LadyGang - The Mental Health Side of Pregnancy & Postpartum Nobody Talks About

Episode Date: June 3, 2026

Becca sits down with her personal Reproductive Psychiatrist and therapist, Dr. Sarah Oreck, for an honest conversation about the realities of motherhood, fertility, pregnancy depression, postpartum anxiety, mom guilt, and the mental health challenges women aren't talking about enough. They discuss IVF grief, intrusive thoughts, relationship stress, and the surprising condition that can cause feelings of depression while breastfeeding. Dr. Oreck shares practical advice, science-backed insights, and reassurance for anyone navigating pregnancy, postpartum, or parenthood. Thank you for supporting our sponsors!BabyGang is presented by Better Help. Sign up and get 10% off at https://BetterHelp.com/BABYGANGSkylight Frames: Go to https://MySkylight.com/BABYGANG for $30 off your 15-inch Calendar.HERS: Ready to reach your goals? Visit https://forhers.com/babygang to get personalized, affordable care that gets you.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Hello, hello, hello. Welcome to the baby game. Baby gang. Wow, I can't talk, you guys. It's summer. It's officially summer. Kids are out of school. It's Becca Tobin. Hi, and thank you so much to our presenting sponsor, BetterHelp. Today's episode is a really special one. It's my personal psychiatrist. She is a reproductive psychiatrist and therapist. Her name is Sarah Oreck, and she is wonderful. I have leaned on her in many of the toughest times of my life. She continues to help me, and I'm really excited. I know we talk a lot about mental health on this series, but that's because we're moms, and we need all the help we can get. I am coming to you from, if you're watching on YouTube, I am in a bunk room,

an adorable bunk room, at my parents' house in Atlanta. We came to visit for the weekend, And when they made this last move, my parents, they made their house this like playground for all grandchildren. And their goal was to just lure them here. And it's working. There's a giant dollhouse behind me for American Girl dolls, for my niece, a bunk room, all the toys you can imagine. It's really sweet. We love being here. But without further ado, well, actually, I'll give you a little backstory.

I don't know if I talk about it in the body of the episode. But I found Dr. Orrick when I was in my second pregnancy and I was experiencing extreme depression. And I just was so confused because we're supposed to be glowing and happy, right? Not always the case. And that's why it's so important for her to be here and to talk about all of this and remove the stigma that comes with all the challenges that can happen and can occur when you are pregnant, trying to get pregnant after pregnancy. after having a child, all the things. So I'm really excited she's here. I think you're going to love this conversation. Hello, everybody. I am joined today by Dr. Sarah Oreck, a Columbia University-trained, board-certified psychiatrist and therapist focusing on women's mental health and wellness, reproductive psychiatry, and perinatal wellness. With rare specialized training in how female reproductive hormones impact mental health across the life cycle from adolescence through pregnancy,

postpartum, and menopause. She's also the founder of Mavita Health, who offers specialized online therapy for women and resources to empower them throughout their journey, and my personal psychiatrist. Love that part. Love that admonition. Hello. Well, it's important. We all have to share. You know, it's like really… You know, everyone shares their plastic surgeon, but not their therapist. It's so true. It's very true. I think this is the new wave of transparency. I remember just right before I – you were the first psychiatrist I ever spoke to. And this was during one of my early pregnancies that – I think it was between one. It was between one really traumatic experience and then in the middle of one pregnancy that ended up being a miscarriage.

but I actually still felt the stigma of the term psychiatrist. I remember it felt like, oh God, people are going to think I'm a crazy person because I'm seeing a psychiatrist. I think it's changing though. Do you feel like it's kind of becoming a little less stigmatized, a little more open conversation? I hope so. But what's really interesting is that you're absolutely right. It extends to even choosing the profession in medical school. Mm-hmm. And my parents are Colombian. And so there's sort of a tradition there of like, you just have to be strong and that's how you fix all your mental health issues. And so it was really interesting that sometimes I think psychiatrists are discounted as not being sort of

medical doctors, but we are, we went, we go to medical school, but we happen to focus on this particular area, which I think is one of the most exciting and rewarding jobs I could have chosen. I think after being in it for so long, I hope that we're starting to de-stigmatize. I'm hearing it more and more, even in your openness of talking about having a psychiatrist. But seeing a psychiatrist doesn't always have to mean that you're on medications. That's one. And two, if it is, it doesn't mean that you're weak, not good enough, crazy, right? It just means that you are looking for all of your resources and getting equipped in what might actually improve your health.

