Jackie Graff | Setting Boundaries and Support Systems Postpartum

In this episode of The Mama Making Podcast, host Jessica sits down with Jackie Graff, a therapist specializing in perinatal mental health, to discuss the importance of understanding and supporting moms through perinatal mood disorders. Jackie shares both personal experiences and professional insights on postpartum depression, anxiety, and intrusive thoughts, highlighting the need for education and support for new mothers.

They explore the stigma surrounding maternal mental health, the importance of setting boundaries, and the value of seeking qualified help. This conversation is a powerful reminder that no mom should face these challenges alone — and that healing and support are always within reach.

You can connect with Jackie:

• On Instagram at: @be_present_therapy
• On the web at: www.bepresenttw.com
• More on Be Present Therapy & Wellness Therapy Services 

This episode is sponsored by Collabs Creative - a digital marketing company supporting makers, creatives, and small business owners with all things digital and design.

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Transcript

Jessica (00:57)
Hello everyone and welcome to the Mama Making Podcast. If you're new here, I'm your host Jessica. If you're not, then welcome back. Today I'm very excited to have Jackie Graff on the podcast. Jackie's the owner of Be Present Therapy and Wellness and we'll be chatting all about perinatal mental health. Welcome and thanks for being on with us.

Jackie (01:16)
Hi, thank you. Thanks so much for having me.

Jessica (01:17)
So tell us a little bit about you, give us a little background on you and what you do and where you're from, whatever you're comfortable sharing.

Jackie (01:25)
Sure, no problem. I am a therapist and I co-own Be Present Therapy and Wellness in St. Charles with my co-owner, Dr. Megan Jenkins. I've been doing this for about 16 years now and I shifted my focus to peri... I've always had a focus on women's mental health, but I focused and shifted to perinatal mental health probably about four to five years ago. On a personal level, I have two traumatic birth stories. One about 13 years ago, one during COVID, so four years ago-ish.

So that kind of really shifted gears and at that point during COVID, I got my perinatal mental health certification. So that's pretty much a big chunk of the clients that I see now and the education awareness that we do now or that I do now.

Jessica (02:06)
amazing. Obviously not that you had a traumatic birth experience, not once, twice, but that you were kind of able to take your experience and transform it into professional work.

Jackie (02:07)
Right.

Yeah, it's really when it was presented the opportunity to do that. I was like, this is an actual certification. This is an actual thing. And it's not talked about enough and not discussed enough. So I love that that piece of it, that women that I see, it's kind of eye opening to the resources and the things that are out there for them to seek help for.

Jessica (02:36)
Yeah, absolutely. And what is your, you talked a little bit before about having an interest in women's health, but what is your professional background? Where did you start? How did you decide to become a therapist? Where did it all begin for you?

Jackie (02:48)
So

I initially was going to go to law school and I did my undergrad at Northeastern and I started working in the court systems and I did an internship with domestic violence and the women who are affected by them and in working in the court system I realized that I didn't want to actually be in the courthouse or the legal aspect of it but working directly with the women definitely was a draw. So I worked it was

always been focusing on women. Not that I don't see men, but just kind of the nature of what I do is that I typically don't. And then I started working for rehab and substance abuse to get everything started, but there was no opportunity for what I want to do there. And then I started going into private practice and working with when I was getting my licensure, doing something with that. And it's still kind of kept gearing.

towards women and then I went out on my own probably about at this point 11 years ago and it kind of just blew up from there.

Jessica (03:50)
So how did you decide to start your own practice? I feel like that's a big leap for most people. And I know you have a coke under. I'd love to hear more about that.

Jackie (03:56)
It was...

Yeah, it was a big leap. So I did, I opened Be Present on my own about four and a half years ago, five years ago. And then it's actually somebody who I shared space with in St. Charles and we became close and we, treats OCD and anxiety and I treat perinatal OCD. And we were thinking of ways to do things on our own in private practice and grow awareness in the community, all the things. And one month we were like,

Why are we trying to do this on our own separately? Like our vision was similar, our personalities are very similar. So I guess it'll be two years in January, two years this month that we sat down and we're like, we're gonna do this together. And that's how Be Present with Dr. Jenkins kind of was created. And that was back in November of 22.

Jessica (04:42)
Yeah, it goes by so quick, I'm sure. Yeah, that's so cool though, to be able to, I mean, by happenstance, you guys just were in the same space, but then kind of had the perfect vibe to match up with each other. That's very, I think it's very rare and unique. So that's really cool that you guys were able to make it work professionally, to team up together.

Jackie (04:43)
It was so fast.

Great.

We talk about all the time and how we bring very unique but needed things to the practice and how we treat and focus. But vision for mental health and the practice are pretty consistent in the same, which is great.

Jessica (05:15)
Yeah, that's amazing. And I'm, I'm a big believer. I've said it on the podcast before. I previously came from a fundraising background and two of my big mentors from that area always said, it's better to collaborate and there's, there's more than enough money in this case, more than enough money to go around. And I feel like it's the same in mental health. And then went on to a project management role in behavioral health.

Jackie (05:23)
Okay.

Jessica (05:42)
So I was able to see kind of that side of things. And I definitely feel the same, that when we're collaborating with each other, not every patient is gonna come to you and be the right fit for you or vice versa. So having a collaborative relationship, feel, and kind of joining forces, how you guys did, is so key to hitting this area of need of women and perinatal, and then the OCD anxiety side of things.

Jackie (06:06)
Thank

Right.

Jessica (06:11)
I mean, we'll talk about it here, but definitely a good merger.

