Heal Your Roots Podcast

Perinatal Mental Health: Overcoming Shame and Seeking Help

• Heal Your Roots Wellness • Season 2 • Episode 3

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In this episode of Heal Your Roots Podcast, we sit down with therapist Nicole Bolognini, LCSW, PMH-C, owner of Skylands Wellness in New Jersey, to discuss various topics related to perinatal mental health. We start by asking Nicole how she became a therapist and what inspired her to specialize in perinatal mental health. We then delve into the most common issues associated with postpartum depression and what can make a birth experience traumatic for some.

Nicole shares her insights on OCD in new moms and the impact of intergenerational attachment and childhood trauma on perinatal mental health. We also explore how having a child can open up past wounds and the importance of screening women after birth for anxiety and depression.

Additionally, we discuss the complex relationship between postpartum depression and trauma and how to deal with insensitive comments from family and friends. We also touch on breastfeeding and the importance of doing what’s best for the whole family. This episode offers valuable information and practical tips for anyone struggling with postpartum mental health issues.

**Trigger Warning**

Before we get started, we want to issue a trigger warning. Today's episode includes a discussion of postpartum mood issues, which may include thoughts of harming oneself or others, as well as a discussion of miscarriage.

We understand that these topics can be difficult to hear for some listeners, and we want to make sure everyone is aware before continuing. It's important to have open and honest conversations about maternal mental health and pregnancy loss, and we also want to prioritize the well-being of our audience.

If you or someone you know is experiencing postpartum mood issues or has experienced a miscarriage, please know that you're not alone. Help is available, and seeking support is a sign of strength. The National Suicide Prevention Lifeline is available 24/7 at 1-800-273-TALK (1-800-273-8255), and resources for pregnancy loss support can be found in the show notes.

We encourage our listeners to prioritize their own mental health, and to seek help if needed. Thank you for listening.

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Nicole Bolognini:

There's a lot of belief for mothers around having to never complain, to always be grateful and always be thankful and a lot of shame around any struggle in the pregnancy experience to getting pregnant being pregnant postpartum parenting stuff, there's so much shame and there's so much hesitation to ask for help. So a lot of times, they see people coming in who probably needed help six months or a year ago, but they weren't gonna get through it in one way or another.

Kira Yakubov:

Before we get started, we want to issue a trigger warning. Today's episode includes a discussion of postpartum mood issues, which may include thoughts of harming oneself or others as well as discussion of miscarriage. We understand that these topics can be difficult to hear for some listeners, and we want to make sure everyone is aware before continuing. It's important to have open and honest conversations about maternal mental health and pregnancy loss. And we also want to prioritize the well being of our audience. If you or someone you know is experiencing postpartum mood issues, or has experienced a miscarriage, please know that you're not alone. Help is available and seeking support is a sign of strength. The National Suicide Prevention Lifeline is available 24/7 At 1-800 273 talk, and resources for pregnancy loss support can be found in the show notes. We encourage your listeners to prioritize their own mental health and to seek help if needed. Thank you for listening. Hi, I'm Kira Yakubov Licensed Marriage and Family Therapist and founder of Heal Your Roots Wellness practice. Every episode, we talk with a professional from the mental health field to learn more about their approaches and specialties. And also their journey of becoming a therapist. In this podcast will uncover a deeper look at the world of therapy from new perspectives. You'll meet the therapist of Heal Your Roots Wellness practice, and trusted colleagues from the community tackling mental well being or your go to Network for practical and professional insight in mental health. Subscribe for new episode releases every other Wednesday. So I'd like to welcome Nicole Bollini as our guest today she's a licensed clinical social worker and owner of Skylands wellness practice that focuses on family building yours. So Nicole, thank you so much for being on today.

Nicole Bolognini:

Thanks for having me. Absolutely.