Do you have advice for people? Because I think this millennial generation of ours is way more open to these concepts. But if you have a family and you come from a family that really does have strong opinions of just getting over it. I know. Just be strong. It could be so much worse. Like that person.

So much worse. Right. You look at what I went through where it's like there's an idea that somehow depression, anxiety, or mental health issues are tied to like suffering and to traumatic events, which sometimes they are and sometimes they're not, frankly. Sometimes it's just a biological kind of underpinning or vulnerability that some people have that others don't. I think a part of it is just to kind of think about it in the way that you would physical health. and sometimes that what I think really helps people who have those kind of old school conceptions. And it was actually how I convinced none. I didn't have to convince her, but I was like, mom, this actually makes sense that I'm going into psychiatry was just like, if you had

diabetes, you wouldn't tell someone, Hey, just go on a great diet. If they're insulin dependent, you would say, no, you, the insulin is going to help your quality of life. Cause if you don't do it, you'll have a lot of complications. Like you may have to have limbs amputated. And I think in some ways it's starting to think about, and I think we are more and more that like mental health is actually the core to your physical health and your emotional wellbeing to how you operate in the world, to your relationships. And I think when you start to think about how it's so central to everything, I mean, think about this. If you're not in a good place with your mental health, you're not going to, if you have diabetes, for example, you're not

going to take the medications. You're not going to go to your doctor. And so this is a real game changer. And that's why we actually talk about mental health is the number one complication of childbirth. Really? And people forget that. Wow. And how does that present? So really outside of everything else, more than gestational diabetes, and yet you're like, you know, chugging that gross drink at 20 something weeks. Mental health issues are going to be the thing that happen with most frequency in pregnancy and then lead to kind of difficult outcomes, whether it's increased risk of cesarean section or preterm delivery. And then of course you have the postpartum issues. And in total, it's the highest risk in terms of mortality. More than hemorrhage is suicide or

death related to mental health issues. Wow. Who needs a psychiatrist? Oh, this is interesting. This is interesting because not all psychiatrists are the same. Right. So the assumption that we're working under is that the psychiatrist is only going to do medication management, which I have to say, I think with our healthcare system, that is a very common occurrence, but there's a lot of psychiatrists. I'm one of them. They're typically trained on the East coast where we have the dual training and we're therapists as well as prescribers of medication. And so what I say is I see people who have mild to moderate symptoms all the way to severe, but with our healthcare system, if it's insurance based, you typically

see people who have more moderate to severe symptoms go to a psychiatrist. Maybe they've already tried therapy and it's not enough and they need something else to kind of help it. But I never think it's too early. Yeah. Well, that's good to know because I feel like some people, they stay in talk therapy for a really long time. And my armchair expert opinion is always kind of like, have they suggested talking to a psychiatrist as that next layer of support? And a lot of the time that doesn't happen. And then I've been really open about just my journey with depression. and that's why I found you and I became medicated. I'm still medicated. It was the best decision I've ever made in my whole life. I still don't know what to tell people when it's like, how did I

know when it was to the point where I needed help and medication? Do you have any hard and fast rules of like, this is anxiety disorder that needs to be addressed. This is depression that needs to be addressed. It's not just like, oh, I'm having a sad day. Yeah. I think, and I'm trying to think back about when we met, but I certainly think that part of what I say to people is when it starts to impair your functioning, obviously that's a really big deal. When you're going about your day because you're driven by your anxiety or fears or you just can't get out of bed, that's a big red flag, but even more nuanced than that is when you're not behaving in a way that's truly aligned with your values. Okay. So if you're not having that baby or you're concerned about that,

