Transcript

Anne Nicholson Weber: 00:00 This is episode 17. Welcome! Today, two doulas, an acupuncturist and a psychotherapist share strategies for managing anxiety during pregnancy. I hope you’ll join us.

Anne Nicholson Weber: 00:17 Welcome to the BirthGuideChicago Podcast, conversations about building your circle of support in the childbearing year.
We connect you with experts in our community who can help you conceive, stay healthy during pregnancy, have a safe and satisfying birth, and embrace the joys and challenges of becoming a new family. I’m your host, Anne Nicholson Weber, and the founder of BirthGuideChicago.com, where every month, thousands of Chicago area families find relationship-centered care from conception through the postpartum period.

Anne Nicholson Weber: 00:54 Our topic today is managing anxiety in pregnancy, and we have a panel of four providers who are going to share their expertise on this topic. Alex Gohla is a licensed clinical social worker and owner of Bluebird Counseling Services, a 100% telehealth practice located in Naperville. Alex has advanced training in cognitive behavioral therapy, dialectical behavioral therapy, internal family systems, and trauma-informed yoga, and she specializes in perinatal mental health, trauma, anxiety, depression, and chronic illness for adults and adolescents. Amy Landolt is an acupuncture sleep specialist, licensed acupuncturist and the owner of North Shore Acupuncture Center. In addition to seeing individual clients, she facilitates healing and community through group five-needle ear acupuncture, which is a cost-effective option for managing anxiety if acupuncture sessions aren’t accessible. Robin Ross is a veteran doula of 16 years who has offered birth support to well over 1000 families, and supported hundreds more through pregnancy education. Robin specializes in working with mothers who may have a lot of anxiety or trauma as they go through pregnancy.

And finally, Jasmine Sassack is a certified birth doula and owner of The Birth Zone Doula agency, which offers education, evidence-based research, and hands-on support for a better birth experience. So thank you so much for joining me to talk about what I think is a very important topic. And I’ll just note that I’ve been spending time on some of the member groups like what to expect and just seeing so much anxiety reflected in the postings there. And I think it’s helpful for listeners to understand what are some of the sources of anxiety, what are some of the interventions then that can help you manage anxiety and, uh, what are red flags for anxiety that might need a higher level of intervention. But let’s start with some of the aspects of pregnancy that most commonly give rise to anxiety, and maybe it makes sense to go trimester by trimester because I imagine those, um, change over time. And I’m just going to start with Robin, who’s at the top of my screen. Robin, what, what are some of the sources of anxiety that you commonly see?

Robin Ross: 03:07 There are many. I feel, I was just interviewing, being interviewed by, uh, family today and a lot is other people’s birth stories that are given to women well before they’re pregnant. And hearing these birth stories, media’s portrayal of birth is not the ideal. So a lot of this really creates a negative headspace. And that’s where a lot of the anxiety really, I feel starts from is just, again, not their own personal stories, but how they’re hearing other people talk about labor and birth. And it’s pretty traumatic for many. And so they kind of go into this a little more fearful of even being pregnant.

Anne Nicholson Weber: 03:48 Yeah. Yeah. So just the culture of birth that we’re all swimming in <laugh> Yeah. Is creating a, a lot of anxiety. Mm-hmm. Uh, Alex, is there anything you want to to add to that as some important sources of anxiety that you see?

Alex Gohla: 04:03 Yeah, I think in the first trimester, just the uncertainty of pregnancy itself, especially for moms who have never been pregnant before, um, or maybe who have experienced loss, they might have some worries about miscarriage or early stage fetal development and what’s to come. Anxiety manifests primarily from worry of the future. Um, depression is worry of your past. So it is like, what is to come? Am I going to be a good parent? Am I, am I going to be able to do this? And it’s okay to seek some of that support and that guidance as early as you want in that journey. And just creating a space for yourself that is nonjudgmental and you surround yourself with people who are positive people.

Anne Nicholson Weber: 04:50 Mm-hmm <affirmative>. People I’ve seen on those same kind of bulletin boards, a lot of anxiety that to me seems to be exacerbated by the availability of so much testing. Um, and I see women who are taking, uh, hormone level tests practically every day in their first trimester because of a fear of a miscarriage. Um, and I wonder, um, if anybody has thoughts about whether that’s helpful or not.

