this space of like I'm still taking care of my baby and I need a lot of care and being in this little fourth trimester bubble and those three months after there's so many adjustments and physical things that happen and yeah that's kind of how I think about it okay all right so when we were talking for trimester would you say you're really thinking kind of three months after birth Um, yes, but I would, I would also say from a mental health perspective, like I look so much farther past fourth trimester in terms of the work I'm doing because mental health, postpartum mental health challenges can show up anywhere in our process of trying to conceive our pregnancies. And then in the first year postpartum, and that could be like, I'm fine for six months and then month seven, I crash. And so. Her brains are crazy that way. Yes. The fourth trimester is so unique. And I see so much in need for care in those 12 weeks, but also beyond. And if we don't address stuff in that first year, it persists. Like I have women come see me two years postpartum and they've never processed their birth. and I still see it as postpartum depression. Yeah. Because it didn't get looked at. Because it's one that just, it's like it started then and it persisted and it's still going. Yeah. Okay. Let's talk a little bit about that six-week checkup. Okay. I'm so fired up about this. We both have feelings about this. So many feelings about this. But we were just talking about the fourth trimester, right? Yes. The six-week check-in happens midway through our fourth trimester. um what do you think about it what do you think about six weeks and why six weeks and what happens at six weeks that feels so arbitrary to me six weeks feels like random in in the perspective of like from a mental health perspective and I think we'll talk more about baby blues later we will but the first two to three weeks is a really critical time where all of those hormone changes are taking place our mood fluctuates a ton a lot of women are really it's you're really tearful you're sleep deprived you're running on adrenaline um and then after that first two to three weeks there's another three weeks before you're seeing anybody for most women I would say the majority and that feels like a huge gap because that's when it stops being the baby blues starts being something else if we're experiencing mental health symptoms they're physically so much is happening like monitoring your bleeding and tear recovery and all of this breastfeeding yes that gets overlooked doesn't get enough attention so yeah uh how do I feel about the six-week checkup I feel that it's inadequate and I and I think that it misses a lot of critical points that should be we should be getting eyes on us we should be getting assessed we people should be checking in on us and agreed yes and I'm like We're not trying to throw our OBGYN, midwife. We love them all, right? But their job is really to monitor during your pregnancy and make sure that your baby is safe during that time frame and delivery. And then I feel like that six weeks from a tissue healing standpoint is a good point to check in. So from physiology, the way that our body heals, tissue, right? You had a tear. It's now back together. The scabs are off. That tissue is back together. That's what I mean from a tissue perspective of things healing. Your uterus size is typically back down to normal. The placenta should be healed by, like your placental scar should be healed by that point, right? So I think our OBGYNs are doing like, okay, this kind of closes your physical chapter, your physical process from a baby. And they're doing the best that they can. And hopefully we are getting a little better. We're screening for some depression stuff. They're starting to ask a little more questions from a pelvic floor physical therapy standpoint. So I'm just hoping that we can be a little bit more robust and maybe looking at this, oh, like this person is still my patient, even though they're done with this pregnancy and delivery journey. I think that's also where the multimodal care comes in. Agreed. Because not everybody can do everything. Right. Right. So in our community, I've seen midwives and doctors who, when you advocate for yourself, they will see you at a week, two weeks postpartum, four weeks postpartum. And that's available for people who ask for it, seek it out. But also if they know that there's mental health resources available, if the medical providers know that there's a group going on, if the medical providers know that all these other resources are available, then they can refer out and we can fill the gaps. And it should, it can extend beyond the tissue check to how are you doing overall as a human being utilizing other forms of care. Agreed. Agreed. Okay. It's a good discussion. I love having it. I love having that discussion. I would just say one take home from that between kind of both of us is do your best to advocate for yourself. Sometimes it's hard because in that early postpartum time frame, you might be in survival mode and it's really hard to be an advocate for yourself when you're surviving. So this is a time to call in your village, call in your moms, call in your friends, call in your husband. And sometimes setting that up as part of your prenatal plan, it can be a good situation. I think that helps a ton. So we, NOVA has a postpartum planning course. We teach the class in person, but we also have it online. But what's included in that