Please join me in welcoming Dr. Catherine Birndorf, MD, author of the book "What No One Tells You: A Guide to Your Emotions from Pregnancy to Motherhood" for a Cake Panel!

About Dr. Birndorf: Catherine Birndorf, MD, is Co-founder and Medical Director of The Motherhood Center, a treatment center in New York City for pregnant and new moms experiencing anxiety and depression. Dr. Birndorf is Founding Director of the Payne Whitney Women's Program at the New York-Presbyterian Hospital Weill Cornell Medical Center, where she is an Associate Professor of Psychiatry and Obstetrics & Gynecology. Dr. Birndorf is a board member of Postpartum Support International, a non-profit organization for awareness, prevention, and treatment of mental health issues related to childbearing worldwide. For ten years, Dr. Birndorf was a regular mental health columnist for Self magazine and has appeared on numerous television programs, including the The Today Show, Good Morning America, MSNBC, and CNN. Her first book, The Nine Rooms of Happiness, co-authored with Lucy Danziger, was published in 2010. She is the author, with Alexandra Sacks, of What No One Tells You.

About the book What No One Tells You: In What No One Tells You, two of America’s top reproductive psychiatrists provide a road map for mothers-to-be, detailing the complicated emotions that bubble up and explaining the psychological and hormonal backstory as to why. With 30 years of combined experience counseling mothers, they show why it’s natural for “matrescence”—the birth of a mother—to be as stressful and transformative a period as adolescence. Here, finally, is the first ever practical guide to help new mothers feel less guilt and more self-esteem, less isolation and more kinship, less resentment and more intimacy, less exhaustion and more pleasure, and learn other tips to navigate the
ups and downs of this exciting, demanding time. Called “loving and practical” by Harvey Karp, MD, NYT bestselling author of The Happiest Baby on the Block and “reassuring, accessible and comprehensive” by Gretchen Rubin, NYT bestselling author of The Happiness Project, What No One Tells You is an indispensable guide for any new mother or mother-to-be.

Welcome Dr. Birndorf!

So this is your second book as an author. What inspired you to partner with Alexandra Sacks, MD to write What No One Tells You: A Guide to Your Emotions from Pregnancy to Motherhood?

Well, Ali and I had worked together for years. She started as my medical student many years ago. We’ve written papers and book chapters together and after long discussions about what wasn’t out there but needed to be said, we partnered to write this book.

As “reproductive psychiatrists”, medical doctors who specialize in helping women navigate their emotions before, during, and after pregnancy,” would you say this book is a good starting point for those who may not be familiar with the field?

Yes. I think it’s a really nice introduction into the idea of thinking about the emotional side of a woman’s life cycle, particularly around reproduction. We don’t generally think about it that way. We usually think about it as going to the physical doctor for X or Y. But reproductive psychiatry addresses a woman’s emotions during specifically female times in their life: from menses to menopause. And perinatal psychiatry is particularly around birth and motherhood. People ask why I went into this field...I always wanted to do women health, women’s reproductive rights, so when I got to med school, it didn’t surprise anyone that I couldn’t decide between OB or psychiatry. So I do both, but from the training and perspective of a psychiatrist.

When I started doing this in the mid-90s, there were so few doctors out there doing it - reproductive psychiatry was a nascent field. And now it’s much more populated; more people -healthcare professionals and the lay public - understand and are interested in it, can talk about it, and the fact we could get a book contract to write about it - is proof! It’s still a small field and we all know of each other. So it’s fun to see the growth of this specialty really taking off and blossoming into other things. Broadly speaking, it includes: PMS, PMDD, all things around fertility, pregnancy, loss, becoming a mother, peri-menopause, and the emotional sides of all of those physical transitions.

I saw a lot of comments online from reviewers or readers saying they wish they’d read or known about this book earlier, rather than later. Why do you think that’s the case?

I just think there’s very limited information out there about this. And if there is, it’s in isolated pockets or moments in the media. It hasn’t been put together in one place. And what was happening while writing this, part of the impetus for writing it, was that I say these things every day in my office for the past 25 years. And when Ali and I were thinking about this, we thought how great would it be to put it on paper. We realized we should put it out there for people who can’t get in to see a professional like us. Lots of folks will never get to a psychiatrist, or therapist, don’t have access locally, or can’t afford it. I’m very interested in making this information accessible to as many women as possible.