Robin Ross: 05:18 It kind of goes both ways, quite honestly. Some people have reassurance. I’ve had women who had significant losses and need that reassurance. They need those ultrasounds and that that gives them that reassurance. Where yes, you know, there’s always going to be a flip side where it can create angst, of course, of, oh my gosh, I had this read and I won’t know for, you know, 10 more weeks if everything’s okay. And it’s like, oh, my. That definitely will create anxiety of not knowing. And you have all these weeks to, you know, understand how is the baby because something might have been found. Or even with ultrasounds in general too, later in pregnancy, not just in the beginning. Um, I’ve had a lot, lot of people say, oh gosh, you know, there was something found with their heart and we won’t know until the baby is born. And it’s like, whoa, we have so much time and all. So it goes both ways. It really does.

Anne Nicholson Weber: 06:08 Yeah. So it sounds like that’s going to be a personal decision. Um, and women have to kind of take into account both the up and the downside of knowing more or knowing a little more, but maybe not enough. Yeah. Alex,

Alex Gohla: 06:22 I think sometimes too, depending on how much testing is done, so let’s say you’re, you know, taking an HCG test at home every day to make sure that you’re still pregnant. Those can turn into some checking behaviors, which then can result in some of that postpartum OCD later on.

Anne Nicholson Weber: 06:39 What — you said checking behaviors? Was that it?

Alex Gohla: 06:41 Yes. Um, a common checking behavior would be checking to make sure you turned your hair straightener off, and then going upstairs and checking again before you leave the house, and then putting your shoes on and being like, did I turn that off again? Like checking behaviors like that. Um, so some of those tests can lead to some of those checking behaviors that are common in OCD and then turn it into that postpartum OCD that we see in that fourth trimester.

Anne Nicholson Weber: 07:09 Interesting, interesting. I mean, it seems like the issue that underlies whether testing is helpful or not is that some of this, there’s absolutely nothing you can do about it either way, right? You don’t actually have control over whether your pregnancy goes to term, for instance. Even if you’ve monitored, that information isn’t always actionable. And perhaps taking into account whether information is going to allow you to make decisions or just become, as Alex is kind of suggesting, slightly obsessive concern, that may be an interesting way to look at decisions about that. Jasmine, is there anything you want to add as a, as another doula to this discussion?

Jasmine Sassack: 07:53 I would say I think a large piece of anxiety in pregnancy has to do with how much information we are inundated with these days. We are used to having answers at the tips of our fingertips, on our cell phones, in our back pocket to almost any question that we can ask. And pregnancy for a lot of people is one of the first times that they’re in a really personal, meaningful situation for themselves where they don’t have those answers that they can just look up, you can look up. And what you end up getting, like Robin said, is a lot of scary stories of other people’s experiences instead of necessarily the statistics or the facts, um, or a, or a counterbalance of the positive outcomes and stories. And there’s so much with pregnancy that’s just unknown and like you said, Anne, testing with results that really are not necessarily actionable.

Jasmine Sassack: 08:52 So it’s a really frustrating and a hard process for people to go through. Um, the loss of control and the loss of answers about this enormous thing happening in your life. We don’t know if the pregnancy is going to be carried to term. We don’t know when you’re going to go into labor. We don’t know how long labor’s going to last. Uh, there’s just so many unknowns and people are really, really uncomfortable. I think people have probably always been very uncomfortable with unknowns, but especially these days, we live in an environment where there are not very many unknowns anymore in life. And so for a lot of people, this is the first time that they’re really having to confront that and learn how to deal with it.

Anne Nicholson Weber: 09:29 Yeah, yeah. And you put on top of that, that especially in that first trimester, you’re likely to feel incredibly crappy, and that I think could probably exacerbate the emotional feelings of anxiety. Well, Amy, you’re an acupuncturist and I’m interested to hear what are some of the things in the first trimester for now – focusing on the first trimester – that you, um, that your therapies can offer to a pregnant woman who may be, um, feeling these kind of overwhelming feelings we’re talking about?