Jackie (06:15)
It's good to have the support. practice can be kind of isolating and lonely, we, our offices, we share a wall, but we check in all the time and with our staff and we're very on top of having that unique close-knit bubble with everybody.

Jessica (06:27)
Yeah, I love that. All right, so let's get we have a ton to chat about. Let's get into it. Let's talk. What is perinatal mental health? What should people know? I'll let you kind of take the reins on where we're going to go to be a little bit more informed educationally on the topic.

Jackie (06:31)
Okay, yep.

Okay.

Awesome. And stop me, please, if there's any questions. talk about this all day long, so and I tend to speak fast, so I'll kind of rattle off some things here. But if anything's confusing and you clearly just let me know. The biggest thing, I think the piece is the getting rid of the stigma, like all mental health issues, right? Like being able to let women know that this is a thing, that this is a normal thing, that this is a very difficult thing, but it happens very frequently.

Jessica (06:51)
Yeah.

Okay.

Okay, sounds great.

Jackie (07:13)
Perinatal mood disorders and postpartum mood disorders are actually the most common complication after childbirth. It supersedes preeclampsia, it supersedes gestational diabetes, hypertension, anything that falls under like that medical scope. is twice, if not three times as likely to happen over those things. And it's often disguised. You know, we have the baby blues and we have things that are mood disorders like anxiety, depression.

psychosis, OCD, perinatal post-traumatic stress disorder. It kind of falls under that umbrella of mood disorders. And unfortunately, the thing today is people just think, post-traumatic depression. And they view it as like, they're struggling, they're having trouble getting in bed, they're not connecting with the baby, but it's so much bigger than that and so much more detailed than that. And unfortunately, not often caught because it's kind of pushed under the rug when a woman will go.

and seek services, whether it's from their doctor or a therapist that's just not qualified to assess it or treat it.

Jessica (08:10)
Yeah,

yeah, I think we've made a great leap just from like the baby blues part of things, which is definitely like those first few weeks, all the hormones, all the emotions, but then having it trail on and realize, there's depression involved. But then from even postpartum depression to the anxiety, the OCD and all, all that comes along with it. I feel like we're starting to make a little bit of headway, but I think.

Jackie (08:14)
Right.

Jessica (08:34)
Obviously having more awareness and less of a stigma in general is a good goal.

Jackie (08:39)
Right? And being able to seek services and the appropriate services. A common thing that I hear from clients in my office or even friends and family is that they didn't know it was a thing. They got, you know, screened, whether it was when baby was born or at their two week visit at the doctors with their baby or one week visit or at their six week if that OB visit. And then that's it. And it can show up from the time baby is conceived.

until one year, and we say loosely one year from the baby is born. So we can see no symptoms at all. And mom and baby are doing great. But at nine or 10 months, she starts having symptoms. And at that point, there may not even be OB-GYN involvement because baby is fine, mom is physically OK. And then they're kind of confused as to what's going on. But it still is at that one year mark that it can be a postpartum perinatal mood disorders. So just being able to educate not only

clients, but medical professionals support people that the specifics of this do not just fall on that window of like, baby's 12 weeks old. Okay, now everything's good to go and we're kind of looking at something else.

Jessica (09:43)
Can you share a little bit about what would fall under a perinatal mood disorder?

Jackie (09:49)
Sure, yeah. So baby blues, like you said, are typically in that two-week window. Things that you can see in baby blues are like tearfulness, being very overwhelmed. It doesn't matter if it's baby one or baby five. The hormone fluctuations are extreme. We have like this, you know, leveling off while you're pregnant and then baby comes out and they plummet. So we're expected to see a lot of mood dysregulation in those two weeks.

lack of sleep, trying to regulate sleep, feeling overwhelmed. When it starts to shift into a mood disorder is pretty much past that two week mark. So if we're inching on three weeks, even three weeks or four weeks, and we're still seeing the same kind of symptoms, it's gonna fall under that umbrella of a mood disorder. The difference is it looks like depression or it looks like anxiety or it looks like post-traumatic stress disorder, but oftentimes it's focused very much on the baby.

So depression, postpartum depression, you'll see a disconnect from the baby, isolating from others. So there'll be, you know, maybe in the bedroom with or without the baby, not wanting to socialize, more tearfulness or being able, not being able to regulate self. It is just beyond the baby blues. Like they can't contain the tears. They can't contain the anxiety and it lasts for longer periods of time. So I always talk about intensity and frequency. Are they?

rest it with sleep or asleep. And it's hard, right? Cause you have a newborn who's probably not sleeping. So being able to tell the sleep restore that, are you having any thoughts of harm to yourself, to the baby? And then anxiety looks kind of the same, but completely different, right? Like the anxious thoughts of baby monitor checking, keeping track of how many feeds, how many diaper changes, many contamination concerns, all that kind of ramps with postpartum anxiety.

which is reasonable and expected when you have a newborn, but is it interfering with their day-to-day life? And then if we're looking at bigger fears and worries, then we're teetering on perinatal OCD, which is new in the mental health world, not in my world, but in the world out there to kind of decipher this anxiety. Or now we're looking at a OCD kind of diagnosis.

Jessica (11:55)
I'm sure you'll talk a little bit more about the more intense psychosis type and what to look out for that, correct?

Jackie (12:05)
I can do, I mean, I can jump into it now.

Jessica (12:07)
whenever

it fits.

Jackie (12:09)
So psychosis and OCD are often kind of confusing to a lot of people, whether it's the support person or the client themselves or medical providers, unfortunately. A couple key takeaways is psychosis will typically present within two to three weeks. It kind of falls in that baby blues window and a little bit further outside of it. It's not to say it can't happen a couple months later, but typically...