Kira Yakubov:

So I like to start all the episodes with really getting to know the therapist and your journey of becoming a therapist. If you can kind of walk us through how did you become a therapist, what made you want to go into this field,

Nicole Bolognini:

I became a social worker in 2006. I got my master's. And I think I initially went into social work because I wanted to help people. And then as you're studying and learning more about the things you can do, that's sort of how I ended up being a therapist. I worked for a long time with families in crisis and in nonprofit families involved with child welfare. I ended up working for a number of years in a residential treatment center. And so I kind of developed a niche around attachment wounds and family issues and family relationship there.

Kira Yakubov:

And so what do you focus on now cuz I know you have a lot of specialties, but kind of covers everything in terms of like family planning and different life stages.

Nicole Bolognini:

So now I focus mostly on perinatal mental health, so pregnancy, postpartum period, and those attachment relationships and parenting issues. I took my experience with attachment and family issues and kind of shifted my focus more toward the caretakers and the parents and those relationships. And so that's generally where I focus now.

Kira Yakubov:

Awesome. And so is that something that like the rest of your practice focus on, I know, you have several therapists that your practice as well.

Nicole Bolognini:

So if two other therapists Jessica has a lot of experience with children and adolescents, she works in a school setting during the day, she also has that family therapy background, which is really helpful anytime you're working on relationships. And then Jamie, in my practice, has some DBT training. So she does a lot of work with people on mood issues, life transitions, managing stress, and she also really enjoys working with the perinatal population.

Kira Yakubov:

Wonderful. So I know you're based in New Jersey, right? We also see clients in Pennsylvania telehealth,

Nicole Bolognini:

yes, so we're based in New Jersey, I have a license in Pennsylvania. So I can see people via telehealth and we're located relatively close to Pennsylvania so that there are some people of course that travel back and forth for work and will see us in the office at times too.

Kira Yakubov:

So super convenient for everybody close by in the tri state area. Right? So can you kind of share a little bit of what you see when it comes to postpartum or perinatal, like the most common things that you see whether it's if it's an individual or a couple or family coming in that you work with?

Nicole Bolognini:

Yeah, so postpartum is issues are commonly depression, anxiety, a lot of birth trauma, which people often will say to me, my birth really wasn't that traumatic but and then they'll tell me all the traumatic things that happened to them. There's a lot of belief for mothers around having to never complain, to always be grateful and always be thankful and a lot of shame around any struggle in the pregnancy experience to getting pregnant being pregnant postpartum parenting stuff, there's so much shame, and there's so much hesitation to ask for help. So a lot of times, they see people coming in who probably needed help six months or a year ago, but they weren't gonna get through it in one way or another. And you also hear a lot about, like you'll hear on social media about postpartum rage. Postpartum rage is usually anxiety, depression, but when you can't lay in bed all day, or you can't cope with your anxiety in ways that would normally be comfortable for you, because you have all these demands, you end up feeling a lot of rage and a lot of irritability and a lot of resentment that other people are getting to rest and you don't get to rest.

Kira Yakubov:

Yeah, I can imagine, right? I mean, it's kind of feeling like in different circumstance, like just feeling burnt out and not having the space for time to release it. So it does come out as anger and resentment. Plus, you have a little child who is literally relying on you for everything. And if you have a partner not have a partner, depending on the circumstances, that's, that's really heavy to be dealing with,

Nicole Bolognini:

right. And oftentimes, there's like, I love this kid and I, but they're also driving me crazy. And it's sitting with mixed emotions, right? Or I want to enjoy being a mother. But I also hate this aspect of it. And that can just bring up that intensity of the emotion that can come out as irritability and rage and frustration.

Kira Yakubov:

And so I know that there are a lot of myths and a lot of misconceptions about postpartum are there something that you see most frequently around that that you would like the audience members to hear, or just people to know. So they have that information and insight.