Amy Landolt: 10:00 I think, so acupuncture just helps with anxiety in general. And in Chinese medicine there isn’t one type of anxiety, so there could be many root causes. And so part of what we do with acupuncture is looking at what is the root cause in this scenario? Um, and I don’t mean just is it overworking, not moving enough, um, obsessing, but looking at what organs are out of balance. So I’m always looking at what’s out of balance and what specific anxiety symptoms  is that person exhibiting? So we talked about different, like over-checking behaviors. Is there a lot of fear? Is there a lot of feelings of an uncomfortable sensation in the heart? Is there breathlessness? Um, so understanding those different symptoms and then treating based on the root cause that would cause those symptoms.

Anne Nicholson Weber: 10:59 That’s really interesting. I don’t think of different kinds of anxiety, but it makes sense as you say it. Maybe, uh, Alex, you’d like to address that as well. This notion that there’s not just one kind of anxiety.

Alex Gohla: 11:13 Very true. Like there are so many different kinds of anxiety, and that anxiety can manifest in different ways, whether it is coming out as somatic symptoms within our body, um, such as like stomachache, headache, things like that. Um, and it, it is important that we understand that there is such a huge brain body connection. So if your body is feeling out of whack, just like Amy said, your brain is, is sensing that and then is trying to overcompensate in a different area. ’cause in that first trimester, your hormones are, are all over the place <laugh>. And so your body’s just trying to kind of balance and get itself to this point where it feels regulated. So, um, you’re going to experience a lot of those different symptoms from hormones that then can be exacerbated by your anxiety. So you may have nausea, but it might be increased nausea because the somatic symptoms of your anxiety are also manifesting as nausea.

Anne Nicholson Weber: 12:14 Yeah. Yeah.

Amy Landolt: 12:15 I think another thing I would add is, um, we’re looking at the body from a mind, body and spirit point of view. And a lot of times, throughout all of the trimesters, um, people are struggling with those strong emotions that they’re experiencing with this large thing that’s happening to them. And with strong emotions, we don’t always learn how to handle those. Um, some of us repress — try to repress strong emotions. Some of us get stuck in them and can’t move them through. So acupuncture, along with lifestyle things that we can discuss, can be helpful for just processing those emotions so they’re not stuck in the body.

Anne Nicholson Weber: 12:58 And are there, um, approaches, interventions, strategies that are especially pertinent in the first trimester that any of you would like to call out for dealing with these anxieties?

Alex Gohla: 13:12 I think talking about it is huge. Um, whether it’s with a therapist or a moms group, a mom support group or an online mom support group, understanding that the things that you’re going through, several other people are probably going through the same thing. Because especially if you’re a new mom, have never gone through this before, you’re like, is this normal? I know for me, I participated in a mom’s group every Wednesday at a local hospital prior to giving birth and then after giving birth with my second child and I didn’t do this with my first. And it made such a huge difference in my confidence level knowing what was to come, knowing that there were other people going through the things that I was going through and normalizing the experiences that I was having, whether it was in my relationships because I had my hormones and my husband and I were getting into it, and I was crying at Super Bowl commercials about puppies, <laugh>, I don’t know, like, and it normalized a lot of those things that were, were going on. And just hearing that there are other people going through it can help you feel like there’s a community behind you. Yeah.

Amy Landolt: 14:23 Um, to add to that, one thing I’ve been fortunate, uh, to fall into I guess — it seems like throughout my life I’ve always had friends that were ahead of me in certain ways. So especially like women that are ten years ahead of me help throughout the whole childbearing thing because they can add that perspective, like Alex said, and they’re not in the same place I am. So they can look back at it with the wisdom that they’ve gained. Just having those people’s perspective is very helpful.

Anne Nicholson Weber: 14:53 Yeah. So kind of those mentor elder types, uh, in your life and, and making the effort perhaps to reach out to them. When you’re going through some of this, are there any red flags? What behaviors might suggest a level of anxiety that’s kind of past normal and might require some special attention? Jasmine, as a doula, do you feel like that’s a question you can answer?

