S11 EP2 - Birth Trauma: Audio automatically transcribed by Sonix

S11 EP2 - Birth Trauma: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Intro/Outro:
Hi, I'm Kristyn Hodgdon, an IVF mom, proud women's health advocate, and co-founder of Rescripted. Welcome to From First Period to Last Period, a science-backed health and wellness podcast dedicated to shining a light on all of the women's health topics that have long been considered taboo. From UTIs to endometriosis, we're amplifying women's needs and voices because we know there's so much more to the female experience than what happens at the doctor's office. With From First Period to Last Period, we're doing the legwork on your whole body so you can be the expert in you. Now, let's dive in.

Kristyn Hodgdon:
Hi everyone, and welcome back to From First Period to Last Period. I'm your host, Kristyn, and I'm here today with Ashley Rodrigues. Hi, Ashley.

Ashley Rodrigues:
Hi! Thanks for having me.

Kristyn Hodgdon:
Of course, welcome back! Ashley is a postpartum women's health and sex therapy licensed psychotherapist. She was with us during our last mini-season, talking all about sexual health, and today, we're here to talk about maternal health, specifically, what to know about birth trauma, PMDD, and postpartum sex. I had to add the sex because it's relevant to all topics. Exactly. So, not to dive in too fast and hard, but birth trauma is something that is close to my heart. I had twins. We both had twins, and I don't know what your delivery was like, but I know my co-founder, Abby, and I both had pretty traumatic twin deliveries, and thankfully, I went into it having twins. I don't have a birth plan. It's just going to be what it's going to be. But I ended up having one, twin A vaginally, and twin B was an emergency C-section. So, the worst-case scenario for a twin birth. But to me, it was as long as they were out and healthy, but then I had a postpartum hemorrhage. Abby also had a postpartum hemorrhage. We bonded when we met on a lot of our like, joint fertility and birth trauma. But all that being said, how does that affect women and couples, and what does that look like for many of your patients?

Ashley Rodrigues:
Yeah, I think it varies. I think this is something I tend not to look at. The DSM is the diagnostic manual to say these symptoms equal this. And I think they define trauma as a life-threatening situation, and a postpartum hemorrhage would fall into that category. And it's like a life-threatening situation, but I also see it in scenarios where I work with a lot of women who don't even really use that verbiage of birth trauma. They just really are carrying a lot of, I don't know, grief and trauma around their birth experience. So, I like to define it more as a feeling that you've lost control, like, yeah, in that scenario. Because the fear there is, if I'm no longer in control, I'm not sure what's happening. Yes, the risk of death to you and or your child, feels very high, even though some people may be like there really wasn't a risk, it was really scary for me that very well that could also fall under that category of of birth trauma. So, I tend to go a little off-book only because I think its repercussions look similar. Those repercussions are a lot of struggling to bond with those first, even like days, weeks, months, and genuine fear of giving birth again, having horrible nightmares or flashbacks to that process. And I think it's tough because we all step into motherhood with this expectation of what you want your birth to be, and you want those days after to be where no one's immune to it.

Kristyn Hodgdon:
Yeah, but even on social media, you see those pictures of, like, women after they give birth who have never felt loved like this before, like with the baby on their chest, and it's, that was not how my experience went. Like I ended up meeting my babies after my parents did because I was knocked out and recovered because I had gotten my epidural, gave birth vaginally, pushed for another hour, then had an emergency C-section, so they had to give me anesthesia again, and I threw up the entire time. I remember asking if my son was okay when he came out and then just passing out and, like, waking up four hours later. Yeah, it wasn't like this; they put your baby on your chest. That can feel right off the bat that something was stolen from you. And especially after fertility, I didn't get that experience. And it could be even, like, it doesn't even have to be birth trauma, but if you wanted to have a vaginal unmedicated birth, and then you end up having an emergency C-section, that can feel like, whoa, how did we get here?