is worksheets that basically encourage you to ask those questions ahead of time. So there's a whole list of who's my pelvic PT provider, who's my midwife, who's my mental health provider who am I going to see for chiropractic who am I going to see you know if I need acupuncture yeah so that a lot of times the pressure is on us as moms to have hold all that stuff in our minds but if all the numbers are written down and we've talked to our partner or our the grandparents that are coming to help or our sisters that are coming to help that they can be like oh oh the the number for my chiropractors in my postpartum plan or they They can watch you and be like, I don't feel like you're doing well. And they can go to that resource so you don't have to regurgitate it or kind of bring it up when you're in that situation. And everybody's on board. Yeah. Because when you're in survival mode, I remember standing in my kitchen postpartum maybe three weeks, and I had to walk the dog with two kids under two. And I was like, I don't have a single friend that I could call. I just couldn't think of a name of anybody I knew. when in reality you probably had 10 friends that all it takes is a phone call and they would have been right I couldn't think of yeah a single name so now I write people's names on a little piece of paper put them on your fridge so when you're having a total blank moment like oh yeah that's who these are my people that I call yes okay let's talk a little bit from the difference I think there's a lot of misnomer or misconception around oh it's just the baby blues so let's talk a little bit about that where you've got more of this. I mean, there's hormonal shifts, but a lot of this is going into how's the brain responding to what's happening in your body? Yes. So I hear women nine months postpartum say things like, oh yeah, I have a little bit of the baby blues. And that's always a red flag to me because the baby blues is really that only that first two to three weeks. And it is due to the hormonal shift. It is due to sleep deprivation. It's a huge change. And the symptoms are so much more mild than a perinatal like mood and anxiety disorder. And things that persist past that point are in the postpartum depression anxiety OCD realm And so even if you do have mild depressive symptoms nine months after the baby blues is not capturing the depth of that experience, in my opinion. And I think people normalize it and then they don't get help because their moms and grandmas are like, oh, honey, you just have the baby blues. And it feels like a disservice. It feels like a disservice to parents in general because moms, dads, caregivers of any kind, even grandparents who are really involved, can all experience a PMAD, perinatal mood and anxiety disorder. So by minimizing it, oh, it's just the baby blues, we're not serving families the way that they deserve to be served. That's a great point that you just don't realize that it's like we have dads that are in this equation. We have caregivers that are in this equation. Yeah. And we're taking on new life roles for pretty much everybody in that scenario. And the baby blues look like mood swings, tearfulness. I hear like, I just cry at everything. I cry when I'm happy. I cry when I'm sad. but depression and anxiety is is has a different quality to it and if those symptoms are more severe in that first month it still isn't the baby blues so you have to look at two factors like the timing and how severe the symptoms are okay um if somebody's wondering is this me what do you know how would you tell them to distinguish or is it like you don't need to distinguish you just need to come see a professional like what would you do if somebody's listening to this and they're like yeah so do I have date like I'm two weeks postpartum do I have baby blues or is it something do I write it out do I go see somebody what would you tell them my really general broad answer would be if you think you should go in to see someone you should just go because someone might come into my office two weeks postpartum and I might do an assessment and feel like, okay, this does feel more like baby blues. I think things are going to get better. But I would never tell any parent who's sitting at home in despair or worrying about their experience or feeling lonely to just wait it out. Because even if it is normal baby blues, should we be alone in that? No. We should still be getting resources. We should still be sharing strategies. We should still be getting support. and the earlier we get that support, the better our outcomes, the less time our symptoms last and that time still deserves so much attention even if it wouldn't qualify as postpartum depression or anxiety. So yeah, my answer would be go talk to somebody. The OB offices and midwives do screen for this. I've even seen a lot of pediatrician offices start to screen moms screen and those are helpful if they follow it up with a conversation. And I think that that's where I've seen a gap is we hand out the questionnaires and I mom's not looking good. Yes. What do I do with that? I want the questionnaire to get out there, but I also want after those questionnaires are filled out I want somebody to call us yeah and say you know oh I only scored a seven on the Edinburgh like come in anyway if you are struggling just come in come to a support group go to the postpartum support international website they have groups all day every day on every topic but if somebody's