Did you write your book as an antidote to the huge pressures that moms and mothers are under to be positive at all times, to dispel the “bliss myth?”

Oh for sure. That was another big impetus for why we wrote it, the idea that there’s one right way to do it. And that it’s all natural, easy, and positive. What I wanted to call this book for a long time was “Between Bliss and the Blues” or “The Wide Range of Normal.” Because the truth is, there’s a teeny slice of women who are all blissed out while becoming a mother. But they are few and far between. I’ve known about 5 of them in my entire career. No joke.

Just the other day I gave grand rounds for a bunch of OBs, and I asked if they had patients who were saying it was the greatest thing they ever did, and not a single hand went up. So it’s a lot of bullshit. But I’ve met a few. I always think of one of the people I met who was so positive, and I realized she was an anomaly. I responded with “That’s great, you’re awesome.” And I meant it! But the problem is that’s what everyone thinks they should be like. And most of us don’t feel that way.

On the other end of the wide range of normal, there’s the pathology side, about 20% of people have anxiety, depression, and other illnesses. Between that 20% and 1%, there’s a wide range of normal. And what’s in there is a multitude of “normal” experiences that people don’t realize, because they think there’s only one way, a perfect way of being. People are so wed to how it should be or how it seems for others. We’ve been sold a bill of goods that’s not accurate. And it puts people under tremendous pressure, potentially making us sick to strive for this false standard, especially when it’s an impossibility.

You and Dr. Sacks organized the book by trimester, which aligns neatly with most pregnancy-related milestones, but for those that could be evergreen, how did you decide to file them?

It was not easy. Because a lot of the issues we address in each chapter could certainly apply to other parts of pregnancy, motherhood, and life. In some ways, It’s not exclusive. But we had to create an organizational strategy, so we thought this made the most sense even if there was some arbitrariness to it. There are things in each chapter that apply in other chapters, and that can be used throughout life. In some ways, it functions as a reference book, you can refer back and forth, find what applies to you, and come back later for other information. The appendix is my personal favorite, only because it’s what I do academically and what I do now at The Motherhood Center, helping women who fall in that 20% who are struggling with anxiety, depression, or other illnesses during pregnancy and the postpartum. Importantly, most new moms don’t fall into the illness category so throughout the book, we help women know what’s normal and what’s outside the range so to speak. As a doctor, I treat women adjusting to motherhood (ie. who this book is written for) and also those outside the range, struggling with illness (as we write about in the appendix).

So “matrescence” is a word I’d never heard before reading your book, that period of life though pregnancy and motherhood, a big time of change. What are your goals for helping readers in that phase in their lives?

Well, the idea, the name was coined by an anthropologist in the 1970s named Dana Raphael. And then about 5-10 years ago, it was brought into psychology by Dr. Aurelie Athan, a professor up at Columbia. She’s not a big social media person, at all, but she came and gave a lecture to one of my groups a few years ago, and I was like “HOLY SHIT she is describing what we’re writing about” - that phase of life that almost feels like a developmental stage, the transitional period of becoming a mother. It sounds like adolescence: matrescence. It’s like adolescence in that it’s a passage through a tumultuous period of time. But unlike adolescence, where everyone expects it to be rocky, off balance and full of struggles, we expect women becoming moms to have it all together, sail on through - which is not the case, and really not a fair expectation. Then when we judge them (and they judge themselves) for when it’s messy! Clearly, this set-up makes a challenging time even harder.

I love that the book empathizes and discusses so many people around motherhood - parents, siblings, partners, grandparents - and helps humanize and ground their reactions towards new roles, new ideas, and shifts in lifestyle. What inspired those sections?

Life. And reality. And the fact that it takes a village. One does not become a mother in a vacuum. This transition is the most profound change any woman can go through. And when you go through it, you’re not alone. Although you may feel like you are alone, you’re not alone. It includes the doctors, anyone who’s involved along the way - a partner, parents, grandparents, workmates, friends, siblings, everybody. And guess what? Everybody has a reaction to it. Sometimes helpful, sometimes not so helpful, sometimes upsetting.