you know, getting pregnant or conceiving because of fears of loss you've had in the past, for example, and yet a part of you is like, no, my, one of my biggest values is to have a family and to have this family life and yet I'm like not able to do it because all of these other things are holding me back. I think that's really important. And you may still be working. You have your relationship. You're still going about your business. But when your behaviors aren't matching up to what you think you value and you want in your life, that's a huge red flag. Yeah. I had a lot of people write in. I pulled Instagram, which is I feel like where I get my most thoughtful questions because it's a little anonymous. I got more than one asking about

depression during pregnancy. And it's kind of touching on what you just said. It's like I've always wanted this baby. I have never really wavered on this decision, yet I'm pregnant right now and I feel very dulled out. I feel zero excitement, even getting past the first trimester, even past the sickness and it doesn't make any logical sense. And this is something that I dealt with. And what is that? And I didn't even know that this was common. I know. And it's even more challenging and people don't even like, think about this. If you have IVF and let's say you've struggled and now you spent, you're like seven years deep and like trying to have a baby and then you have this ambivalence or these mood symptoms and pregnancy, you're like, what is

going on. This is what I've wanted for the last decade, and here we are. I think there's a couple of layers to this. First, it's really important to note, we talk about postpartum depression and anxiety so much, but a third of those cases actually start in pregnancy. So for many people, pregnancy is not this delightful, oh, I should be so grateful type of era. Also, I think with hormones, people underestimate the impact that they can have. You are having an increase in hormones that you've never had in your life. And for some people, it is, they're just really sensitive to those hormone changes. You can sometimes kind of have a feeling about whether this is going to be you. If for example, you have really difficult PMS or even premenstrual

dysphoric disorder, that means for you, those fluctuations make your body and your brain is just really sensitive to it. It's nothing personal. It's just how you're feeling. And I think it's so important to get early intervention because what people don't realize, and again, they're so afraid of the side effects of the medications, what's going to happen to the baby, but you should have therapy at the very minimum when you're having these symptoms because untreated mental health issues actually do have an impact on the baby and your postpartum and your delivery. Yeah. I remember you telling me that, and that sort of felt like the permission I needed to consider medication was the impact of being unmedicated.

There's like a lot going, you know, there's so much on the internet, you know, fun, fun stuff. It's noise. It's a lot of noise. A lot of noise. But you're a data-driven, science-based person. There are medications you can be on while pregnant, correct? Yes. And which ones are those? Are you able to say? Yeah. You know, what's really interesting is that people will always throw out Sertraline, which the brand name is called Zoloft. That one's kind of like in the water that everyone talks about and OBs feel really comfortable prescribing it. But I like to say that actually whatever has worked for you is likely going to be the right choice. So if you've taken Prozac or fluoxetine

in the past, that might actually be the right choice for you. It's not about like what everyone else uses. SSRIs, so selective serotonin reuptake inhibitors, we have the greatest amount of data in pregnancy than any other medication. Wow. Which is like, it's crazy to me because no one flinches out like, I need this medication for my blood pressure or I need this. But when it comes to an SSRI, they're like, I don't know. I don't know what you're giving me. And it's actually, we don't have randomized control trials. So that's been a limitation for a lot of things in pregnancy, but we have the biggest amount of observational studies. So this is on the order of millions of patients have taken these medications and we've been able to track

their pregnancies and to see like that it was a healthy baby, healthy mom, et cetera. When there's more complicated medical issues, so bipolar disorder at like the need for stimulants, for example, with someone with severe ADHD. So for example, if you can't drive safely, because you might get into a car accident without your ADHD medications. Sometimes staying on them is an option. We just have to talk about the risk versus risk. There's only a very few, only like I would say even one medication that you can absolutely not take during pregnancy. It's called Depakote or valproic acid because we know it actually causes neural tube defects. But for the most part, everything else is a very nuanced conversation. Wow. But that's not what