Jasmine Sassack: 15:17 Well, I never hesitate to refer people to mental health services, um, and seeing a qualified therapist and looking into medication if they feel like that’s something that might be beneficial to them. So, you know, whenever I get a sense that . . . you know, if somebody’s just calling me with what seems to be kind of an average run of the mill question or worry concern, that’s very typical. But, you know, when it becomes something where people are losing sleep or not eating or, you know, running to the doctor or emergency room to get checked all the time on different things, you know, that’s definitely where I would recommend that they seek kind of a higher level of care for their mental health and see a therapist, um, or like I said, talk to their doctor about medication. Uh, I think sometimes removing the stigma around medication helps a lot too, to let people know that there are medications that are safe during pregnancy, there are medications that are safe during breastfeeding. Sharing some of my own personal experiences with that is helpful. And then, you know, uh, certainly other types of preventative self-care, like acupuncture, massage, um, taking a walk, having a list of friends to talk to or call when they need to. So there’s sort of like stages in between needing more urgent care, but you know, when things are starting to get a little derailed, stepping in and making sure that people have the support that they need to stay as mentally healthy as they can.

Alex Gohla: 16:46 I’m going to piggyback off that a little bit ’cause I did love what you said about, um, those activities of daily functioning. So normal anxiety does fluctuate during pregnancy and is often linked to a specific concern that you have and can be managed with a self-care strategy. So going for a walk, drinking more water, taking some time for you, taking a break, deep breathing, things like that. If anxiety is going to be persistent, overwhelming, interfering with those daily functioning activities such as difficulty sleeping or avoiding necessary tasks, that might be a time where you’re worried more about those in-depth interventions, um, and seeking that professional help. I think the big red flags that I would say, if you’re experiencing a panic attack, intrusive thoughts, severe emotional distress, those are going to require you to seek some immediate medical assistance. Whether it is talking to a primary care doctor about getting on medication or discussing it with a therapist. Um, and particularly those with a history of infertility or loss anxiety might be compounded. Um, and if you’re experiencing those feelings of dread or excessive worry that are not part of that normal pregnancy process that is a sign for some deeper emotional need and connection to a mental health professional.

Anne Nicholson Weber: 18:16 Speaking from my own personal experience, I had, uh, a series of miscarriages and then a third pregnancy. And the first trimester of that I was just quite, uh, obsessed with this feeling of was I going to be able to keep this baby? And something that was helpful to me was, um, doing guided meditations. And I think in some ways it’s almost anything that you can do, because that feeling of anxiety invading you and you’re kind of helpless in the face of it. <laugh>– having any strategy that you can kind of proactively glom onto. But for me it was super helpful to start building internal images and just relax in that way. So that’s just a personal suggestion. And, um, I think it was Jasmine talked about sleep. And if sleeplessness is obviously very troubling in any, at any time of life. Amy, I happen to know that you, you were actually first referred to me as someone who worked miracles with insomnia. Do you want to talk at all about that? Is that something that you’ve done particularly with pregnant women? 

Amy Landolt: 19:20 Um, again, it goes to — with sleep, there’s 12 different root causes from Chinese medicine. So we’d be looking at what type of sleep disruptions. ’cause from my perspective, it’s different if you’re having problems falling asleep or your sleep is very restless or you wake up too early and can’t go back to sleep. Those are all different. And then there’s different things beyond that. So it would be working through which ones are you suffering from, what other symptoms do you have? And adjusting that, but also making lifestyle changes. So when we’re young as kids, we have bedtime routines —  hopefully, um, depending on the parenting we have —  but we might sing a song, we might turn off lights, we have a bedtime routine and we get out of that habit when we’re teenagers and in our twenties. ’cause a lot of times we’re able to just fall asleep as soon as we want to.

Amy Landolt: 20:17 But when we have a large lifestyle change like this or period of change, it can be more difficult to sleep again. So sometimes going back to the basics to see what used to work for me as a kid and how can I incorporate those routines can be helpful. Um, but then sometimes it’s also the opposite. When we have a big life transition like this, um, sometimes what always worked for us might not work any longer. And so if you were someone that regularly meditated and you would do that by sitting down and, you know, breathing for 20 minutes, all of a sudden that doesn’t work. And uh, if you’re like me, I think sometimes you say, ‘but this has always worked for me.’ And you try to keep doing it instead of taking a step back to say there’s other options. Maybe chanting would be more beneficial for me right now. Maybe I need to journal, maybe I need to connect with friends. So realizing when things haven’t worked for you that have worked in the past in the shift is needed.