Nicole Bolognini:

So one of the main things that I think causes women to hesitate to get help is this fear that people are going to think she wants to harm her child, because the sort of awful news stories about women who do harm their children. And I'm not saying that that never happened, but that is generally not the rule. Most women who are dealing with depression, anxiety, those beliefs are what we call ego dystonic. Right? They don't feel right to them. So it's like I have this intrusive thought about tripping while I hold the baby or I have this intrusive thought that I don't wash the bottle well enough, it's something bad happens to the baby. And I hate that thought I don't like that thought. That's generally what you see when you see postpartum depression, postpartum anxiety, sometimes, on very rare occasions, there is postpartum psychosis. It's extremely rare. It's not something we see commonly, it's something we have to take seriously. And in the case of postpartum psychosis, sometimes you will see women who think that they need to harm their child. But this is really not the norm. And so as professionals, we have a responsibility not to go into like panic mode and call child welfare, if we have a woman who says she's depressed, and she gets these intrusive thoughts about something bad happening to her baby, because most likely, she will be the first one to protect that baby, and wants the best for that baby, and won't get help or won't continue to seek help if she feels like there's any threat to that relationship.

Kira Yakubov:

Okay, so there's a lot of stigma around that. Where do you think that comes from? Is that some of these rare cases that are like on the news that make it feel like it's like it's happening a lot more than it actually is?

Nicole Bolognini:

Yeah, I think those kinds of cases get a lot of coverage in the news. Women who harm their children make for a really interesting story, because it feels so strange to most of us, right? Like most of us wouldn't want to harm our children and can't quite understand it. And so there's a lot of curiosity when something like that happens, in all honesty, even in the cases where women do harm their children, if there is postpartum psychosis. They also don't want to harm their children. But they're at a psychotic episode. And so they're not able to think clearly and make clear decision. But I really do think the media coverage, it's not, it's not too interesting to talk about women that are just depressed, and that are sort of trudging through the day. It's not going to get a lot of Watchers or you know, a lot of attention if we talk about those stories, but that's kind of the norm. It's more common to have the postpartum anxiety to just struggle with. I can't let other people hold the baby. I can't leave the house. I don't know how to handle things. I feel overwhelmed. I want to hurt myself. That's a more common concern is that women feel so hopeless about how they feel that they think their children are better off without them there. That's where we really want to make sure we're intervening as early as possible because there's just no need to suffer that way.

Kira Yakubov:

And that sounds really hard. That sounds really sad and painful to think that your children or your family better off without you Since you're feeling so anxious or depressed or you can't be as present As you feel like you should be,

Nicole Bolognini:

yeah. And oftentimes, it's really scary to the woman experiencing that to that they're like I I've never thought this way before, I've never had these kinds of thoughts. I don't understand why I'm, I don't feel like myself anymore. Anytime somebody tells you, they don't feel like themselves after the birth of a child or the adoption of a child, it's a good idea to think about screening a little more closely for postpartum depression, postpartum anxiety, or trauma.

Kira Yakubov:

Yeah. And so I know you mentioned that some of these like traumatic birth experiences, and I don't honestly want to scare people listening, but it's part of the reality for a lot of women that experienced this. I know, you mentioned that they don't even recognize that it was traumatic. But as a, you know, trained professional, you can pick up on that. And so would you feel comfortable sharing a little bit like what would make a traumatic birth experience or what has happened to some women that have some of those symptoms, or things come up after the fact,

Nicole Bolognini:

anytime, your life or safety or your child's life or safety feels threatened, we can have a pretty significant trauma response. And that can happen often in the birthing experience, not only because we can have real threats to life or safety, but because oftentimes, the focus is on getting that baby out safely. And not on explaining to the mother what's really going on. We all have heard horror stories around birth, there are of course, lots and lots of births that are not horrible, and that are wonderful. Those people are not coming to me for services for trauma, because things were fine. They might come for other reasons. But a lot of times when women come in having had a blood transfusion forceps used in birth, or you know, extremely long, extremely painful labor. They'll say to me, I know, I know, it's not that bad, though. I know people have it way worse. And I will say, well, it is though, right? Like we labor for 36 hours, even if you didn't think you were gonna die, it feels like you're gonna die in that moment. It does not feel like you can go on. And a lot of times that I think the medical community can be dismissive of women like this is normal. This is what happens with all kinds of births. And so there's a lack of comfort, having a nurse in the room that can just explain what's happening, can so effectively mitigate the potential traumatic effects of birth. You know, sometimes nurses come in, and they really save the day, because they're like, Let me hold your hand and tell you what's happening here. But a lot of women don't have that experience. And they sort of feel like, Is the doctor gonna make it in time? Or am I going to, you know, feel every ounce of this pain when I have an epidural, these sorts of experiences can be traumatic for women.