Ashley Rodrigues:
Yeah, and even the comment, the one comment you made when you were like, going back down, going back under, you're concerned about the safety of your son. And biologically speaking, women have been giving birth forever. So this is such a fragile moment. Even hormonally and biologically, we're already hyper-vigilant in this protective frame of mind. So it even speaks to how strong that kind of, just like biological innate-like protective factor that that trauma mode you are in of hyper-vigilance is like the one moment you were like conscious. So you were like, where's my baby? Is he okay? And awareness of anything else, it just speaks to the biology that goes into play. It's just really fragile moments of burning out.

Kristyn Hodgdon:
Yeah. So, what do you advise your patients when they have a less-than-ideal birth situation?

Ashley Rodrigues:
I usually create a lot of space to process what happened. And I also like to say that this doesn't have to happen with a licensed therapist. You also might find yourself with a licensed therapist who maybe hasn't given birth or isn't quite the first in this area, and they may not even think that this is something to process because they may not perceive it. That's like me going off book in that sense that there's a range of experiences that can be traumatic. They may not even engage in it as traumatic. But with that said, someone who understands the importance of giving you the space, so that could be a licensed therapist, it could be someone who specializes in postpartum stuff. It could be your mom, it could be your sister, right? It could be your best friend who gives you that space to talk through what happens, talk about your genuine fears, and not try to paint that moment of, oh, the first time I held him. Yeah, I meant to throw up because that's the truth. That wasn't this magical moment. And I think that also gives a lot of space for grief because it's that I lost this moment that I think that is usually the starting point in general. And I think for most, not most, but a large percentage of women, I think once you have that space, it's normalized. You can grieve, and you realize you're not alone in it. The fog starts to lift, and I would say most symptoms, so to speak, may dissipate. For some women, it will linger, and I always think of it as the trauma has just gone a little bit deeper. And so if you're having nightmares or panic attacks or we see nervous system dysregulation pretty consistently if certain things are triggering you every time the baby cries, then I think that's a little bit more specific trauma work. And there are a lot of different modalities that can work for trauma work. There's brain spotting, there's EMDR, there's somatic work. So you can engage in, specialize, and find someone to work through the trauma piece specifically. If you notice, even after the grief and processing, that there's still lingering stuff.

Kristyn Hodgdon:
Yeah, and some, I remember what, kind of wanting to because my OB/GYN was, I think, desensitized, stillbirths happening and so many difficulties, and like circumstances. And I didn't get a ton of information about what happened. I still feel fuzzy on, I think what happened was my daughter came out, and then he flipped after the fact, and then it was just like he wouldn't come out, and we had to do the C-section. But I feel like sometimes doctors are a little bit, you don't realize that you want answers because if you do want to give birth again, you want to know what exactly went wrong. ...

Ashley Rodrigues:
Yeah, they are desensitized. Nurses are also desensitized because even though they very clearly may have experienced an increase in blood pressure, they know this is the next step. Maybe they're not concerned about anyone's safety. They know this is what we have to do. It doesn't mean you weren't experiencing it. And so they don't think twice about being like, oh yeah, that might be something they need explained. And honestly, too, I think if you're, and this is for people who are about to give birth, I think that's a great conversation to have with your doula to say if something went wrong after the fact, can you make sure that we get clear explanations as specifically what happened? Because even, you're talking about your experience like you weren't even conscious. And when you were so foggy, like, that's such a not a great physical state to be in. All of a sudden, I have to advocate and be like, hey, can you explain to me the logistics of what happened? Yeah, I think it's great that you brought that up, too, because that can also be a healing place I don't know what happened, so how can I move on or create this closure for myself if there's like big chunks missing in my story.

Kristyn Hodgdon:
Even now, like I'm pregnant again, and I am pretty sure that 95% of my complications were because of multiple pregnancies the first time around. But how can you be sure? It's scary.

Ashley Rodrigues:
For sure. Yeah, it's really common to see a resurgence of the PTSD stuff. The birth trauma stuff comes back when you're about to have to do it again.

Kristyn Hodgdon:
You forget, but then, as it gets closer into your life.

Ashley Rodrigues:
Yeah, yeah.

Kristyn Hodgdon:
It's not fun. Yeah. Can you explain really quickly to those who may not know what a doula is and how they can help?