Jessica (12:16)
Thank

Jackie (12:33)
pretty soon after baby's born. It's one in a thousand births, one in a thousand women that it can present, and it is treatable if it's treated soon. So if we catch it and we say, okay, hey, we gotta get this person treated, we gotta get them to a doctor, typically hospitalization or inpatient, postpartum psychosis is not something that is treated in my therapy room. It is not something that you go and seek a therapist and wait three or four weeks to get in to see them for their first session.

It is an emergency type of situation. Not only because there may be thoughts of harm to yourself or baby, even if those aren't present, there's still these underlying symptoms like a disassociation with reality. There could be delusions and hallucinations. There could be no insight and just kind of safety concerns in general. So even everyone's like, they're not going to hurt themselves. They're not going to hurt the baby. It can still be postpartum psychosis and it has to be treated and it can be treated right out of the gates.

Jessica (13:29)
Yeah, and I think along the lines of the destigmatization is I feel like in the media, the only time we're hearing about, we're hearing about like baby blues and postpartum depression, and then we're just hearing about a psychosis kind of tragedy. So I love to hear you say this is treatable. It's not like a.

something that happens and there's nothing to do about it. think it's very important that if this is an area that you're feeling like you see someone in or you are in that this is treatable. It's not just what we see in the media.

Jackie (13:53)
Great.

And we can typically get engaged in talking to the support person or talking to the individual themselves. I know if I'm looking at postpartum psychosis, again, it's rare, but it happens, or postpartum OCD. And those can very easily get confused. And we want to educate the biggest thing, as I say all the time, educate, educate, educate. I'm not going to educate somebody in my room if they are actively psychotic. It's not going to work.

but I can educate them if they're having OCD thoughts. And unfortunately, sometimes OCD thoughts or what's called intrusive thoughts can be misinterpreted as psychosis. And that's what keeps some women from seeking treatment. They're afraid to tell their doctor or their therapist that they're having these intrusive thoughts because they don't want their baby taken away. They don't want to be hospitalized. So seeing a provider that knows the difference and is educated and are certified in that is going to be key in doing that.

Jessica (14:55)
Awesome. I know I've derailed you a little bit, so feel free to just hop onto your plan there.

Jackie (14:57)
No, that's okay.

And being able to educate, I think, everybody about intrusive thoughts is huge, especially new moms. Intrusive thoughts are scary. They can kind of take on this whole anxiety stance on their own, and they can be a little unnerving and even support people might be a little unnerved and unsettled about that. So I think.

focusing on that piece right out of the gates. And when I see pregnant women, we do education about, this could happen. This is what it looks like. So that if it does hit him in the face, you know, two months down or eight months down the road, they're not completely shocked. And intrusive thoughts. I don't know if you want me to go into what that difference is for moms. So the biggest difference between psychosis and OCD is that if there's an OCD thought, you're going to see the woman very

Jessica (15:40)
Yeah, sure.

Jackie (15:49)
rattled about it. They're that thought. They're going thought. They're going thought. There could be somet trigger wording moms will s thought of drowning my baby a bath or my goodness, was going to throw my baby when I was changing the l intrusive thoughts. they want to drown their baby or the baby on the stairs, th I will flat out ask the

And more often than not, they're like, my goodness, no, why would I ever want to do that? OK, that's an intrusive thought. If they're saying, yes, I want to harm my baby, all bets are off and we're looking at something bigger than that. So really, really educating on what intrusive thoughts are is key. And they can ramp with hormones. So they ramp postpartum. They ramp during PMS. They ramp during pregnancy. They ramp when a woman goes into menopause. So that hormonal component might be the kickstart of the first intrusive thought that they have ever had.

Jessica (16:45)
Yeah, and I think it's important to kind of normalize intrusive thoughts. think when I was prior, when I was postpartum, one of my biggest things is like, okay, what's a normal thought that is based in some kind of like, primal need to have safety? And what is something that's like, okay, this is obsessive. I was huge when I was postpartum on safety and like,

Jackie (16:49)
Right.

Jessica (17:08)
triple checking the car seat to make sure it was latched correctly and things like that. But I was very lucky to have a postpartum doula who would say, okay, this is like something that's a little overboard and that we need to talk about or to say, it's normal to think about like, well, what if someone comes into our house? How am I going to protect my baby? Obviously not a wanted thought.

but that there's like, I imagine there's some like deeply rooted primal need to like keep everyone safe. So there's definitely some normalization I feel like needs to happen there as well. I remember another like weird thing that I was not expecting was when my baby was just a couple of weeks old, I didn't want anyone else to hold him. And I was so shocked by that. I'm very much like.

Jackie (17:33)
Thank

Jessica (17:57)
take him, I need a break, whatever, now. But then I was so shocked by this need to have him near me. And luckily I had an incredible doula who was like, yeah, that's normal. Think about 100 years ago, your baby was strapped to you and it was normal. Whereas now we live in a regular world and our bodies still sometimes react the same way. So I don't know if you...

Jackie (17:58)
Yep.

Jessica (18:20)
have validity to those experiences. Yeah.

Jackie (18:22)
Yeah, like that innate feeling. And we always talk to moms

about what's reasonable and expected. Like you said, that somebody's going to break into your house. Reasonable, like at any given moment, and expect it. Is it reasonable to not go outside at night ever because of it? Is it reasonable to triple check each lock of each door every single night, multiple nights a week? Probably not. So again, we're back to like that intensity and frequency.