Kira Yakubov:

Yeah, I can only imagine. I mean, this is a crazy event, right? I mean, it's normal, because we've been doing this since the beginning of time, but to not feel like you're in control of that process or to not have all the information. It's kind of just happening to you. And at that moment. Sounds horrifying.

Nicole Bolognini:

Yeah. Well, and that lack of control is what makes it more likely to be a traumatic experience, right? Yeah, the same sort of things. As we think about other traumas, what's scary about them is we have no control, we can't protect ourselves. And so when we go into the birthing experience, we have no idea how it's gonna go. And for some women, it goes very, very smoothly, or we have great providers who get us through those difficult spots and make sure we feel safe. And for a lot of women, that just isn't the case. Unfortunately, in the US, we have a high cesarean rate, we have a lot of mortality around birth. And so we know that birth here in the US is not what it could be for women. And sometimes women go in already fearful around what to expect if they've never seen a birth, which most of us haven't, until we can birth ourselves, they don't really know what to expect, right?

Kira Yakubov:

Why do you think that the medical professionals maybe don't explain as much or they're not as well prepared for some of these births, or these situations for women to know ahead of time?

Nicole Bolognini:

You know, I think some of it is, you know, they have a job to do, which is to protect life and safety and to get that being safely and there isn't time to explain things. I think some of it can be complacency. They've done it a million times, multiple times a day for many, many years. And they can you know, we as mental health professionals can get complacent too, and forget to explain things. Sometimes. We can just forget that this is the first time this person has done this, even though I've done it 9000 times before, I think we have a medical system that focuses on getting the baby here, but maybe not always on the well being of the mother. And I think this is true postpartum too, right. We have baby friendly hospitals, they're not Mother and Baby Friendly Hospital. That's not the term we're using. And women that sometimes feel like they have to keep the baby in the room with them and they have to nurse and they have to and even if these things aren't working for them personally, they will push themselves to continue because of the messages they get. Okay.

Kira Yakubov:

I appreciate that. That makes a lot of sense. And so I know for a lot of this postpartum you mentioned that there's postpartum depression, anxiety, rarely psychosis. Is there also OCD and things like that that come up maybe afterwards that they may have never experienced? Before that this is like a new way of processing and viewing the world around them.

Nicole Bolognini:

Postpartum OCD is fairly common, more common than people realize that having a baby can trigger OCD or it can worsen an existing sort of mild OCD or anxiety you might have had OCD is on that anxiety spectrum. But we see women who compulsively do things like make sure the baby is breathing. And that can feel again, really like you should be doing it right. Of course, you want your baby to be breathing, that's really important. But if you can't sleep at night, because you're checking to make sure the baby's breathing, now, we may have crossed that line into obsessive compulsive behavior, I can't sleep I check it the baby's breathing, I relax a little bit. 10 minutes later, I'm anxious again. And they check again, we can have OCD around cleaning, we can have OCD around avoidance, right, I'm not going to get in the car and drive to baby, I have to check all the tires, I've got to make sure the car seats installed properly, right? Going through these sort of checking behaviors can become really, really distressing for women.

Kira Yakubov:

Yeah, absolutely. I mean, I don't have any children, I can only imagine where like I've babysat. And I've seen other kids. And it's like every movement that they make you have all these scenarios in your mind that play out how horribly could go. And so having that in your body of that fear constantly takes a toll on anybody dealing with that constantly.