people talk about. No. You talk to a lot of women who are still struggling to get their family, to get their baby, to have a successful egg retrieval, IVF, all the whole thing. If they're not, if they don't fall into the category of being clinically depressed or have any sort of, you know, disorder or mental illness. But there's a lot of misconceptions here. So when you're on your fertility journey, the rates of depression and anxiety in both partners can actually be extremely high. The data right now shows 50% of people in an IVF clinic will have depression or anxiety. I actually think it might be higher because when you look at some studies, including some that note that, um, infertility diagnosis is equivalent in terms of grief as a, as being

diagnosed with cancer. Yeah. So when you think about that, like that's a really big issue and sometimes it happens in both partners, which is interesting. So I actually think that there's a lot of underestimation because we're normalizing it. Hey, a lot of people can't conceive. Look at all these IVF warriors. And I love the idea of like, let's universalize, but let's not normalize this grief and sorrow and difficulty functioning, that also lends itself to treatment. And I think you've experienced some of this. But the need for a particular outcome and the control can be really difficult. And sometimes when you start to have some acceptance around your current situation and how you can get to where you want to go, that can just be so relieving in a lot of ways.

So I think people underestimate the grief, the loss, and the mental health symptoms during the journey to conceive. Wow. It's very true. It just feels like those couple years just felt like my life was on hold. It's like a limbo. Yeah. It's such a limbo. It's purgatory where you're like, I can't really feel – I've tapped out with joy because even though I'm feeling this thing, the other thing in my life could be going really well, but it's like grief where you're just holding on to this sort of dark cloud. And so it does sort of cloud the whole experience of living in that time. I remember when I had my pretty traumatic second trimester loss and then we still wanted a baby. You kind of go into like, okay, I'm doing this and we're going here. And

then it's like, it comes back. It's absolutely like when you lose someone close and you kind like try to go through your day and then it kind of comes back and, and, and sucks you in in some ways. And I think a lot of people don't have the resources to really help them during that journey where they're, they minimize it. What's the big deal? Or I have other kids. Why am I, what's, what, you know, what's going on here? Especially some secondary infertility can be really tricky because you're like, I should be grateful. I have one kid at home. Yeah. Oh, it's so true. I even remember, I'm going to be very honest here and say, when I was going through attempting to have my first child, I had the same kind of judgments when dealing with friends or people in my life

who already had their first and wanted a second or had their two and wanted a third. I was like, don't be so greedy. I'm like, you have enough. That's right. And it's really shitty. Yeah, but it's internal. Yeah. Okay. So this is a really – this is a spicy question, but – Love it. Do you think that there are women or have you dealt with women who genuinely regret becoming parents or having babies? Oh, that's interesting. I mean, I can say there's a part of me that certainly regrets it. Yeah. I think it is like the caricature of like the Reddit threads that are like, I actually hate being a mother. And I think what I hear it a lot is if I had known how much this work was going to be or how much of my independence would go away

or part of me, like I may have made another decision, but I love my children and I would never like do that differently. It's almost like the fork in the road. And as human beings, we're like the only species that can unfortunately have the like what ifs and the what if questions. What if I would have become a rocket scientist? I don't know. Maybe I'd have been on that flight with Katy Perry. 11 minutes in space. Be glad you weren't. I'm glad I weren't. I'm glad I wasn't. So I think it's like, yes, you can always do that fork in the road. What I love about that conversation is that I don't actually think people are like, I don't want to have my children or I wish I was like this single woman out in town. But I think what it does is that it gives you

nuance. And it's nuance for those that decide not to have children. And for those that have children, there's no perfect answer. There's always grief about what I would have, all the hours I could work and sort of advance my career and travel are gone. And then I get to have this other joy and love. But I think what I love about it is that nothing's perfect. Everything is sort of nuanced. And I just think regret is something we have to start to talk about and normalize it and universalize it. And things may change. When your kids are older, you kind of gain some independence. But I also think it's so valid. I think it's validating also to those people who decide not to have children, which I think also they deserve a voice. And that's a valid choice