If you have the thought of it, like, somebody could come in my house and steal my baby, like, that's going to rattle you, of course. It's what you do with that thought. And this comes from years of knowing CBT and years of treating clients. It's what you do with that that matters. If you're able to say it's just a thought and I'm going to make sure my doors are locked and I'm going to go to bed, OK, if it's a thought that is controlling most of how you function, then we're probably looking at something a little bit different.

Jessica (19:15)
Yeah. I, I, every, we talk a lot about mental health on the podcast and I am constantly like harping on being connected to care prior to needing it, whether it's like a lactation consultant or a pediatric dentist, like whatever it is, but I'm such a huge believer that having a therapist that you're connected to during pregnancy and then in those early days, even, I mean, up through the first year.

Jackie (19:26)
S.

Jessica (19:40)
to be able to say, I'm having this thought, like judgment free, hey, I'm having this thought, how do I know if it's a valid understandable thought or like what the next thing is for me when I'm having this thought? I think that that would eliminate so much like stress and isolation from moms. Cause I think having some of these thoughts is like, my God, what is happening? This is not normal. So I think, yeah.

Jackie (20:00)
Right.

Who am I? What's going on?

Jessica (20:07)
Yeah, so I think another plug for finding care to have during this whole time to be able to help you if you are having like intrusive thoughts to say, is this something that's harmful or is this something that is normal?

Jackie (20:21)
And that's not exclusive to intrusive thoughts, Like I hope, my hope is to normalize all the like ick thoughts that women and new moms and pregnant moms have. It's like, it's okay to have the thought to not love every single second of being pregnant. I hate it, both my pregnancies, I hate it being pregnant. And I will tell everybody that, but I know what the means to an end was. Or it's okay to have a thought that you don't want to be around your baby 24 seven after they're born. You need a break and that's okay to say.

Jessica (20:23)
.

Jackie (20:48)
that you don't love if you have chosen to become a stay at home mom or go to work mom, that you don't love every single thing that comes along with that. Like these are normal thoughts and humanizing that piece is so big because postpartum and being pregnant and having kids brings on a lot of feelings that were not there before and new feelings for a lot of mom. Like you said, you never thought you would have the thought of somebody not wanting to hold him or not having them not pass him around. Some moms have like when they're pregnant, they sit in my office like

I can't wait to be a state home mom. It's going to be so exciting. And at week three, they're like, holy crap, I hate this. Like, I just want to go back to work. So we have this space where we can talk about that. And maybe that's something that they do. Maybe they go back to work in two months.

Jessica (21:24)
Yeah.

Yeah, yeah, the normalization of everyone's experience and kind of where they're at with things is so needed. So I'm loving this conversation.

Jackie (21:33)
Great.

And being able to normalize their support people as well. Like being able to bring dad, I know we talk about women all the time, but bringing dads into it's going to be huge. People are surprised to hear that one in 10 dads actually experience a perinatal mood disorder. My husband actually, and he gave me permission today to talk about, like he experienced a little bit of postpartum depression after our second one was born. He was born during COVID. My husband was not allowed in the room for delivery.

So he had a real difficult time with connecting and being there for me and him. Thankfully, we caught it. We knew what it was, and he was able to work on it with me and with outside resources. But it presents differently in males. Sometimes we'll see like anger in males. Sometimes we'll see just a complete disconnect, not just with baby, but they'll be leaving the house. They're hanging out with friends and just kind of pulling away.

If the person has a history of substance or alcohol abuse, we might see an uptick in that or uptick in, you know, smoking weed or smoking cigarettes, like something that they just did occasionally. Now we're seeing it ramp. And men, unfortunately, will not and are not the first to acknowledge when they are struggling as a whole. But it's one in ten and women is one in five to seven. So it's not that big of a jump. It's pretty prevalent out there. It's not just not true to recognize as much as ours is.

Jessica (22:56)
Yeah. Yeah. And I think it's so easy. And I'm definitely, I was guilty of it when I had my first, I was like, you're not dealing with anything. Like you're not pregnant. You're just here. But, through my labor, I had a really, I actually just posted my birth story, this week on the podcast. Yeah. And, we had a really crazy birth and make you experience. And it wasn't until that we had that experience and like did it together that I was like, the, can't imagine. Like I felt very helpless. I couldn't imagine just being a support.

Jackie (23:03)
I'm trying.

I saw her.

Right.

Jessica (23:24)
and not going through any of it physically and you're just so helpless. And I didn't ever think of it that way until I was doing it. And so that was very insightful to me to see, wow, my husband is definitely going through something as well, that it's not just me because I'm physically doing it, that there's a whole other component to it.

Jackie (23:52)
Right? And being able to speak to that during pregnancy or even during, you know, if I deal with women who are struggling with fertility or secondary infertility or going through IVF, I will often invite their partner or their spouse in the room for at least a session or two so that I can provide education about what that looks like for dad or for mom number two or whatever we need to kind of have that support piece while they're going through it.

And always, always, always, and it doesn't always happen when they take me up on it. would say 90 % of the time between second and third trimester, I invite them into the room to say, what does this look like at the hospital? What does this look like for the first few weeks postpartum? And what supports do we have in place in case we're feeling not so great on both ends? Because I don't want them to always be like, baby's here. We never talked about this. So we have, I load them up with probably more worksheets than they want and say,

Jessica (24:41)
Mm. Yeah.

Jackie (24:46)
put this on your app, put it on your fridge, put it somewhere so that if she's struggling or if mom too or dad is struggling, we can look and say, okay, Jackie said, like, this is who we call. Jackie said, you know, let's check in with this. They have it right there because baby's crying, they're exhausted. Maybe they're not getting help that they need, but it's something that they can actually tangibly look at and have.