Anne Nicholson Weber: 21:22 So often, if you just define a problem — you say, I’m not falling asleep even though I’m doing the things that have always worked — it becomes much more possible to realize there are lots of options, lots of solutions and strategies and it, and it can be kind of a systematic process. Um, but so I think we get kind of stuck in the problem instead of stepping outside it. Yeah. Well, we’ve talked about some of the smorgasbord, <laugh> of interventions, of strategies, and I’d like to try to expand that if we can. So we’ve talked specifically about support, you know, from other people. We’ve talked about specifically seeking out a therapist when, um, anxiety is getting greater. We’ve talked about self-care in different forms. Um, I mentioned, uh, guided meditation, we’ve talked about acupuncture. Are there any other strategies or resources that you would want a pregnant woman to kind of be aware of as an option if she’s just trying to manage a mostly normal level anxiety, but it’s uncomfortable? Did I leave anything out? Jasmine?

Jasmine Sassack: 22:31 One thing that I offer to my clients so that they don’t go down sort of the Google rabbit hole of, uh, finding every, oh, every negative story in the world –when they’re, uh, especially if their, if their doctor or midwife has brought up a, you know, a health concern or something that they want to research or look into– is I offer that they can send me what their concern is and I can send them some of the research on that. I usually refer them to, to articles from the website, Evidence-Based Birth. Um, and that way they’re not just going blindly onto the whole internet searching randomly for, for information, but they’re getting, um, the facts, the statistics, the studies that they want to have some answers. And then I follow that up with a phone call to them or a zoom session or meeting so we can talk through, you know, what did you take away from that?

Jasmine Sassack: 23:24 And I can find out from them what are the important factors here for you? Because every individual is, of course, different. And so how those statistics and studies affect everyone individually is a different case. So we can, we can get to the heart of what is their concern, what is their anxiety about? And you know, ’cause some people might be really concerned about one aspect of a health concern. And for somebody else it might be a completely different aspect of that same condition —  of that same overarching topic. So we can find out what their actual problem is and kind of drill down on that and, and find some answers from there. Again, without them having to go through the whole, the whole internet searching for things. Because then they’re going to find all kinds of horror stories that are just going to feed into that fear.

Amy Landolt: 24:13 Can I add on to that? Oh, <laugh>. Um, so I, to what Jasmine said, um, I was struggling this with this myself during Covid and wanting to obsess and spend too much time on it. So what I suggest for people is setting a certain amount of time that they’re going to budget in a day for that activity. And um, if you have a resource like Jasmine, that’s great, otherwise, um, identifying what is a trusted source of information and you could go to your providers to find that. And then only using that source and not everything else that’s on the internet, and then deciding at the end of that 15 minutes or whatever you budgeted, okay, what actions can I take today based on this information? And then when it comes back, because it does ’cause we’re people, um, you just tell your brain, I’ve already decided what action I can take. This is handled. And, um, I suggest people look around to bring themselves back to the present. What do I see? What do I hear? What do I smell? What do I taste? And 30 seconds later when it pops up in your mind again, you tell your brain, I’ve already handled that, what do I see? What do I smell  . . . ? And each time you’re doing that, you’re training your brain, um, to create more space between the worries.

Alex Gohla: 25:37 Mm-hmm <affirmative>. And with that Amy, I think writing it down, journaling that so that you can see it and see that progression. So if it does become a compulsion to check the same thing over and over, you can flip back through that journal and be like, oh, I’ve already been there. I’ve already done that. Um, and then just as you said, those CBT grounding strategies to address those negative thought patterns and come back to grounding techniques to stay present in that moment are going to be what really drives you. And then focusing on that self-compassion piece from there. So allowing yourself to say like, it’s okay that I have some of these worries. It’s okay that I have some of this anxiety, but how can I move forward and be resilient? And then utilizing all of those strategies along with self-care, adequate rest, healthy diet, engaging in things that bring you joy and relaxation to bring you back to that present moment so you can focus on what really matters right now in the here and now.

Anne Nicholson Weber: 26:43 Yeah. Robin, were you going to add to any of that?