because so much, especially in this very regressive time we're living in, is the value of a woman is on her ability to reproduce. It's so interesting that I feel the same way. I'm like, catch me on the wrong day. And I could absolutely say, I think I could find happiness and fulfillment if I didn't get this outcome. And I do think it's important to talk like that because it's really demystifying this like romantic idea that everyone has with having a child. And especially when you've worked really hard to get that child, I think there's extra, like, you know, there's guilt. There's guilt to say, I should be enjoying and sucking in every minute of this and soaking it in and loving it. And I think letting yourself off the hook that that's just never, that's just not

realistic. And it, and it also, when you say those things, I want to be clear. If anything ever happened to any of my children, it would be the most devastating loss of my life. Um, and I think that's how most parents feel. But sometimes when I have, I have three children and I'm an only child, I'm like, what was I? Yeah. I was like, this is like, you know, a Mormon amount of children. And they're like, no, it's not like people have three children. I'm like, I don't know about that. It just, it just seems like a lot to me. And again, I don't actually want any of them to go away, but there is a fantasy when I go out with one of my children and it's like, we can go to a restaurant and not, and everyone doesn't look

at us because we're behaving like normal people, you know, but when they're all together, I'm just like, Oh, that's a lot. Are we? It's a lot. So there's comedy in it. I think there's relief. It just lets off some of the steam. But I think that's all fantasy and in jest. And I think the conversation is important and it's not to be taken literally. Yeah. Okay. This is a question for the new moms. And because my son was born via surrogacy, I can never really give my two cents on this one topic, which is women who feel a tremendous amount of anxiety or guilt when leaving their child, not wanting to leave their child with a caretaker or even with the father or the other partner in the relationship. I say that I can't do it because I can give a little

bit and I still have those normal mom guilt moments where I don't want to leave my son for a long time. And I, you know, think about like, I go to those, like, um, what's it called? Uh, intrusive thoughts. Yes. Yes. But I think because I did not have as much of a hormonal shift in myself and I'm also not separating physically from this little human I grew inside of my body, it's a little bit different. Oh, interesting. I was going to say, I think it might be different for you because you had some practice early on in kind of trusting someone. with this. I think in some ways you developed that ability very early on. And I know it was like a little bit of a road, but in some ways when you have a surrogate, you're kind of like,

I'm trusting that this person is eating right. They're not subjecting themselves to a lot of trauma that we're sort of in a good space here. So I think in some ways you had practice that maybe a new mom doesn't. I don't know if it has to do with the biological piece. That makes sense. Yeah. And also, yeah, your mental health symptoms, I think also really impact this for people that are really afraid of leaving their babies. I do want to call and I love that you said intrusive thoughts. I think it's really important to kind of think about if the intrusive thoughts, if the health anxiety is so much that you think you're the only caretaker for that child, I typically think that there's something where therapy could help, medications

could be helpful because that is sort of the volume is turned up on the maternal instinct or the difficulty separating. Similarly, if you feel like you really do believe that you wish you didn't have children, I also suspect that there is probably some significant mood or anxiety issue there as well. So I think these can also be used as like a barometer of like, oh, maybe this is the thing. Because without a village, like you will burn out. This is not, it's not sustainable to take care of your child 24 seven. Yeah, that's the truth. breastfeeding i that kind of ties into it um with the new mom guilt of my best friend um she was breastfeeding she had a great pregnancy she loved being pregnant was very happy a really

like smooth delivery and a really easy newborn. But she had this depression that the moment she started to breastfeed, the moment like her milk was dropping and she was sitting down to breastfeed her son, she was like, it was the darkest moments of my whole life. Oh, I love that you're bringing this up. I didn't know this was a thing. And thank God her OBGYN was like, this is a thing. but why don't we hear what is the thing and why don't we hear about it? The thing is called Deemer, which is like a very weird name, but it's dysphoric milk ejection reflex. It's poorly, it's understudied. Like we know very little about it. We think it happens and it basically, what we think is going on is that there are some hormones when you let down