Nicole Bolognini:

Right? And that's what can make it hard to know whether this is really a mental illness because it feels like I shouldn't be anxious about my kids, I shouldn't be checking things. And if I don't, am I a bad mother. And we can almost not want to let go of that obsessive thinking that compulsive behavior or even just general anxiety, we don't maybe don't want to let go of it. Because it feels like we need to do that to keep that baby. And so that's another reason why a lot of women I don't think it helps right away, because it feels like, No, this is what I should be feeling. I've never had a kid before, but I'm pretty sure I'm supposed to be super, super protective. And then a lot of times, that's when they say, Well, what are the other people that love you and care about you saying, right? Like, if your partner is saying, No, I really think you're maybe a little more anxious, right, or you're checking a little more than you need to or you don't seem like yourself, you're just not enjoying things the way you used to. That might be another red flag that somebody needs to get help.

Kira Yakubov:

And so I know something that I've seen within my clients, too, as new moms, and you've mentioned it too, is feeling like nobody else can do a good enough job, or you can't necessarily trust anybody else to take care of your baby the way you wouldn't like releasing that control. What are some kind of strategies or things you do to help people through that, because that's a very real fear, right? Like that goes back to the control piece of not trusting anyone else around you to take care of your baby,

Nicole Bolognini:

one of the things I do is acknowledge that probably nobody else is going to do it as well as you do. Right? If you're the mother, and you know that baby and you've been there from day one, nobody else is going to get it quite right. But are they going to harm your child, right? Who can you trust that wouldn't harm your child, certainly the other parent is somebody we want to be able to help that baby build an attachment relationship with Yeah, I try to share with moms how important it is for kids to have more than one attachment figure to be able to feel safe with other people and to be able to know that they can be taken care of by other people and to be able to know that I can separate from mom and come back to mom and be okay. That's a really important part of that development of attachment. I don't always introduce that right away. Because if it's going to come off as shaming or it's going to come off as something that mom is going to feel guilty about. I don't want to introduce that right away. But if they're open to hearing that, and it feels to them, like maybe this is a problem for me, I might share that information. And I teach women about you know, threat detection systems and our brain right and so feels threatening to you. If it feels dangerous to you to let someone else hold your baby. You're gonna respond to that by not doing that thing because you're smart, and you don't do the thing that is dangerous. But you can override that system if you know that you're not in a dangerous situation, right? If you know you need to go take a nap and take a shower. And that's going to make you a better mother. Yeah, it feels very scary to hand the baby over. Can you kind of talk yourself through that process and call them your threat detection system down? It's not a tiger about to eat us. It's just a scary thing that I haven't done before. Because this baby is new in my life. And I haven't had to hand them over yet.

Kira Yakubov:

Yeah. So it sounds like kind of challenging those thoughts, right? Like a little bit of that CBT is challenging those thoughts, looking for other things to differentiate between releasing that control, and then kind of calming down their nervous system to get in a place where they can go do whatever else that they need to do to take care of themselves.

Nicole Bolognini:

Yeah, yeah. So teaching people how to tell when the threat detection system is turning on. And then how to kind of discern whether there really is a threat or not. And if there isn't a threat, how to calm that system down so that you can feel safe doing things and and some of it truthfully, is it exposure, right, but you have to be within a window of tolerance to do that exposure piece. So you can't jump right into, I'm just gonna force myself to do it because you'll go into panic. But if we can get ourselves within that window of tolerance, we can get our clients within that window of tolerance to be able to calm the nervous system enough to be able to say, Okay, I'm going to do this thing, see that it's okay. Actually, baby, we can then start to extend that time that they're separated, if that's a goal for that mother. Yeah,

Kira Yakubov:

so just practicing because I know how important support is right? Like it takes a village, it takes a lot of people to give you breaks and time off. So not feeling comfortable to let other people take care of your baby means you're not getting any rest, which is also going to cause I'm sure a lot of that anger and resentment and anxiety that we've been talking about too,

Nicole Bolognini:

right. And this is where that intergenerational attachment stuff comes in. Because if I don't trust other people, is it because I have avoidant dismissive attachment and have been put in situations in my own life and my own childhood where I couldn't trust people, right. And now I have this baby. And I don't know if I can feel safe. And so a lot of times, exploring those histories with parents helps them understand, okay, this is how I got here, and I'm going to do things differently with my child, I'm going to make sure that this kid does trust other people, and is, you know, does feel both competent, but also is able to trust others.