Robin Ross: 26:45 Yeah, I mean, I think what everybody said is, is pretty spot on. I think it’s also the understanding of where to get that, because it’s when you say, well yeah, just do this, but it’s like, well, how and where? So it’s like having the support. I mean that’s, that’s key for everything is knowing where the support is. And I mean, as I, I’m not, I’m not going to speak for Jasmine, but I think we’re on the same page. Yes. A doula for everybody. Like whatever that might look like because this is such an intense vulnerable time in a person’s life. Um, even if she has a strong support system, there is so much information that even her, her mother and her partner and her sister and cousin and all these people are saying that, I like what Jasmine said too is like where everybody is saying, having a consistent platform that you’re following that gives evidence-based information is consistent because, oh gosh.

Robin Ross: 27:41 I mean, it can be all out there. And even working with different providers where I’m like hearing one person say, even in the same group, even providers are on different pages and these people, these families, these moms are getting so overwhelmed and confused. Like, I was just meeting with a client of mine, she actually is a healthcare worker, um, an ICU nurse and she’s, um, with doctors that I work with a lot. And she’s like, oh my gosh, I was at an appointment and one doctor said this, another doctor said this, it’s like, I put on my medical hat, but it’s like, I don’t want to put on my medical hat. It’s like, Robin, what do you think? I’m like, well, this is what the research says. This is what evidence-based information says, but what do you think <laugh>? You know, so, but it is, it’s overwhelming, especially when you’re getting so many conflicting things and that can just produce a lot of anxiety.

Robin Ross: 28:27 So having the strategies is key, but knowing how to get those strategies. Like I have a wonderful therapist and I’ve learned these strategies. It took a long time to do this, but when I was pregnant, I didn’t, I didn’t have these strategies. I was not even with a great fit as a, as a therapist. ’cause she didn’t provide these strategies either. Um, so that, that’s also the common thread too, is how do we educate each other as people in our field to know who to send to and be consistent in what’s being suggested as well for better helping the people we serve.

Anne Nicholson Weber: 29:03 So I, I’m going to get to you, Alex, but I just want to emphasize two things that have just gone by. One was Evidence Based Birth, which Jasmine recommended. This is a fantastic site. They compile the, um, studies and summarize them in ways that are quite accessible for virtually all the aspects of pregnancy and childbirth. And so I personally would say, if you’re going to pick your guru site, that’s a really good one to pick. And the other thing, uh, that Robin said is, um, have a doula. And you know, we all are aware that not every family can afford that. That it’s, it’s not something yet that, um, our society provides for every family. But I think not just have a doula, but understand that doulas are very useful much earlier in pregnancy than you might realize — that it’s not just someone who’s going to be there at your birth, uh, but someone who can be this kind of trusted advisor, um, throughout pregnancy, someone to turn to and help you sort through as Jasmine mentioned. Which by the way I think is a fantastic strategy, as someone who has gone through the nightmarish byways of the internet and gotten completely overwhelmed by horrific images in my time.

Anne Nicholson Weber: 30:12 And learning how to just get only the information you need and not all the scary stuff that you don’t. Okay, Alex, what were you going to say?

Alex Gohla: 30:20 As providers, one thing that we need to do is create that safe and supportive and non-judgmental space for our clients to feel safe and to share those fears —  that creating that space and having that space for clients makes a significant difference in the healing process. Yeah,

Anne Nicholson Weber: 30:40 And it’s a, it’s a little bit relates to the, the core mission of birth guide, which is finding a good fit with providers. And if, uh, one of the things I talk about, uh, in relation to your doctor or midwife,  your birth team,  is to really listen to red flags. If you’re not really feeling comfortable, if you have questions, if things just don’t feel right. And the same I imagine would be true, you may have a therapist, but if it isn’t, if you’re not a hundred percent sure it’s the right therapist,  being proactive to, to look elsewhere and to ask other kinds of experts and perhaps look for people who have perinatal, um, focus. Because what’s clear as we’re talking is there’s so many issues that are very specific to this particular transition. Um, so that finding someone who knows all about that would be great. Yeah. Robin.