milk that trigger this feeling for people. It's interesting. People describe it as homesickness is one of the things, but it can feel really depressing, low, hopeless, and it just lasts through the breastfeeding episode. For some people, it's a couple of minutes. For some people, there's some residual, but I think it can be so dissociating and so significant that it makes people feel like, oh my God, am I depressed? Am I having an issue? Um, it's not depression. It's not postpartum depression. It's independent of it. Uh, but what happens if people don't understand what's going on, it can continue to linger. Uh, for some people, the solution is like, maybe it's not breastfeeding is not compatible with them. And for others, sometimes

it's some therapy for, frankly, for some, it's just understanding what it is. Um, it's not necessarily something we don't know. We don't have any good medications for it. There's just either you ride the wave and you know what's going on or you say, this wave is not for me and I'll pass. Yeah. Well, and like breastfeeding in general, I just, nine out of 10 of my friends all hated the experience. And one of them loved it so much, she'd still be breastfeeding her 12-year-old. It is such a range of what that experience is. and I think for women who absolutely hate it, they feel very broken. And then they feel some of them have the, you know, they throw in the towel and they make the decision and they feel

very confident in that. And then there are some that still kind of struggle through it. What would you, what do you say? Like, how do you gauge when it's time to make the change or to adjust or to just do it? This one's so hard because I think there's also like systemic issues that we need to change. Like, I think that there is this pendulum swing like around the, our, our vintage when we were born in the eighties, like breast, like formula was in no big deal. It was just kind of like, Oh, I'm going to do formula. I think there's been such a pendulum swing where there's something of like, almost like with goodness, with goodness and good mother is the one that breastfeeds. A good mom is the one that has an unmedicated vaginal delivery. Like all of those

ideas I think are very much in the pipeline of thinness is goodness, right? I think all of that is connected. And where do we start to kind of question that narrative and say, it's not, it's what's best for me. And if I'm doing well, that's what's best for baby. So I wish that our culture and our hospitals, right? Like baby friendly is kind of the worst thing that's ever happened. I think to moms and to mental health and hospital systems where they're pushing breastfeeding over autonomy, over what's right for this person. I mean, it's not even a discourse of like, if you have sexual assault, which frankly, a lot of women do about one in four, probably more like having tits out and like a baby on your breast is, could be very, very triggering.

And yet I'm not hearing that being a question. Are you comfortable with people walking in while your breasts are kind of out in the open? Like, I just don't think we're talking about that enough. And then ultimately I think if we talk so much about reproductive rights and autonomy, like I think breastfeeding is exactly that. And so I think everyone has to find where it's important in their value system, but I would hope that you start to listen to like an inner voice versus what is that influencer saying about breastfeeding and how great it is versus how it actually fits in with your day and your life. And like, if for you, it's being like, you know, plugged into a wall all day with like your nipples bleeding and you barely get to spend time with

your baby because you're like, you're breastfeeding and you're pumping and you're, you know, whatever it is, I think reconsider it. So interesting you say that about women just having to have their breasts out and they're in the hospital and the doctors are coming and the nurses, the lactation and the dad and the partners. And I just thought because I hadn't had this experience and I'd been there with my sister when she gave birth, with my best friend when she gave birth, a lot of friends really early postpartum. And I thought this was really, until this moment, I thought something hormonally just shifted in you where you just didn't mind it. I remember sitting there with my sister, who's a very private person.

Yeah, modest. Yeah. I was the always nude person. And it's like I was watching her with this stranger on her, touching her nipple, squeezing her nipple. And my sister, I'm sure if I were to ask her now, I'm sure she said on the inside, she was probably not thrilled about it or maybe even a little traumatized by it, but she's just sort of very stoic doing it. And so I thought that you just like, that was the magic of pushing a baby out or getting a baby out. I mean, and we're talking so much more about consent now, but I remember after my first, like there wasn't even consent of like, I'm going to throw the baby on the breast right now. And I was just like, wait, what are we doing