Ashley Rodrigues:
Absolutely. So, doulas, they're not medical professionals. They're basically like support for Mom. So I think people get midwives and birthed and doulas confused. Midwives are medical professionals. Doulas are trained in the process of birth. They're trained in pain relief tactics. They have a little bit of a vast array of knowledge. So essentially, the point of hiring a doula is mostly to support the mom in that scenario. You can have a doula present for a home birth. Oftentimes, a doula's role is to help with pain relief techniques or walk you through this normally. You're going through the transition. Why don't you try this? Make sure you're eating and hydrated. A hospital doula can also serve a lot, so a lot of an advocacy role. Like I mentioned, if something happens after, I really want to make sure I have all the facts because I may not be in a state where I can advocate for myself. And oftentimes, when you're in labor, there are times where you go into this fog, or you're just so focused, or there's a lot of pain happening that you're trying to work through. And so when a nurse comes in and asks a lot of questions, and it's throwing a lot of stuff at you, the role of the doula is to absorb it and then help you and her kind of navigate, okay, this is what she's saying is happening. Where do you want to go from here? A doula can advocate your wishes if you can at the moment. Doulas are great at telling partners what to do to be helpful, so think of them as the emcee of the whole process.

Kristyn Hodgdon:
They are typically allowed in?

Ashley Rodrigues:
They're allowed, barely. I've had stories of doulas going into operating rooms. If dad is staying with a baby or so, they are considered part of your birth team.

Kristyn Hodgdon:
Yeah, something to consider for sure. What would you say to a mom who's worried about having another baby after a traumatic birth experience?

Ashley Rodrigues:
Oh yeah. I think the question is, what do you want to feel different? That would be the ask, but with an emphasis on the feel piece, because in reality, yes, we don't want to repeat the same, but we also can't guarantee anything at birth. And so if, for example, they're like, I want to feel more supported or more knowledgeable, then maybe we look at doulas, and we look at, okay, what's some more like education piece that you can dive into so you feel like you can be more informed? I think education, like the knowledge of birth and the knowledge of what may happen, is also really helpful because it avoids that out-of-control feeling. So very ignorantly, I had a home birth with my first, and I was surrounded by the knowledge of just watching all the positive birth stories and not worrying about all the horror stories and not even thinking about C-sections because if you think about it, then that's where it's going to head. And I think that was really ignorant advice that I had received. Because, right, in my second time around, I had twins, and it was one of those moments where I realized I don't even know what a C-section procedure looks like. So I sat down and read step-by-step what they do during a C-section. And I think it gave me a sense of, okay, so if this is what we end up going, I at least know what's happening to my body. And I think there's a less yes, it's going to be scary, but I think it's less of a feeling of out of control because you're at least knowledgeable of what's happening. So, the education piece is great. I think creating an environment that may create a feeling that they want to experience. Maybe it's certain room members that you don't want in the room anymore. Or maybe it's, I don't want to make a really strict birth plan because creating a really strict birth plan sabotaged me last time, and so I want to keep things more open. So, really making practical, tangible changes with your experience that aren't dependent on the outcome.

Kristyn Hodgdon:
Yeah, for me, I want a scheduled C-section because I want to know exactly what's not going to end in an emergency C-section.

Ashley Rodrigues:
For sure. Then, look at the control piece there, right? ... Now I can have peace in it. I can understand that it's going to happen at this time and could be done at this time.

Kristyn Hodgdon:
Yeah, that, because that emergency piece was just so scary for me, and I don't want to feel like that. Quick pivot, oh my gosh, this is going to go a completely different way. And I didn't realize I was carrying that weight until my OB appointment last week when I talked to her about it, and she was like, yep, no problem. I scheduled a C-section, and I had a huge weight off my shoulders, and I was like, I didn't even realize I was carrying that. But you never know if your doctor is going to push. Oh, you had one successful vaginal birth. You should try for another, or you never know what they're going to suggest. And I didn't, I was like, no, please, just I've been through enough.