Jessica (25:06)
Yeah, that's amazing. So you talked a little bit about some like facts and figures about the prevalence of each mental health challenge. Do you want to talk a little bit more about some of the numbers behind everything?

Jackie (25:22)
Yeah, so we're looking, I said, one in five to seven women are going to experience it. That is not the number of women that are treated. So that's an important takeaway is that this is happening, but not everyone is seeking the help that they need or aware that they seek the help. The it's often caught later on postpartum. So like I said, we're looking at screenings being done at one to two week, like the baby well visit again, if they go to the baby well visit and the six week postpartum.

postpartum visit. OBs or labor and delivery nurses will give the screening oftentimes in after baby's born, like before discharge, which is great, awesome, but we're not gonna get a good gauge on that. So we're gonna see an uptick in those numbers even post, at the six week mark. I would say more than half, about 75 % of the women I see will say, yeah, I took this screening that I give them and I over screen for obvious reasons.

And I will say, what was your score? And 75 % them have no idea what I'm talking about. So it's a piece of paper. They felt the piece of paper. The docs have it or whoever had, you know, gave it to them has it. And then nothing is done with it. More often than not, it is a number that is scored above something that would qualify as a postpartum or perinatal mood disorder. So I do do one right out of the gates, no matter where they are. And you can screen them actually while they're pregnant.

And then I will follow up, I would say, every six to eight weeks, depending on that. But it shows up pretty prevalent when they're here. It's just not always caught before that.

Jessica (26:53)
yeah, yes, it does. So you talked a little bit about screening. What is that? So for those who've been through it, it's the Edinburgh scale that you just just rate the numbers. But like you said, you're just rating it and passing it on to your doctor. So that's a more like medical screening. Are there other other types of screening that you utilize or that even like?

Jackie (27:02)
Yes.

Jessica (27:15)
a spouse or partner or family member can be like, okay, they're kind of hitting all these different areas. What does screening look like in the medical side of things? How often? You just talked about that a little bit, but is there any other like screening types that people can do when they're a support person of?

Jackie (27:34)
so I think that's where the education piece is huge before baby is born, because I give them pretty much most of the information of here are signs and symptoms to look for to say, okay, this is something that's normal and typical, and this is something that warrants a call either to me or to the doctor or to the emergency room or just, you know, there's crisis numbers and things like that. The screening tool, the medical tool is the same one that I use. But again, it's

Jessica (27:38)
Thank

Jackie (27:59)
Even in my room, it's just a piece of paper. It gives me like that foundational score. I'm to get much more information during session. I'm going to know typically how they're going to score on that. You know, after a few weeks, even though I'm going to hand it to them, it's conversations with them. It's conversations with their support people. It's saying, OK, what are you seeing at home and how can I help this at home? But we equip them with the same kind of information both as they're pregnant and a couple of weeks out and say here are the.

here are the signs and here's where we're looking at something bigger. You hear me say it over and over again, like the intensity and frequency. If it's interfering with their day-to-day in a big way, then we need to shift gears a little bit.

Jessica (28:39)
And what does it look like post-screening? What does it look like for them in terms of, I mean, this is kind of getting, my question's getting a little in depth of like, what does care look like when you have been identified for having a perineatal mood disorder? Obviously everyone's treated differently, but what does it kind of look like? What can people expect their care to look like in a therapeutic setting?

Jackie (29:03)
Sure, and you're right, depends totally on the moment and what they're presenting with. If we're looking at like the clinical kind of framework that we use, if we're looking at anxiety and OCD, the gold standard is CBT, which is Cognitive Behavioral Therapy, and ERP, Exposure and Response Prevention Therapy. So fortunately, we live in a time where we can get pretty creative in doing that. If they're having OCD or anxious thoughts, we do exposures where if they're afraid to,

leave the house with the baby. I can meet them at Target and we can do that together or we can sit outside and have somebody else hold the baby while I'm there and that support person if that's the kind of intrusive thoughts we're looking at. Sometimes we have to really, really process their birth story before we do any of this. More often than not, the birth story is not the story as you've experienced and I've experienced that they ever imagined it would be. And maybe having that space to just do that for a couple of months, obviously if they're not.

acute or a safety concern, that happens before we do anything else because they had this baby and now I'm saying, okay, well, what do we look like for anxiety or OCD, whatever that is. But I can't do that if they're still trying to process what happened weeks ago or a couple of months ago. So they really, really invite the process of the birth story if they need to do that.

Jessica (30:12)
Tch.

Yeah, I think that's amazing. I totally identify with like, there's no way you can, I mean, there's ways you can start working on things. But if you have this enormous story, a place of that, that was so like vulnerable and scary, just kind of shelving that and trying to move on. Our brains are incredible at protecting us, but at some point it's gonna come out at some point. Yeah, so I think...

Jackie (30:25)
Right.

It doesn't work out, he's right.

Jessica (30:42)
I had a point to make, let me think about it. For processing a birth story, I feel like it's very similar to preconception. like you're planning to have a baby, start doing the tracking of your cycle. You're like so into this area. You have all like the acronyms memorized of days post birth. Yes. Yeah. So it's like.

Jackie (31:00)
You have your playlist.

Jessica (31:04)
You're so prepared in that area. And then the second you get successfully pregnant, all of that is like rear-view mirror. You never think about it. You never talk about it. So there's not a ton of information out there for people getting into it. So I feel like birth stories are very traumatic birth stories specifically are very similar. in, in birth in general, that it's like, okay, I did the thing to get the baby here and now the baby's here. And that's what's important and getting through that.