here. Yeah. Wow. And yeah, I think it's something that people are undertrained in and I think it may contribute to – and listen, you've gone through so much as a new mom that sometimes you're just like, I have to do the right thing. And I do think there has to be more training around what's – we should ask for consent to manipulate someone's nipple. Yeah. Yeah. I would hope so. And then I had a few people ask me, just to sort of distill the idea down, women who are really struggling with being new mothers, and they believe that a lot of that struggle is feeling very alone and not supported by their partner. Or their country. Right. Or that. Just anybody. They're like, you're on your own, babe. Do the hardest thing

in the whole fucking world, but like do it alone and don't complain about it. I mean, that's like where they shifted the nurseries. You know, like these women have been through like going through, they may have labored for two days. They may have had an emergency C-section and they're like, oh, here, take the baby. The baby's staying here at night and don't you dare fall asleep with the baby in your arms. It's so true. I remember getting our one-day-old son, two-hour-old son, and I had not labored. And I was still so stressed and exhausted. I cannot imagine what that is like to go through a major surgery or to deliver it vaginally and then also have that. There's women that, as they should because

of the narrative, give themselves a pat on the back and a trophy for sending the baby to the nursery for the night. I'm like, no, that should be standard practice. Like what? You just had an abdominal surgery. Like I can't, I can't. I really, it's just, it's like we don't treat any other surgical or big, you know, someone who's had a big procedure like that anywhere else in a hospital. No. What do you do for women that you suspect the majority of the suffering that they are experiencing are because they are with someone who is not carrying their weight or? No, I mean, it's really hard. And I think, again, let's start with like the systemic issues. We don't have you know federal paid leave we don't have practices in place that are like you know

affordable child care that makes it so people can like take a little breath and then sort of move on so I think it's important to address those and always like talk to get engaged politically because even if you say I don't get involved in politics actually these this is a really great example of how politics actually affects you yeah yeah your access to resources and support as parents are very limited in this country. And you can do things about that. That's one. But two, partners can be very challenging, especially in like heteronormative relationships. And I think what's really important about that is level setting beforehand, trying to understand how are our responsibilities going to actually change and how are we going to catch up with those?

um because often you'll find um women again in sort of these traditional relationships and even in non-traditional relations i remember early on my husband and i both work we're like when we had a house together it's like we both shared laundry and cooking and then all of a sudden it's like wait why am i changing all the diapers how is it suddenly like my job to do everything like we became more traditional than we'd ever had and it just needed to be like a call out of like okay left level set. Here's like the mountain of responsibilities or what we like to call the invisible load, ordering the diaper, ordering the right formula, you know, all of these things that kind of like, I think sometimes people don't talk about or give themselves credit for because

it's almost expected and putting them all on the table to be like, how can we share some of this? I think the other important piece that people often forget is that male partners can also have postpartum depression. They're also going through a transition in fatherhood. And that can look, unfortunately, sometimes more angry or irritable and more disconnected. Oh, wow. And that can sometimes be the disconnect of like the lack of involvement or engagement. I also think that sometimes the criticism of like, you're not doing it right. This is how you do a diaper. How could you not know this? That can be difficult. So some of the work is also like seating control of like, it's not going to be done how I want it to be done. You know, maybe,

maybe they won't put the dishes in the, in the correct way in the dishwasher, but it's going to get done. And so sometimes just good enough is, is enough to move on. So I think it's a little bit of a modulating of like, okay, I need help. And I'm also going to release some control of how that's done because it just needs to get done. Yeah. Oh, good luck. Therapy is so good for this also. Yeah. Like I think people only go to couples sometimes because they think they have to be on the brink of breaking up or a divorce, it is so good for a big life change. I like, if I could, I would say before, during any pregnancy, or if you're struggling with fertility, start couples therapy. If you're pregnant with your first child and you want to set yourself up for success,

do couples therapy. And that gives you so much more information about what's happening. Um, and I think, you know, I would even start to plan for, okay, in the postpartum, I'm going to take care of this parts of the baby and I'm recovering. You're going to take care of every single food. You're going to make sure that we are fed throughout this process, or you're going to make sure you do all the laundry, um, really simple things like that. Yeah. Zach and I started couples therapy when we were going through our fertility stuff and I didn't know what to expect. I just thought at this point we just were, we were drowning. We were so disconnected. I felt so misunderstood. My partner is not somebody who gaslights me by any means,