questioning their experience, just find support any way you can. I love that recommendation. Where would they go to find, didn't say they're wanting to find someone like you, but they're not in an area where you can help. Yes. How would they find somebody that's maybe specializing with moms or postpartum issues? Yes. I love broadly, internationally and nationally in the u.s postpartum support international their website's postpartum.net they have a whole section of their website that's resources for parents they have resources for professionals and they have free virtual support groups happening that's really constantly and this is like pregnancy loss infant loss miscarriage traumatic birth bipoc groups dad groups you name it they've got it have it so that's a great place to start and I think they also have a provider directory so in your area if you're listening not in Utah you can find a provider who's gotten trained you have to show your training to be listed on their website that you've done maternal mental health training so that would be my first place to look in Utah there's the Maternal Mental Health Network. And we will put those in the show notes, the link to that. But that you can separate by specialty, location, what insurance they take. And it's the same thing. You have to demonstrate that you're trained in maternal mental health to be listed. So those are my favorite go-tos. Okay. So now let's kind of move into that where it's like, okay, this would be kind of a clinical diagnosis, right? They meet the criteria. What is the difference between like postpartum depression, postpartum anxiety, you said postpartum OCD, like those kind of main classifications that you may see? Yes. I love talking about this because I had postpartum anxiety with my first and nobody in my world was helping me understand that experience. I loved my OB, but when I went for my six-week checkup, I wasn't doing well, and he said, are you depressed? And I said, I don't know, maybe. Does everybody feel this way? And I was offered medication, and that was pretty much the extent of my mental health assessment postpartum. Like, that was all that I got. And so I remember feeling like everybody else must be feeling this way and are handling it better than me. So now you've got a comparison that leads to a little bit more shame. Yeah. Right? I'm falling short of the mark. Yes. And I didn't have a lot of other friends who were mothers. It was, I mean, added on that this was COVID year, like going, had a baby in December of 2019, like went into the most isolating period of all of our lives. But I couldn't find a group here. I just, I had nothing to, nothing to really understand if what I was going through was normal. So depression can look like low mood. It can look like sadness. It can look like not having a lot of interest in your baby, not feeling connected with your baby just kind of meh meh low motivation um and not motivation like i'm gonna train for a marathon but like i don't want to get out of bed um it intrusive thoughts across the board anxiety depression ocd it's part of it's part of being a mother but intrusive thoughts come into all of these. Sorry. You're good. So tell me again, sorry, I'm just medical jargon. What would be, what's an intrusive thought? What does that mean? Yes. Intrusive thoughts, we all have thousands of them a day. So in terms of statistics, a hundred percent of parents have intrusive thoughts and those can look like, they can be scary intrusive thoughts. They can be things that we think about ourselves, our spouse, our baby, that feel kind of startling and icky and scary about our baby's safety, about our safety. I usually give examples like if you're driving on a two-lane highway like out of Cache Valley, there's a marsh on either side and you think, oh, I could just drive my car off the side of Valley View. That's an intrusive thought. Okay. So a lot of our intrusive thoughts we're able to ignore, but when they start to latch on to motherhood, they get spooky. Okay. Thank you for that explanation. Yes. I'm sure that I was just saying they're like, so what classifies as an intrusive thought? Intrusive thoughts are like, I am not purposefully trying to think about this. But it comes in and you're like, geez, where'd that come from? Yeah. Yeah. Feelings of also like guilt, worthlessness are big hallmarks of depression, profound guilt and worthlessness, thinking you're not a good mom, your baby would be better off without you. Those are big signs. Anxiety is sneaky because it can look like excessive worry. So you might be stressed about a lot of things about your baby or one specific thing like is my baby eating enough is my baby has to take a nap at this time we might get really rigid about stuff um am I using the right laundry detergent it can look like specific worries but it can also look like irritability and anger and rage so for me and I talk about this all the time which is like I didn't feel like a worried mom but I looked like an angry mom and that was how my anxiety presented was just like I would now that I can look back like I would start to feel scared and I would get mad and because mad is a more acceptable emotion or maybe I don't know I'm putting that meaning to it but sometimes it's like it's not okay to be scared if I'm angry it's it's more powerful it shows up differently. Yeah for me I would rather be mad than scared and I see I actually work with a ton of moms who don't want to be