Ashley Rodrigues:
Please don't make me try. Please don't open more of the, and that's the thing, too. I think the piece that we often forget, especially when it comes to women in general in our mental health, is that we love to consider the external data. Okay, so if I do try for in your scenario, okay, so if I try for a vaginal birth, then this is less risky, and then the complications may be whatever, but all that comes at a cost, and the cost is your mental health. And I think doctors and medical professionals typically do a great job of weighing out the pros and cons, the risks and benefits of certain procedures that are very external. Still, they don't consider it, and I would say they probably can't consider it. Only you can put the weight on this if there is a cost of going this other route on your mental health, and so sometimes that cost is too much. And so it makes more sense for you to make an informed choice to say, no, we're going to do a scheduled C-section because this is going to weigh on me. And even subconsciously, too. You just knew that's what she needed. And afterward, what a beautiful, intuitive gut feeling of being like, no, that's exactly what you needed. That was a great call.

Kristyn Hodgdon:
And I think it's also like everyone's unique situation like I have two other kids. I don't want a scary situation that will make me feel like something could happen. It's just that anything can happen at any point, obviously, but if I can do anything I can to prevent that emergency situation, I will. I think that conversation, like above all else, is just so validating because I think some people don't even give themselves the space, like you said, to grieve their birth experience. You're just expected to, like, I'm a mom now, and I need to be strong, and I need to be, my own feelings aside, and if you don't process it, it might creep up later.

Ashley Rodrigues:
Totally. And I will say, too, just to get this out here is like, I process birth with clients whose kids are two years old. I think about the season immediately postpartum. You are still in survival mode. And so it may not be until significantly later in the motherhood journey that you realize that this has been weighing on you, and it's always been weighing on you. I often get tears in the middle of the session, and women are like, I didn't know that this was still a thing, and my kid is two. And it's, yeah, because you've been in survival mode since then. So I think that's a really important point to say. It doesn't matter how old your kid is, if you haven't given yourself that space, as if you deserve the space to heal, really with some intentionality. Allow yourself that.

Kristyn Hodgdon:
Yeah. So, jumping on to PMDD, we've actually never talked about this on the podcast before. We talked about PMS and stuff. But can you tell us a little bit about PMDD, what it is, its symptoms, how they can creep up in a new parent's life, and all of the above?

Ashley Rodrigues:
Absolutely. So PMDD is one of those gray area diagnoses, mostly because I think it pertains to women's health. I will try to stay off my soapbox in this one, but you can have PMDD or experienced PMDD at any point in time in your life. That's actually what it is: extreme PMS symptoms. This can be extreme mood swings. This can be paralyzing cramps. And this can be, you know, extreme highs during ovulation. And by highs, it's just like super active cannot sit still. Restlessness typically the way that it's diagnosed is that we think about your daily quality of life, your PMS symptoms, or even just the phases of your cycle have to be impacting your quality of daily life pretty consistently for about four months, and they can't find another cause. Sometimes, like endometriosis and PCOS, it can cause really extreme symptoms. But this would be a different flavor of the same umbrella. In that sense, it's really common to just be like, think about being bedridden during menstruation or that day before, or you are ruining relationships with people those two days before you start your bleeding. So it is really underdiagnosed. We don't have a lot of study on it, unfortunately, but it really impacts a lot of women.

Kristyn Hodgdon:
Yeah, I know. I noticed that you talk about it a lot on socials. I wanted to bring it up and ask you why you're passionate about it and how you treat it from a mental health point of view.