Robin Ross: 31:28 Just one more thing to add. And I like that whole idea of the trust thing and you know, whether or not somebody has a doula or whatever, it is so much on trust, trusting your birth team. Because when there’s just trust in your birth team, if somebody is getting backlash from their doctor or midwife and they start to feel, Ooh, I don’t know if they have my best interest at stake, but I feel stuck. And then they go into their experience, they go into the hospital or even a home birth and feel distrustful, that just spirals. So there, there is so much on trust in, in how you’re forming  your birth team and even speaking to that, um, as, as providers, whoever you are, as you know, in what you offer is — like, like, um, Alex was saying too, and even Jasmine, everybody’s saying here too —  is like that nonjudgmental, just making them feel you’re a safe place even if they don’t feel they can disclose this to their provider, which I’ve had, um, some very deep seated conversations of a mom opening up to me of some sexual trauma of the past of childhood.

Robin Ross: 32:25 Some really deep things where I’m like, oh boy, oh, this is heavy. But thank you so much for sharing because this is very important. Have you shared this with your provider, your doctor or midwife? No, I haven’t. How can I help you share this? ’cause I think this is extremely important, but I want to, I want to, you know, also be aware of how you feel about this, but I think we all need to be aware to support you better, especially if there’s any triggers of words or where we’re positioned and so forth. So not that it has to be trauma of that deep nature, but anything that might be a trigger of any sort where this family, mother especially, feels that trust to let go. And that’s where a lot of this really does reside in how she can communicate.

Anne Nicholson Weber: 33:11 Yeah, communicate was the word that was ringing in my head as you were talking. Um, and you raise a special case, which is past trauma or we haven’t really talked about the possibility of a woman who comes into pregnancy already with an anxiety disorder. And that’s perhaps a different case than the main focus of this podcast, but something to be aware of as another uh, kind of issue. Um, so we’ve talked mostly about anxiety in pregnancy, uh. For the second and going into third trimester, there’s a special form of anxiety, which is fear of childbirth. And um, I know Robin, that you do some particular work with that. Am I right about that fear release? Mm-hmm <affirmative>. Do you want to talk a little bit about that?

Robin Ross: 33:58 Absolutely. So I am a certified hypnobirthing instructor. I’ve been doing that work for 16 years, same with doula work. And we got trained in doing something called a fear release, um, where we have specific questions we go over with the family, mom especially, and they provide the answers and then we do a one-on-one to go over all those answers and questions and then we do a guided imagery. And then, um, just, you know, rehash that. Over the years I’ve kind of tailored to my own ideas as I’ve worked with so many families. So I do offer fear release for anybody, um, especially, you know, pregnant and going into birth just to understand what the fears are, anxieties, um, how, how we can let those go. So really working one-on-one. And then I’ve also come up with, especially as Covid came through, birth healing sessions, no matter if you birthed yesterday, three years ago, 20 years ago, there’s so much trauma around birth. Of how we can, again, I give specific questions, I look at their answers, we go over each one and pick it apart, and then I actually use art with that and then a guided imagery, art again, and then we chat about it.

Robin Ross: 35:07 So really, really lovely of just really delving deep into what the specifics are to let go with.

Anne Nicholson Weber: 35:16 Yeah. Alex, you wanted to add something?

Alex Gohla: 35:18 Yeah, so I, I am going to provide a testimonial to this because I am one of Robin’s clients, so I experienced a traumatic first birth and my second birth was with Robin. Um, and this process that she guides you through does really help you feel in control in the delivery room. I chose the second time around rather than a medicated birth to have a natural delivery mostly due to this process because I felt more in control of my own body. So even for moms that are maybe, you know, going through that second time around, experiencing like the birth that you didn’t necessarily want the first time, you have that opportunity to do that and gain that empowerment tool from, um, going through this trauma release. And you do definitely go into that delivery room feeling more confident, feeling more comfortable. You have a plan, you know what your specific target words are, images, your partner does, and they know how to support you. And I can say our second delivery did not go as planned either. Um, and I ended up being okay with it and going with the flow rather than sitting in my anxious thoughts and sitting in the uncomfortability. I was able to let things go with Robin and with my husband being my support system in that room, trusting on my team because they knew what the plan was because it was properly communicated by my doula and my partner.