mad so they're coming in really ashamed for feeling rage post partum and I'm like oh good you're in the right place like we're gonna normalize the rage and actually talk about what's behind it but it can look like excessive worry not being able to sleep when your baby's sleeping is a big one like if I get the chance to rest I can't because no we're None of us are sleeping with a newborn. But if somebody's taking care of your baby and you cannot quiet your brain and you cannot sleep when you're given the chance, that is usually a concern to me. Yeah, those are big anxiety ones. OCD is the anxiety, like the obsessive thoughts, plus an effort to relieve the distress with some kind of compulsion. So those can be actions or mental compulsions. And there's a lot of nuance in there, but it comes along with a lot of behaviors to try to neutralize the stress. Okay, because they can control it by doing something. Or we think we can. Yeah, right? Okay. Some good distinctions to be like, does this sound like me? at all yes because there are things I'm struggling with here yeah yeah and when you know just like speaking to the audience I think there can be a lot of stigma and a lot of shame around experiencing these things and it can be scary to talk about especially like intrusive thoughts it's like I don't want to tell anybody that I've actually popped into my head yeah that I'm thinking these things but like therapy is the perfect place to do that because we're nothing feels too out of the box to hear. Um, but normalizing those experiences and feeling like you're not alone in them. And just because you're experiencing those symptoms does not make you a bad mother would be like my biggest message is these, these kinds of things are completely treatable and you can feel better. And the best thing you can do is say something. yeah and from your experience what do you see contributing to these issues oh so many things um there was a study I'm not even going to say the year because I can't remember but there's a lot of factors that put you more at risk so previous losses difficulty conceiving can be a risk factor. Being a younger parent is a risk factor. Financial standing, like how financially stable you are, what kind of resources you have. I'm trying to think of some others, like how much support you have in your environment, a personal or family history of anxiety and depression, especially if other women in your family have experienced postpartum. That's usually a risk factor and if you have had generalized anxiety before you were ever pregnant it's let's compound this yes life change and some hormone changes and yeah it's likely to sneak in and be like oh I have something new for you to worry about so like thanks I really appreciate it I have a list I been preparing yeah um so yeah there quite a few okay that some great things to look at I just want to add a couple other risk factors that I didn mention Having a complicated pregnancy or delivery Like I have had peers and doula clients who had hyperemesis. Meaning you throw up all the time. Constantly. Yes, hyperemesis is not just a morning sickness. It is like, oh, if I can't keep food down, and for a lot of people it'll last a long time. Yeah, and needing a lot of medical intervention like IVs and PICC lines and going to the hospital for fluids and meds. So any complications during pregnancy or delivery, your baby going to the NICU or having a preterm baby. Breastfeeding and feeding challenges also are huge because we think like, oh, I'm going to have a baby and then I'll breastfeed. Like we should be able to do this. your body this is breast is best yes and I'm like while there may be a little bit of truth to that right it's just I really feel it comes from these shoulds yes and there's a lot of there's a lot of anticipation and expectations that go into how we are going to feed our babies and when that does not go how we planned one way or the other it can contribute totally um multiple births like twins or triplets or more babies um relationships stress and then perfectionism is a huge one that we just expect the most of ourselves and yeah life does not babies don't really cooperate with that yeah and you talked about a statistic that I just thought was interesting earlier about Utah having such a higher prevalence of this. So let's speak to that just a little bit. I find this super interesting. I have my theories, but the national average is about 20 to 25 percent for anxiety and depression. And Utah's statistic is about 44, 45 percent. So it's like twofold higher. Yes. To me, I know it's not quite 50, but to me that feels like half of our parents, half of our mothers who are getting screened in these studies are presenting with a mood and anxiety disorder. So that is huge. So we'll just say if you live in Utah, your risk is a little bit higher. Yes. So we might need to be aware of that. We have a lot of young families, you know, there's a lot of reasons why I think that comes into play here, but it's startling. Yeah. So I just like to, I don't know, I just think it's interesting. So it's like, yes, in Utah, we need, especially in Utah, we need to be talking about these things. Yeah, we need to be talking about it. And it's, I think there's a discrepancy between the number of people who experience these symptoms and how many people actually get treatment. So could we even just have a higher acceptance or reporting rate in Utah? that that more people are more people are