But birth is such a monumental like landmark that we're often just shelving it because we got to the end point when really there's like a lot of processing to be done, whether you had a traumatic birth or not. It's just such a crazy experience. I mean, mine was really nuts. So I can only talk from a traumatic birth standpoint, like,

Whether it's your first, like you said, your first or your fifth, every birth is going to be different. Every experience is going to be different. You have different providers, you have a different team, maybe a different hospital or wherever you're choosing to birth. I imagine that if it's more traumatic, you really have to get through those like tough points to be able to kind of address some of the other things that are happening in present day.

Jackie (32:19)
And it's so important to give women, not just in the therapy room in general, that opportunity. work with women who have experienced loss and whether they need to talk about it two weeks or as it's happening. I've had women that are 20 years away from one and they have grown children and they never ever talked about it or their birth story and saying like, this happened and it's actual, you know.

validating for them because maybe I was the first person they told or maybe their husband never knew or all the things that come along with that. Like you said, that happened before they had a baby in their arms and that's everybody's excited and everybody wants to see the baby and do all the things. And then nobody really checks in with mom about how she's feeling or what got her to the point to have the baby. Was it easy? Was it hard? Was it years? Was it a month? Was it a planned pregnancy? 50 % of pregnancies are not.

Jessica (33:05)
Yeah.

Jackie (33:12)
It doesn't mean that 50 % are not delivered, but 50 % of them are not planned and not everybody knows that in their families.

Jessica (33:19)
Yeah, absolutely. So if someone, I think there's a lot of people who are like, I just thought that this was what birth was like. How do you, what would be like a landmark of, hey, your birth was a little traumatic and you should probably talk through it.

Jackie (33:35)
So typically the window for this is so wide open and it has changed right in the past four or five years. So the list that I'm about to give is not by any means you know, exhaustive but so things that include birth trauma are NICU babies, mom having to stay in hospital longer than that, what's called a near miss which is where mom was close to passing away during delivery. Obviously baby not surviving the birth.

any kind of medical intervention that was not wanted or thought that they needed. So an unplanned c-section, an emergency c-section, epidural if they didn't want an epidural, any kind of induction, any pateaus, any of those interventions that they're like, no, I'm going into this and I'm just going to do it on my own. Even just that simply could be a traumatic birth story. Anything that contains a partner being in the room, anything that says, you know, after the birth. So.

delivery went fine or labor went fine, delivery went fine, and then something happened two to three days later in the delivery room. So it's not just as baby as being born, but other medical complications, baby needing forceps. Some women have experience, and this kind of falls under the PTSD part, but a birth trauma of providers not really feel like they're not really heard by providers or negative experiences with the staff or

something that had to be done to or with baby to get baby out. That's not a C-section. So we look at this a lot with sexual assault victims or victims of child abuse that might not be taken into consideration when they're trying to get baby out. And it's so, so unfortunately prevalent and needs to be addressed. So that adds to not just birth trauma, but previous trauma we're looking at.

Jessica (35:09)
So what would it look like to kind of deep dive on your birth trauma?

Jackie (35:15)
I let them take the lead for sure. I say like, is your time, this is your space, if you wanna talk about it and tell me three things and we just sit here for the rest of the hour, that's fine too. If you need six months to talk about it, that's okay too. I consider it a huge honor to be part of anybody's birth story and birth trauma because it is such, like you said, a vulnerable thing to be. And there's not many people knew about mine the second time. The first one, was a...

preterm baby and a NICU baby, so it was kind of just a given. But if somebody wants to let me in with that, then I let them do it at their speed. I never say, okay, we have to talk about this before we do anything else, because maybe we don't. Maybe it'll come up in eight months and maybe they just want to jump into their anxiety and their OCD or some intrusive thoughts and that's fine. But clinically and professionally, like you said, it's going to come up at some point. And it's just a matter of when they decide it's okay for us to talk about it.

Jessica (36:08)
Yeah, I remember for me, there were so many just like random things that I, through the use of a therapist were like, this is definitely connected to XYZ from my birth or XYZ from my postpartum. So while I was actively working on it, there were so many things that popped up that I was like, my God, what is this about? And then realize that there was a very clear connection between my story and like what was happening now. So yeah, I'm a big advocate for.

whether you had a traumatic birth or not, like talking through your experience and what it looked like. There's a ton of birth story podcasts out there and not a lot of them talk about trauma. So I think starting to normalize it in the therapeutic session is like an amazing step to making it more prevalent outside of and more like media, I guess.

Jackie (37:01)
Yeah, and seeing all the positive sides that this is a beautiful birth story and look at all of this and look at the baby's room and look at how it very rarely happens like that. And speaking to that, it's huge. making sure that that piece is more normal than the part that they actually expected. I hope that every woman has their birth story, but I softly prepare them for the chance that that might not happen. And we just want to prep. don't want to.

over prep in like an obsessive anxious way, right? For what does it look like when you go into labor? But we can have some things into place and those key things can be, you know, a provider you trust, a support person, and it could be something as silly as clothes that you want to wear. You might not always get to wear those or who's going to be at the hospital when baby's born, like these very basic things that are key and that you have control over because you don't have control over much once labor starts happening.

Jessica (37:30)
Mm-hmm.

Yeah.

Yeah. So my next question is kind of a mix between two things we, we're going to chat about. So one is like setting up boundaries postpartum, and kind of utilizing that to like protect yourself a little bit and protect your experience. but then I, I think it also goes perfectly into, into birth trauma and kind of the, the PMAD risk afterwards and kind of,

Jackie (38:07)
Right?

Okay.