Ashley Rodrigues:
Totally. I think I'm passionate about it because it falls under that category of the stuff we don't talk about and or study in Western psychology that really impacts women. So I feel like I'm like, yeah, come on along, PMDD. Also, just out of nowhere, I saw a lot of clients with PMDD, and I didn't know if the universe was trying to send me a very clear message that this also needs to be part of your thing. But essentially, the way I will give you the science scientifically backed, we have studies that show the treatment of PMDD is typically hormonal birth control, which is what most OB/GYNs will immediately do, and then talk therapy, but specifically, CBT, which is like behavioral stuff. I tend to also add in a, I don't necessarily condone or mandate the birth control method only because it's a Band-Aid. So whenever you decide to get off of it, then you were still going to have to deal with, managing these huge kind of mood shifts throughout your month. So, I leave that up to my clients and their doctor. Obviously, CBT is a way that I approach it, but cycle syncing, and this has become popular in some of the holistic mom crowds, which I kind of love. But essentially, what cycle syncing is understanding what's going on with your hormones during each phase of your cycle and understanding that when you have this certain combination of hormones pumping through your system, you're actually predisposed to being better at certain things and not as great at other things. For example, like, you're right, right? You're you just finished your period, you're headed up to ovulation, your hormones are coming back. We're actually really great at public speaking. We're much more extroverted. We are, you'll notice, less kind of social anxiety. We're a little bit more social butterflies. We're very creative, for example, during our menstrual phase, but we don't necessarily have the energy to act on that creativity. I always recommend lots of journaling and making sure that you're, like, writing your ideas down because in our menstrual phase, the right and left sides of our brain are actually 10% more connected. Stuff like that, just the biology of it that I'm like, we're actually better at certain things and not as great as certain things, depending on our cycle. When we're in that latter half of our cycle, that luteal, we're actually more critical, which we all see surface in relationships. But it's also a really great time if you do any editing or proofreading or you need to find errors or fine-tune a system. That's the best time in your phase, your cycle, to do it. I also really love the cycle syncing lens in that sense that we can actually, if we have the freedom, tailor our lives in a way that we're going to work with the hormones instead of fighting against them.

Kristyn Hodgdon:
Yeah, and I was going to ask if it's hormonal, then how do you look at it from a mental health lens? But that's such a great point. It's like giving yourself grace when you feel like you aren't at your best, but you might be better at other things during that time, so it's tweaking it as needed.

Ashley Rodrigues:
Totally. If I know I'm so antisocial in the second half of my phase, I'm not going to schedule some big marketing event when I'm at my low point, or if I have to because we don't all have the freedom to schedule their lives around their cycle. But if I do have to, I know that I'm like, okay, this is going to take every ounce of me. So I'm going to approach it differently and give myself the grace to be like, I'm not showing up my best today, and it's going to be fine because I understand why, and it's not this: I'm a horrible human. I'm just bad at people. So it's almost that lens of what happens if you don't expect yourself to show up the exact same every day. What happens when you give yourself that permission to, like, really lean into your low points and really take advantage of your high points and understand that they both can, like, coexist, you know?

Kristyn Hodgdon:
And is PMDD more prevalent, like after giving birth?

Ashley Rodrigues:
I don't know.

Kristyn Hodgdon:
Oh. Yeah, no, you just want, I don't know how it tied into maternal health, but maybe it doesn't. Maybe it's just some people are more prone to it than others.

Ashley Rodrigues:
I am not exactly sure of the studies, but I do have a lot of, anecdotally speaking, I have worked with a lot of women who've had it show up after birth, and I would just, I'm going to suspect it has to do with the massive hormone changes. Yeah, part of that maybe it just never fully got back. It's like the new normal, you know, the postpartum new normal. Yeah. I'm actually really curious, so maybe...

Kristyn Hodgdon:
Yeah. No, we can do a social post on that or something after it. But speaking of postpartum, diving into postpartum sex could be so hard because you've just gone through either a major surgery or torn down there or just not feeling it. What are some of the common concerns that you see in your practice regarding postpartum sex?

Ashley Rodrigues:
I would say the number one concern is probably the concern over what their partner feels and thinks about it.

Kristyn Hodgdon:
Oh.

Ashley Rodrigues:
The pressure of, and whether it's coming from them and maybe overtly the partner pressuring. But I would say the majority is a, I just, he hasn't said anything about it, but I just feel bad. And then I think the secondary one would be pain. What is it going to feel like? ... to be a different experience? I don't have the energy to figure this out.

Kristyn Hodgdon:
Healing your body, lack of sleep, hormonal changes. Like you just don't feel like yourself.

Ashley Rodrigues:
Absolutely. Feel over-touched; that's a really common one postpartum, especially if you're breastfeeding. But even if you're not breastfeeding, Baby wants to be with you and on you all the time. Albeit, it's a very different kind of touch, but then your partner steps in with a touch to try to be intimate, and there can be this very, please don't touch me, reaction.

Kristyn Hodgdon:
Yeah. What are your typical recommendations?