willing to report and be truthful about what they're experiencing i don't know swing it for right it's just some interesting things about that data of like because you're saying it's under reported maybe or i think that i think that the statistics of people who are reporting symptoms is that all of those people are not getting treatment yeah And that scares me. Hurts your heart. Yeah, yeah, that gets me because we are needing more support as a state, as a community. And I don't know that everybody needs to be getting it. Maybe let's just watch out for our friends a little bit, our new mamas, right? Yeah. Give them a little bit of support. I just thought it was interesting when you were like, we in Utah. And I know people may be listening to this all over, but it just kind of hits close to home that it's like, yeah, we have an issue with higher rates of this and we need to be aware of that. I also think any other, any people around new moms, the more you know the symptoms, the more you can say something. So partners should absolutely learn the symptoms. Friends, family members. If you know the symptoms, then you can look out for it in a new family. and you're not doing any harm by saying something or saying I'm worried about you, you're actually likely being the first person who sees them and says, you don't have to feel this way. Not everybody feels this way. I feel like I see the show you're trying to put on and I see the reality behind it. Yeah. And I'm concerned about you. Yeah. Let's talk about a little bit around the identity change that happens. We're going to focus specifically on moms, but we could also talk about just general parenthood, right? But like what identity change happens when you have a baby? Well, profound identity changes. I think we go from being whole people in the world with a lot of times a relationship, but not always. And we might be pursuing an education. We might have a career. We have friends. And then we become a parent. So now we have this new identity and there's not a lot of guidance in my experience on how to integrate who was I before and now I'm this and I have this little person or people that I have to take care of. And where's that person? Versus just, oh, I completely leave that person behind and I take on this new identity and that is all that I am. Right. And I think that early on, and this is what I see in my postpartum groups actually, is we dive right into motherhood with this newborn. Because we don't really have a choice not to. Right. We have to. And that's the fourth trimester, right? We're in this little cocoon with our baby. And that starts to not be sustainable after a while. and that's where people start coming to therapy and coming to our groups and saying like well I'm with my baby 24 7 but I'm starting to I'm starting to feel something that's not compatible so what do I do what do I do with that yes and there's a lot I mean a lot of guilt that comes with like I miss kind of some of the things I used to do and who I used to be and um just a lot of complexity to that experience yeah of how do I make both of these things true and good because I do think we we get in the black and white thinking that either or like I can either be that person who I was before kids or I can be this new person yeah and it's an it's an evolution it's never I'm gonna be who I was before but there's pieces we can bring with us yeah and what does that look like and are you having those discussions and yes giving yourself time to be you yeah and talking about it before again like I had my first baby I did I knew everything about my pregnancy I was so into researching birth and I think there was part of me that just like couldn't believe there was a baby at the end of it and then when she was born and we went home with a baby, I had not planned for that at all. And we had had no conversations of like, how do me and my husband each still tap into our friendships? How do we take care of ourselves? When do we get time alone? How do we navigate our roles and responsibilities? And all of that should be part of the conversation for planning for birth includes postpartum planning so that it eases that transition. Yeah. Cause it's a whole new thing. Oh, so interesting. Yeah. Well, I just look back to my experience and I'm so grateful doing it for the support that I had and, but it was a whirlwind for sure. And my first pregnancy was twins and they came a month early. So we had some NICU time. Um, luckily I have a very supportive involved spouse that made that more doable to where we were tag-teaming babies and working together a lot and I still remember sitting in the hospital it was right after I'm trying to think when it was probably 24 hours or so after delivery and I was watching a movie and they delivered flowers to a new mom and I just broke down and I was bawling and my babies were in the NICU and I was up in my room because I can't remember. I'm like, I can't remember. I think my baby's vitals weren't doing super great. And it was one of those time frames where it's like, okay, we're just going to let them sit and chill for just a minute. So I ended up going back up to my room. But then the nurse came in and I'm bawling and she's like, are you okay? And I'm like, yeah, they just delivered flowers to a new mom. And I'm, you know, and I was like sitting there thinking like, this is crazy. Like, I don't know why I'm having this response. But then there was also some of that like I just had