Jessica (38:18)
I mean, I guess it's kind of a mix between like support systems, setting boundaries and risk. So wherever you want to go with that, I'm good with.

Jackie (38:23)
Right.

So asking like how to set those boundaries.

Jessica (38:30)
Yeah, and kind of how they, how to set the, how to set the boundaries, which things are, are how to choose what's most important to you during a timeframe that you may not know what it's going to look like. Yeah.

Jackie (38:41)
what that looks like is

one of the big things to focus on before a baby comes. We work on a plan of who do you want at the hospital, who do you definitely not want at the hospital. We have families barging in and we're back at a time where you can have people come in and speaking to a partner or a support person about help postpartum.

Who do you want at the house? Do you not want anybody at the house? Sometimes there's a cultural concern or people decide to nest in. They don't want anybody in and out for a certain number of days. And that's fine. We just want to keep a very close eye on when that turns into anxiety. Are you staying in the house because you have a newborn and you want to kind of be in your bubble and kind of protect that bubble for a little bit? Or are you too anxious to leave the house? I tell women all the time like this is going to be

Jessica (39:24)
you

Jackie (39:30)
the time where you're probably going to piss some people off because you're going to tell them you don't want them in the house, you need them to leave, you need them to wash their hands, you need them to, you know, don't kiss the baby on the face, whatever it is. They have a very difficult time. I can't say that to my mom or I can't tell that to my sister. All the things I was like, you can. We will work with what that feels like to implement those boundaries. And they might get frustrated, but it's your baby and your family and you're allowed to kind of implement whatever rule.

that you want. And that's hard for a lot of women because they haven't done that yet.

Jessica (40:00)
Yeah, I think it can be hard to figure out how to have those challenging conversations. But on the other hand, I think it's great to like, these are the boundaries that I want to have and then working through like, that made me feel really shitty. I feel uncomfortable. Yeah. Yeah. And then what are some of the

Jackie (40:16)
People won't like it.

Jessica (40:21)
supports that you feel like are most helpful for moms and postpartum to have set up ahead of time.

Jackie (40:27)
Definitely a person or two that they can go to that will be completely honest with them and direct about what they're seeing. It's not always an option. Sometimes they are alone and that's okay and that's why I encourage like helplines and things like that are just checking in with me more frequently. But somebody that's gonna be like, hey, I'm noticing this. We need to chat or you need to do X, Y, Z. Another support is having realistic expectations of your sleep.

of your house, both are to be shitty and a mess and that's okay. Being able to have somebody that's going to come and let you sleep, being able to have somebody that's going to come and hold the baby, outside providers. So having, like you said, set up with a lactation if you are choosing to nurse, having somebody set up with your postpartum visits that can maybe drive you, you know, get you to the appointments if need be, and somebody that's going to for sure.

gets you out of the house, if that's something that you're choosing to do. It's very easy, especially in the coming months, not to leave the house, but somebody that will even sit on your porch with you for 20 minutes while you hold the baby. And having that piece of connection, the social connection, once you choose to get to that point postpartum is gonna be huge, because it is isolating. You could have tons of friends who have tons of babies, but that window of postpartum can feel very, very isolating.

Jessica (41:43)
Yeah, I agree. think, and because everyone's experience is so different and you're just like kind of going through the day and seeing what hits you, it's hard to connect with other people whose lives are just continuing to go on. One of the tips that I got, because I did feel like super isolated. Everyone's lives were just moving while I had this like.

Jackie (41:58)
Yep.

Jessica (42:06)
crazy, transformative experience and the world just keeps going. And so that was really isolating to me. And so one of the pieces of advice, I can't remember where I got it from, but everyone's always interested in seeing the baby. So I would text my friend groups and just a picture of the baby from that day. And then kind of initiate conversation from there about like what was happening for me.

And that was super helpful to be like, okay, one, I want to talk about it. Cause I think a lot of times people are like, do they want to talk about how they're doing? Like, how do I approach them? So for me, it was an easy, like buy-in, like, here's a cute picture of my baby. I'd like to talk about what's happening with me. And my friends knew that ahead of time, which was great that they were like, okay, she's ready to talk.

Jackie (42:39)
Yeah.

can sweat, yeah.

Jessica (42:53)
And so that was super helpful just to have, and if you don't have that group of friends, I think like you said, having those help lines or even like, I know Facebook groups get kind of crazy and social media is nuts, but yeah, but I found a lot of, not even connection, but just like, these people are going through the same thing I am in a birth month group. So I joined a group that of women who,

Jackie (43:03)
they can.

Yeah, that's great.

Jessica (43:15)
had the same birth month, same birth year, and they would just randomly post and be like, here's what we're doing today, or I'm feeling this way. I really had to filter out what I was taking in from the group, but I was able to see like, okay, everyone's still just laying in bed or, yeah, I'm not the only one having a hard time nursing or whatever it was. But I think validating your experience.

Jackie (43:32)
We're just hanging out,

Yeah.

Jessica (43:41)
kind of seeking out the ways that are healthy for you and the way that you need. I know it was key for me to relate to other people, but within a distance, if you will.

Jackie (43:52)
And being able to speak to the people who are not in the postpartum period of pregnancy, people are always like, I don't know how to help. I don't know what to say. My biggest piece of advice is don't ask what they need. Just do it. Drop off food. Say you're coming over and you're going to hold the baby while she naps. Send over a Starbucks Giffords. Anything. Because if you ask a new mom what they need, chances are she has no idea. She's exhausted and she's trying to figure it out. And she's like,

I don't know, like whatever, just check in or do all the things. So just do, do what you would want to do even if you don't have kids or never were postpartum. Like if you were struggling, would you want pizza delivered? Probably. If you were struggling and you want somebody to come over and watch a movie and hang out in pajamas, probably. So just do the thing. Say like, hey, I'm stopping over at one o'clock. What can I bring you? And make it just, this is what I'm doing for you.