Ashley Rodrigues:
I think everybody's different. I think I want to understand more of the specifics of your postpartum, and if you're scared to try to be intimate or don't have the desire to be intimate. I think giving yourself a lot of time and space and permission, if it's the guilt of maybe your partner being frustrated, then I always encourage that's some kind of internalized patriarchal stuff.

Kristyn Hodgdon:
But sometimes you really just get that 6 or 8-week appointment with your OB/GYN, and then they're just like, bye, see you for your annual. You get A-Okay to start having sex or to start working out or go back to normal, but you don't feel normal.

Ashley Rodrigues:
Absolutely. I think when it comes to that immediate birth to postpartum, like, once again, we don't talk about sex like after birth. It doesn't mean you can't have sex. It just means you cannot put anything in your vagina for six weeks. So that doesn't mean you can't be intimate in other ways. So, I think that's a mentality shift right off the bat. Oftentimes, I think there is a psychological component of I just need to shut it down entirely, which is not necessarily the case. And so there's no education about that piece. We just say no sex, and then we don't define what sex is. And then yeah. And I think because there's only one appointment and it's become a cultural thing, it's did you get cleared? Did you get the clearance?

Kristyn Hodgdon:
No.

Ashley Rodrigues:
If you think about it, it completely removes you from the equation. It's the doctor who gets to make the decision for you by giving you the green flag. No, you get to make the decision. What are you ready for? I always encourage, like, if you're at the point where you're wanting to regain that piece of yourself, which may not be at six weeks, it may be six months, it may be a year, being like, okay, instead of stepping into this moment of vulnerability with your partner, like, why don't you figure out what it's like down there? And so masturbation is your friend. You figure out what's working and what feels good, and that can relieve 90% of the anxiety. I think also the communication with your partner of we don't know what this is going to be like and giving it the permission to not be great sex at the beginning.

Kristyn Hodgdon:
They're afraid too, like, they're like, I don't want to hurt you, or they're more hesitant than you are sometimes.

Ashley Rodrigues:
But if you've taken the initiative at that point to figure it out, evaluate what's going on. I think there can be some great communication and being like, okay, and I'm feeling really confident that this is going to be okay. And if it's not, I think there's a little bit more built confidence in that sense when it's, I have no idea. I'm just as scared as you are. No one is always great in that moment to be like, we don't know. Once again, here we are as new parents, not knowing what...

Kristyn Hodgdon:
You have no idea what we're doing, and it's not the same, but its...

Ashley Rodrigues:
Yeah, we'll figure it out.

Kristyn Hodgdon:
Yeah, we'll figure it out, and it might be different, but it can still be good. Cool. We went over so much. But what I always like to ask is, what would you rescript about, I guess the common theme today was just like the postpartum period and feeling maybe not yourself. Things may or may not have gone the way you expected, a lot of hormonal changes. What would you rescript about the way people see themselves or think about that period of time?

Ashley Rodrigues:
Yeah, I'll be really general because I think it'll check all the boxes and all the categories. But I think giving yourself permission to be different during a season and embracing the fact that this is a season.

Kristyn Hodgdon:
Yes.

Ashley Rodrigues:
I think a lot of fear and overwhelm are the new norm for me, when in reality, these are all seasonal. It's a very extreme season of your life that has a lot of repercussions. So, I think giving yourself permission to be like this is just the way the season is, and this season will change.

Kristyn Hodgdon:
It's so true, though, because I'm in like first trimester, like not feeling like myself right now, and not working out, and not, it's just not my normal routine. And I feel, I remember feeling the same during the postpartum period because you're like on strict orders not to work out. For me, it was like eight weeks, and working out at such a part of what makes me feel good and gives me confidence, and you just have to say you said, okay, this is a finite period of time. This is not forever.

Ashley Rodrigues:
Yeah, this is the season we're in. Sometimes, if it feels really long or you feel very stuck in the season, get the support to get out of it. But sometimes, it's just perfectly okay to be in the season.

Kristyn Hodgdon:
Yeah, exactly. Thank you so much, Ashley. This is wonderful. We can dig into a million more topics I'm sure, and I'm sure we will, down the road.

Ashley Rodrigues:
Looking forward to it. Always a pleasure.

Kristyn Hodgdon:
Thanks for joining.

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