a baby and my babies aren't here with me and at that point in time I don't know if this was the truth but it was my truth at the time was that I felt like I wasn't welcome in their room because they had been too stimulated that day didn't it needed some time away and I was at the time frame too where my babies were little in little incubators to help them with their body temperatures so they were also like I can't hold them both do I choose one or the other to hold when they you know it was just kind of like had to back away from that space but just navigating all of that it's yeah it's a lot and did you know that your babies would be early and did you know they would go to the NICU like was that something that you felt prepared for or did it somewhat but it was I'm like we I've been on best bed rest to keep them from coming so I had a good idea they were going to come early um but the NICU time didn't they're like we've given them shots for to help develop their lungs we've done did it and they were generally pretty healthy they were just tiny babies yeah and needed some help they'd run out of energy before they could take a full feed and they were so tiny they can't not take a full feed so we were kind of in that they call them feeder growers in the NICU but um it was just one of those where I'm like so they were healthy it wasn't super scary but it was still just kind of this navigating like I don't want to go home without my babies and so I'm staying in the hospital on what they call the hotel stay so you pay like a super cheap amount to stay if they've got room in a hospital room so you can walk down it was just an interesting experience so I can just imagine doing it and like we navigate so so much yeah and it can change things yeah and just thinking about your story like there's all these factors that were on the list that we just talked about yep right and it's like I did not seek care but I probably really could have benefited even I like sometimes just to check in and get some tools to be aware of what what you need to deal with yeah honestly that's something that I talk about a ton when we advertise our groups is you don't have to have a diagnosis to get support as a mom you don't and I worry that that turns people away from going to a postpartum group or a support group is like oh I'm not I think I have depression I'm not depressed I'm not struggling enough to have to go to this or other people need it more than me. That those spaces are super welcoming and everybody could use tools and community and that social peer support. Yeah. So good. Actually, let's talk about, let's go into the birth trauma stuff just a little bit first. And then I do want to talk a little bit where I'm a physical therapist. Doing kind of the mind-body connection. Yeah. And how that can affect, how the body affects the mind and how the mind affects the body. Totally. Okay. So let's talk birth trauma. Okay. What is, what is birth trauma? What is it? What is this? We've, we've started hearing the term more. Yes. Like what actually is birth trauma? Okay. One distinction I want to make is that birth trauma is distinct from medical trauma. So you can have healthy mom, healthy baby, uncomplicated pregnancy and delivery and still experience birth trauma. And things that contribute, this isn't an exhaustive list, but things that contribute to birth trauma are not being heard or listened to in your birth space. So a loss of autonomy, providers not listening to you, not being involved in the informed consent process can contribute. Um, any time that you feel like your life or your baby's life was in danger and for spouses or non birthing parents that can happen if you're looking at your spouse or baby worrying about their safety. Could you argue that birth trauma goes like things that didn't go? Yes. Okay. With what you expected? Totally. I mean, that's a very, very broad, but if you go in and expecting one thing and another thing happened I maybe it's an incorrect definition but just kind of that set you up for maybe experiencing some birth trauma yes um yeah unexpected events even if your baby was fine can be traumatic um NICU NICU stays this was an interesting experience I had where my second baby unexpectedly went to the NICU and I experienced that as very traumatic. And a friend of mine, her baby also went to the NICU, but she was expecting it and she did not find the NICU experience to be traumatic. So the same thing can happen to two people and the trauma is really in the eye of the beholder and how we experience the event. Other things I want to say about birth trauma are kind of the hallmarks. Like first and foremost if you feel that aspects of your birth were traumatic I going to believe you And I think that should be across the board But other things that can show up after are like flashbacks or recurrent memories of what happened. And a lot of times those interfere with sleep. They just love to sneak up at night in our quiet moments. But they can come up any time of the day feeling like you're back in the experience again. if you find yourself avoiding any reminders of the event that can be a sign of postpartum PTSD so like I don't want to go back to my six-week checkup because I don't want to be back in the hospital those things can also come up unexpectedly like walking into the doctor's office and like the smell causes you to have a panic attack like oh I'm sweating and I'm dizzy and I don't know what's going on here that