Anne Nicholson Weber: 36:50 Yeah, and what you just said, Alex, touches on something that, um, came up in a podcast I did about trauma, which is that trauma doesn’t come from not getting the birth that you wanted. Trauma comes from how you’re treated, how you understand what’s happening during the birth process. It’s, it’s not about outcome, it’s about process, um, during labor. And I think that’s important to have in mind because it seems to me it’s very dominant in the culture right now. Oh, birth is uncontrollable, birth is, um, unpredictable. Don’t even like have an idea for what you hope for because you’ll only be disappointed. And I think Alex, you’re saying, and probably you would all say — that’s not right. You do want to have a picture of what matters to you, but that doesn’t have to mean that you’re wedded to it in a way that becomes traumatic if you don’t get it. Jasmine, this is probably something that you address with your clients as well.

Jasmine Sassack: 37:44 Yeah, absolutely. And our birth planning session, people always have this concept of what a birth plan is, um, being like, you know, what medications they want or don’t want during labor and what medical interventions they want or don’t want. And we definitely discuss all of those things because I want to understand their kind of first, second, third choices, um, of how things will ideally go. But I explain to them in that birth planning session, that’s what’s more important to me is the conversations that are taking place underneath those choices because I want to know what’s driving those choices so that at the end, whatever situation arises, I want my client to feel like their triggers were watched out for, the things that were most important to them were being listened to, um, and that I get to know them and their little ways of communicating and, and, um, some of their body language and just getting to know them.

Jasmine Sassack: 38:40 That’s really the most important part of our birth planning. Because, you know, at the end of the day when I go to a birth, I don’t need to know on a sheet of paper whether they wanted the lights turned on or off in the room. I’m going to ask them that at the time and they’re going to change their mind a lot of the time over those 20 hours that they’re in labor and we’re going to turn the lights on and we’re going to turn the lights off and we’re going to get in the shower and we’re going to get out of the shower and we’re going to use every tool, you know, I’m going to offer every tool available to them that I have knowledge of. Um, so, you know, it’s lovely to have that all written out and there’s nothing wrong with that, but it’s really the conversation around those choices that’s more important so that I know how to support what, what’s really driving those choices for them and their wishes and desires.

Anne Nicholson Weber: 39:24 Yeah. We’ve talked about first, second, and third trimesters. I actually think fourth trimester is kind of beyond the scope of this podcast. It’s a whole topic of its own, um, and perinatal mood disorders and postpartum mood disorders and just taking outside the pathology of it, but just normal adjustment to being a mother <laugh>. That’s a big topic, which we don’t have time for, but um, within the scope of what we have already talked about, what, what did anybody want to add? What didn’t we mention? What important, um, points have been missed?

Alex Gohla: 40:00 I think that preparation period while you’re pregnant is something that we kind of looked over a little bit. ’cause that can be something that causes a lot of worry and anxiety as well. Do I have all the things that I need? Am I going to figure out childcare or work life balance or things like that. And those are common things that I think moms start to worry about in that second and third trimester. Um, as they’re becoming more and more pregnant and they’re coming into this role of a parent and how to nurture and care for kids. And it’s again, as I’ll say, over and over, it’s okay to seek support, to feel anxious. Like it’s okay because sometimes we can take that anxiety and change it into an excitement. Um, so instead of feeling those anxious fears, we can use that to empower ourselves to be great mothers and to be great caretakers for our kids and to be great spouses and partners, um, and really rechanneling our anxiety into a positive mindset.

Anne Nicholson Weber: 41:05 Great. Amy, is there anything you want to add? ’cause you have a kind of slightly different perspective or um, lens for all of this. I just don’t want to leave anything, any of your wisdom on the table.

Amy Landolt: 41:18 No, I was going to add to what Alex said. Um, my coach always says to me, what is, what is that sensation you’re experiencing or emotion trying to inform you of? Because behind anxiety is fear, uh, possibly some sadness or grief or anger. Um, so just being aware that it’s information and it’s telling me that I’m excited about being a parent, that’s important to me to be a good parent. Those are all good things. So framing it that way too can be helpful.

Anne Nicholson Weber: 41:52 Great. Well this has been a terrific conversation and I thank you so much for making yourselves available to have it. Thank you. Thank you.