but during this experience, I just needed to sit there with a third party to validate what I was also experiencing and for him to feel the weight of that. Because sometimes men hear like, oh, I'm a little sad right now. Or it doesn't register as I'm really, really struggling. And this has been a physical toll, an emotional, a spiritual, all of the things. And it really helped him to hear from someone else, she needs help. She needs some support and this is how you can do it. And also I think because of how we raise men, there's maybe a lack of emotional, and I'm, I'm stereotyping. There's of course, men who are more, have higher emotional IQs, et cetera. But there is a lack of sort of understanding of nuanced emotional language

of being able to mirror that back. And so you have a lot of men who are very used to like, oh, but, but we're good. We just got three embryos. What do you mean? Like, things are great. And that you like, I don't need problem solving. I just need like someone to listen, to hear, to validate, to say, how are you feeling? But I think a lot of men don't even have the vocabulary to say, oh, I'm feeling X. And therapy can sometimes be the place to develop it. And it sounds like in addition to like, I think a lot of what you probably need was emotional support, not like someone to problem solve. I'll go to your next appointment and it'll be great. I know. So true. I loved your take on what Victoria may or may not be experiencing. Like,

Can you just give us a little bit of a taste of that? It was very entertaining. Oh, absolutely. I think, you know, people got really focused on the back and forth, but ultimately, like I, well, I love Posh Spice, but also the empathy of being a mother to boys and what I imagine it would be like and what I've experienced with a lot of my patients around, you know, what you perceived as your baby kind of finding his home somewhere else and individuating is what we call it, which is a perfectly natural and reasonable part of growing up.

But I think ultimately what that feels like sometimes for a mom can feel like rejection. You can feel like your son has moved on. You're no longer their confidant. You're no longer kind of like the center of their world. And I want to just make space for that because it comes for some women in a time where they are perimenopausal or menopausal. So they stop having the ability to reproduce, which we just talked about earlier is something our culture really reveres, right? The obsession with looking young and being young is partially because of that. Old women are kind of discarded. And I think ultimately what I want to just highlight is during this emotional kind of hormonal turmoil, you, then you also have this, like the babies are gone. They found their other

woman. They found the next woman and I'm out. And like, that is actually loss and grief. Your, Your child hasn't died. They're doing exactly what they're supposed to do, but you're no longer serving that role for them. And I imagine that that can be really painful. You know, that also highlights that we're all having – not all. A lot of us are having children much later. And so our point of perimenopause is actually going to be when our kids are a bit younger, which I'm sure could be challenging because you're still kind of in the weeds, but it could also be maybe a gift because you're… Less of like a double hit because you used to… Like Victoria Beckham was a young mother. So she, of course, had like going

away. You have like this empty nester syndrome happen typically like for people who have kids younger when they're in their early 50s. And that was the case for her. But for us, they're like still at home and they're like, I'm not going to be that old. And I actually think that that might be easier because you've been able to sort of process some of those aging. I think your relationship starts to maybe have some issues, but you don't have to deal with the empty nest that early. Wow. Okay. Another advantage to being an old mom. Another advantage. I'm going to look like his grandma at graduation, but that's okay. But you'll be so confident in that sort of aging woman role. So I think that's really important. Oh, great. I just thank you so much. I'm so

grateful for these conversations. I'm so grateful for what you're doing on the internet and people getting access to you and your brilliance and where can they find you? You can follow me at Sarah Oreck MD on Instagram or at Mavita Health on Instagram as well. And then if you want clinical services and you feel like you need either medication management, individual group or couples therapy it's all available on Mavida that's M-A-V-I-D-A health.com great thanks for having me thank you football is back every game every weekend DraftKings sportsbook has you covered every snap matters every comeback can shift the game and every fourth quarter moment can change everything follow the action with DraftKings the number one sportsbook for live

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