could be a sign a sign um also having like you don't want to you want to avoid any reminders you don't want to talk about it you want to avoid the feelings associated with your birth those can all be birth uh postpartum ptsd okay warning signs okay where does ptsd play with what we were talking about with like postpartum depression, anxiety, OCD, baby blues. Is there correlations there? Would you say no, we're like completely treating them differently? No, we're there. The treatments for. OK, so there's five things, and this is something like I always think about our parents generation, like mothers and grandmothers, that a lot of older generations will say like, oh, she has postpartum. And when people are saying that, they're usually saying that somebody has postpartum depression. But if you've had a baby, you're postpartum. Postpartum mood and anxiety disorders can be postpartum depression, postpartum anxiety, postpartum OCD, postpartum PTSD, and postpartum psychosis, which we haven't touched on at all. But that's another thing that I think we're not educated on at all as new mothers is your experience could include this whole range of things and not just feeling sad. Yeah. So just kind of watching those like varying degrees of severity. And they can overlap. Varying contributors. And they can overlap. so I I'm not excluding somebody from a diagnosis if they have one a different one it could be both okay let's move into then the brain and body connection okay it's fascinating to me I see it so much within my practice as well um but let's kind of yeah what I was going to ask you if you would say what you see? Yes. So I will say the brain is a driver of emotion and the emotion is a driver of responses. And those responses often show up in the body. So if people don't feel safe, the body will protect. And those protection responses from a physical therapy standpoint often show up as muscle tension, which muscle tension can lead to pain and joints not moving great because the muscles aren't allowing it or painful intercourse because we're protecting some like just an example had a gal that had some birth trauma um her body was afraid of getting pregnant again or her brain doing it was like i almost died during that experience my brain now is saying life matters yeah we cannot get pregnant again and therefore started making it difficult or impossible for them to participate in intercourse. So we can kind of see those responses as well. There's a book called The Body Keeps the Score. And it's like, I'm like, a lot of people are familiar. It's a big read, but I do think it's worth even just a bird's eye view where it's like things are stored in the body. And I have seen sometimes we'll release a muscle and we'll get a release that produces remote emotional responses and oftentimes people are like I have no idea why I had that big of emotional response to that and it's like it's okay it was stored there like so the body keeps the score even sometimes when the brain doesn't consciously I do say the brain does it subconsciously but we see that brain and body connection between a lot of safety I see a lot of illness come out a lot of pain and how that can affect things but I also think the body can affect the brain. Like if we're in a lot of pain, it also can affect mental health and vice versa. So it's like there's a huge brain body connection there. Yeah. Agreed. And I teach my clients that a lot of times the emotion is pre-verbal, like it's in the body before we have the words for it. So it's starting in our viscera. It's starting in our muscles that the sensation, when we touch a hot stove we move our hand away from it before our brain says that was hot and so like like just to add to your point that it's come the information is coming up to the brain not the brain producing the emotion the emotion or the information yeah yeah it's just an interesting thing there because we see so much shouldn't the brain and the body connected. It's like, I even tell people, I'm like, pain is two things. It's a signal and a perception. And the perception part is done by the brain. The signal part is often given from the body. And it's the interaction between those two. What are we doing with that perception? That then produce sensations or produce action or produce thoughts about them. So it's just this interplay between the two. And from a therapy perspective, a lot of times what I'm, because I have a very emotion focused somatic approach to therapy, that I'm guiding people to let their emotions get, their sensations and emotions get bigger, which is so different than I think the messages we receive a lot of the time, which is like, I should be coping, I should be regulated. but like can I have like a sensation my belly right now but like can I tune in to the cues my body's giving me and get curious about what this is and let the energy move all the way through like in your practice release that muscle can I let it go where it needs to go yeah so that I can free up that space. Yeah. So I'm like, we often talk when you think of emotion, it's energy and motion. And if we stop the motion, it becomes dis-ease, which becomes disease. So, and disease can look at a lot of different things, but I just like that idea of like energy and motion when stuck, you know what I mean? Causes dis-ease and can produce negative results in our body. And I'm guessing you also teach the pain, tension, fear cycle. Yes, very much so. Back to fear. Do you want to