Jessica (44:39)
Yeah.

Yeah, I love that. I, I, for a friend who recently had a baby would give her like two choices. I can do this. That's like me being present and physically there, or I can just drop something at your door. And I feel like sometimes it was like, yes, please. I need another human being here. Or it was like, we're resting. Just leave it at the door. So I think, yeah, yeah. I think giving the option and just saying like, Hey, I'm available. Or even like you said, sending a Starbucks gift card. I'm just so big. I'm just sending you a gift card.

Jackie (44:48)
Right.

I'll take the pasta.

Jessica (45:09)
And then that person can just reply when they're ready and chat if they want and otherwise not. yeah, I think there's always, like you said, just do the thing. Whatever you think and just so that that person knows that you're there and available to them, I think can be huge.

Jackie (45:26)
Yep. One of the things I still remember with baby number two, just turned four, is like he was maybe like five days old, six days old, and we were home. And I got a text from a neighbor who I was not close to, but our kids went to school and familiar with her. And all the text said was, I'm baking banana bread. Do you want chocolate chips in it or not? And that was it. So I looked at my oldest and he's like, I want chocolate chips in it. So said, chocolate chips, please. And an hour and a half later, she was at my front door.

willing to like hang out on the front porch and she had this beautiful banana bread ready to go. And that was one of the things I remember from those like two weeks postpartum is that just, Tam, doing this, here you go, and I'll see you later.

Jessica (46:04)
Yeah. Yeah. I know I always

recommend doing a meal train. Like if someone will do a meal train for you, it's so nice to like not have to worry about it, but then also know like, Hey, I can expect this person to drop by at this time and I can either chat with them if I want, or just tell them to leave it on the, on the porch. those were also really helpful to not obviously for having meals, but then for like little interaction if you wanted it or if not. but yeah, that's a, that's a good.

I mean, you obviously remembered it as a joke.

Jackie (46:33)
Right. And being able to, know,

random ideas if it's financially able, like, can you drop off a pack of diapers or wipes on their front porch? Can you do anything like these little things that you would not think make a difference, make a huge difference for a woman that's just, again, baby one or baby five, like, they're overwhelmed. There's no mom that I've spoken to that is like, this is the easiest thing I've ever done in my life. It's not. It's the hardest thing. We're just not talking about it enough.

Jessica (46:51)
Yeah.

Yeah, yeah. And every day, I remember being like, okay, I've got this. And then the next day, everything was completely different. I had to like relearn. Yeah. So I think that that's huge too, that like, it could be three months from now and like, moms still need your support. So I think just like a check-in text to be like, hey, how's it going? How are things? How are things in general? Yeah. Anything else?

Jackie (47:06)
You're like, crap, I don't.

Yeah, just saying hi.

Jessica (47:25)
think we're getting to the end here, but anything else that you think is important for people to know about perinatal mental health, mood disorders, support, resources, anything you can think of?

Jackie (47:38)
I think in like the therapy, mental health world, it's super important to find a therapist that is qualified and treating using the tools and the resources and the skills that what you're coming to the table with. Dr. Jenkins and I have a very unique specialty. I have the certification with the Post-Parm Support International, which is the only international certification to do that. Dr. Jenkins has been doing OCD and anxiety treatment for years. She trained

at Alexine with Dr. McGrath. So being able to know that your provider is treating the thing that you're going to see them for and not just, it's not just a list in their profile. Ask the questions if you're seeking help. Ask, you know, how often do you see this? How many years have you been doing this? What gives you expertise over any other therapist out there? And they should be able to provide those answers that show their skill and their expertise in it.

I have some clients that come in and say like, yeah, they said that they treated period natal women on their profile, but I was their first one. Or they said that they treat OCD, but that wasn't the case. We see a very long line of people who do not get treated for postpartum mood disorders, but on the OCD front, it takes 14 to 17 years for somebody to get the appropriate treatment for OCD. So really, really ask your questions when seeking treatment.

Jessica (48:51)
Thank

Yeah, I second that. think perinatal mood disorders is a very specialized area that finding a professional that is certified in this area is key for this population, if you will. Any other resources that you have that you wanted to pass on that we could share in our show notes?

Jackie (49:12)
Yeah, for sure. So Post-Parm Support International is huge. They have virtual support groups weekly, multiple reasons for those support groups. So new moms, infertility, losses, breastfeeding, like on their website is a huge option to look at what you want to log on to. And it's not like you have to sign up and then go to every single one. It's just as you need it. That would be the biggest go to. And then any kind of support groups with socials, would

again, be cautious with, if you can find things like the walking group that I know is out there, the walk collective, I think it's called, or being able to connect with preschool moms, school age moms, finding your group is sometimes the biggest support rather than finding an online support group. But when we're talking crisis, we can do the PSI groups for sure.

Jessica (49:58)
Yeah, that's amazing. So we'll post the PSI support groups. I'll look and see if there's any local groups in our Fox Valley area. But thank you so much for being on. I know this is a lot of info just packed into one episode. But I think, like I always say, if one person can take something away from this, I'm sure a ton of other people can as well.

Jackie (50:09)
We're sorry.

It is.

Jessica (50:20)
So I appreciate you coming on and kind of condensing a lot of information into one. And I appreciate you being here.

Jackie (50:24)
problem.

Thanks so much for having me.