So we wanted to address the idea that becoming a mom has a wide-reaching effect. It’s bi-directional, the experience of becoming a mother is not only a personal experience, it also affects those around you. And because it’s such a shifting identity for yourself - who are you now as a mother versus a single person, what happens in your marriage or partnership when it goes from 2 to 3, and now that you’re a mother, you’re still your mother’s daughter, but she’s not the only mother in the room anymore. It’s a new identity in so many ways. And that, I think, gets missed.

Hormones are a huge part of pregnancy and something that you tackle at several points in the book. What are some general tips and words of wisdom you’d recommend both those expecting and their partners to factor around Human Chorionic Gonadotropin, Progesterone, Oxytocin, Estrogen?

Hormones are gonna take their natural course, assuming you’re a healthy person. I think what’s interesting is they can create some unexpected feelings along the way. Some of the initial hormones contribute to how sick you feel, morning sickness. Some of the hormones that rise at the end, when you give birth, Oxytocin, the bonding hormone, that’s important in terms of getting the baby out and bonding and breastfeeding. Hormones provide the landscape, the context, in which all of these physical changes are taking place. They’re not front and center, they’re behind the scenes, but very much a part of the orchestra that is playing for this journey.

Something that I think it’s interesting you tackle is “Mommy brain and the divided mind.” Can you elaborate a bit on that?

I would if I could, but I’m too busy being distracted! Haha. I always say “once a mother, always a mother.” You are never the same again. And you’re never alone again! Literally and figuratively. What I mean by that is you always have baby on the mind. I like to describe it as a highway: when you’re single, you have a one lane highway in your brain. Then you get married, or partner up, and you consider the other person, what’s up with them, and now it’s a two lane highway. Then you have a baby, a far more dependent creature, in fact entirely dependent on you for a long period of time. This is a third lane on the highway in your brain.

You tend to be aware of everything they’re doing, even if you aren’t with them, like when you’re at work - so now you have a multi-lane highway in your head at all times. Add kids, add lanes! How do you put things aside? Do one thing at a time? It’s really hard! There’s this experience we as mothers have of constantly feeling like we are multitasking forevermore. We are so rarely alone or have one thing to do.

It’s a blessing and a curse. Many women excel at multitasking, but it can be a very stressful place to live. Because there are so many competing demands. In some ways these new demands grow the brain; it’s not a deficit, per se. You expand parts of your brain that have to be engaged to manage these new requirements. But it can also leave you feeling like you’re forgetful or distracted, because if you’re doing one thing and are supposed to be doing another, of course you’re going to feel distracted or forgetful. There’s a lot going on at all times.

So that’s how I understand the “mommy brain” phenomenon. It’s a growth spurt in the brain to accommodate the massive new load of what you have to manage. And it’s not easy. Women will say to me “Do I have early dementia? What’s going on? Why can’t I remember anything? I do 10 things and then I forget my keys at home” and I respond with “YEAH! Because having a baby is an enormous change that requires your time and attention in a whole new way.”

This book is really written from a raw, honest place. You and Dr. Sacks have many years of experience between you, and you bring that perspective of writing like an honest, trusted advisor. Have you gotten that reaction from book readers?

Yeah, we have. I think people feel very much like they are understood, that we “get” what they are going through. We write from a professional but friendly standpoint. We are sources you can trust and have a certain authority because we share a breadth of knowledge and experience. Ali and I come from different places, but we’re writing as doctors, so we stay in the realm of a Dr. Spock or some other trusted authority.

Who would you recommend get this book?

I think the book could be informative for anyone, really. I think it’s good for new and expecting parents. It’s good for current parents, or for second, third, fourth time around. And I think it’s good for grandparents, because they could learn a lot about what’s happening psychologically for their children. We hope that the book becomes a “go to” source for the emotional side of becoming a mother or parent.

How can we best stay up to date with you and your work?

Most of my social media I do through TheMotherhoodCenter.com:

The Motherhood Center of New York - Postpartum Depression Support for NYC Moms (and Dads)At The Motherhood Center of New York, we provide supportive services for new and expecting moms, including a range of treatment options for women suffering from postpartum depression and other perinatal mood and anxiety disorders (PMADs.)www.themotherhoodcenter.com

And @CBirndorfMD

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The Motherhood Center of New YorkThe Motherhood Center of New York. 1,695 likes · 114 talking about this · 65 were here. Motherhood can be tough. But with our help, it doesn't have to be.www.facebook.com