go into depth? Back to feeling. We have to feel afraid. Yes, right. But really when we're talking about that, we're saying, okay, we feel fear. We get a fight or flight response. And then we experience pain. And then we experience pain. And then it cycles again. pain often will produce more fear which will produce more body responses which produce fear so you can cycle in and I think from a mental health and a physical perspective we can affect that from different angles you're affecting it from the emotional and mental side of that of what's feeding the fear and we're looking at seeing can we give the brain a different experience from oh that actually wasn't painful so then it cycles out from the fear response as well you're breaking you're great there's different places to break the cycle and I call them the exit routes like they're the off ramps when we get stuck in the anxiety cycle when we get stuck in the fear cycle like where where's my turn yeah all right what's one thing that every new mom needs to hear that it's okay if you don't enjoy every single moment of motherhood I think that's the thing I say the most to my clients and the people that come to our groups is that message of like just enjoy every single minute you're gonna miss this yes so that may be true and you can still be a good mom and and not enjoy every single second and it's you don't have to feel guilty about those things you heard it from the expert what is your favorite self-care recommendation I love I mean I just kind of did this like little movement thing I move your body in whatever way even if it's even if you're running for your life down the street because you're having a big like thing dancing just let your outsides match your insides to get some of those things some of those things moving I think movement for me is huge I use it constantly even in really small ways and I teach it and we do a lot a lot of performing in motherhood and the more that we can be true be true to ourselves i love that make the inside match the outside yeah yeah that's a good that's a really easy simple self-care thing so good um what is your favorite food guilty pleasure i do not feel guilty about food i just refuse to you know what i've been loving costco got me with the true fruit samples you're like those yeah i don't get got by costco samples usually but I've been I have a like that one's it right I don't want to share them with my family I keep them in the fridge in the garage and I'll be like I have to go out and get to get something from the outside fridge and I eat true fruits by myself so nobody else can have them and I don't feel bad about it so great and then tell me what's your what's your favorite thing or your guilty pleasure in time oh how I spend my time I like when I get the chance I really genuinely love sitting quietly by myself. I used to do it a ton when I first met my husband. When we were dating, he'd come over and be like, what are you doing? I would just sit on my couch and look out the window and I don't get the chance very often anymore, but when I just get to be quiet, I love it. So good. Well, Hannah, thanks for coming and being here with us today. I think it was a really great discussion. I'm excited. I hope everybody can be more aware of kind of postpartum moms and mental health. And, and maybe this is one thing I usually say common is not normal, but maybe this is something we want to say, this is normal. So, um, not normal in the fact that you should seek help for it. Yeah. Right. But also like, let's normalize the way we're feeling a little bit. You are not an anomaly. You're not needing to stuff it or address it. And you're not a bad mom. I think that's a huge fear that gets in the way of people reaching out for help from anyone. You know, if you're seeing a pelvic floor PT, if you're going to your OB, say something. Because even if you don't have a mental health provider, those are the people that are going to help connect you. But, yeah, don't be afraid to reach out to anybody who will listen. To take care of yourself. and to recognize what you're feeling. And it's okay to get help. So it's really good. Okay. All right. Where can people find you if they would like to work with you? Okay. Our website is thrivewithnova.com, all spelled out. Same with all of our social handles. So we're pretty easy to find that way. I will give you some resources to post with the podcast of cheat sheets to maternal mental health symptoms. so everybody knows what to look out for. And, yeah, we've got, like, we're trying to build a community. So we've got a lot of free resources. We have peer support. We have therapy in Utah and Montana and Idaho and Texas. And that postpartum planning course is super accessible too. And I want, I'd really love to spread that resource around because I think that's, like, a missing piece. in to think about not just what's happening to get ready for the baby, but what's happening once the baby's here and for mom and mom and dad. Yes. Yeah. So those are our resources and we're on Instagram and Facebook and all the interwebs. So good. Okay. Well, thanks again for joining us at Healing at Your Core, where we're looking to heal you from the inside out. Millions of women are still waiting for someone to take their symptoms seriously. You found this show. Share it. New episodes of Healing at Your Core release every week. Evidence-based, non-surgical, and built around one belief. You do not have to live with this.