Kira Yakubov:

I love that you say that, right? Because it is everything that we not everything, but majority of the things we learn about relationships and other people is based on our previous attachments with our caretakers, or parents or family members. So can you speak a little bit more to that attachment style, like what that looks like in counseling or with your clients, if one of the individuals realizes, Oh, I kind of inherited this attachment from my parents or grandparents and now I recognize it. And my partner might have a completely different kind of attachment than I have.

Nicole Bolognini:

Almost everybody will come in and tell their therapist, I had a great childhood. Everything's wonderful, right? Very, very common, especially in private practice, where you get a lot of high functioning people, if a joke with some of my therapist, friends, but that should be the title of our book, like I had a child, because usually sure you probably did, and you probably very, very loved by your parents. But if you have difficulty trusting other people, if you feel like you can't rely on other people, if you don't like to be around people when you're stressed, you're maybe a little bit more on that avoidant dismissive side of the attachment spectrum. On the other hand, if you can't trust yourself, if you feel like you can't figure things out on your own, if you need someone there with you when you're upset, because you can never kind of calm yourself down, you may be a little bit more on that anxious side of the attachment spectrum. Generally there people are not like all the way one direction or the other, they're pretty secure. But there have been some childhood experiences that have pushed them a little bit more one way or the other, or under different types of stress, they swing one way than the other. And so we wanted people to be able to both regulate their emotions alone, but also regulate their emotions with other people. I do teach a lot of people about attachment and we draw their genogram and social work, we call it a genogram. It's basically a family tree. And we talk about family relationships. And we talk about you know, what happened when you were upset as a child? What if you were afraid? What would happen? What are some of your, you know, sort of big childhood memories, which ones were positive, which ones were distressing. And a lot of times just opening that insight to Oh, like my parents making me scrub the baseboards every time someone came over maybe really, really stressed and made me really feel like my job was to make my parents happy, right. And that's an attachment dynamic that's really important to talk about, and to understand how that plays out in your adult relationships.

Kira Yakubov:

Wow. So I mean, it really sounds like having a child triggers all all of those attachment things and opens up all these maybe past wounds, or even just the narratives and beliefs that we have about ourselves and the kind of support we need. And like you're saying trust, and how we kind of connect with other people or not?

Nicole Bolognini:

Yeah, a lot of times, I think it's having a child that gets people into therapy, because it's like, I can get through it for myself. But now I've got this other person, depending on me, and I want to understand why I am this way in relationships, or why I respond this way to other people. And it's both scary parents because it feels like such an important job. But it's also so exciting to be able to kind of look at your own history, understand yourself better.

Kira Yakubov:

I know you do family therapy, right. So when you have a couple come in, what does that look like for each partner if it happens to be heterosexual or even if it seems sex where the partner isn't the one who carry the child or birth the child like what that looks like, as a couple of dealing with postpartum anxiety, depression, any of that.

Nicole Bolognini:

So I don't often get couples looking for therapy postpartum because usually the couple is in such like a survival state and first year postpartum. A lot of times they see couples a couple of years down the line. When you know the kids are now kind of slow. Feeling a little better. And they're like, we get to work on ourselves. Because we've really grown apart. I do try to meet with couples together. But also I try to do at least one session alone with each person to try to understand how they relate to other people, right? So I'm always looking through that lens of how do you relate to other people? Can you trust other people? Do you feel competent to regulate your emotions on your own? And where are the wounds? And how are the wounds getting triggered in that couple, right? So where are those interactions hitting a nerve that existed before this couple was ever together? Because oftentimes, that's where we keep getting into the same fight over and over again, because this wound is getting triggered. And the other person is not even aware that that's what's happening.

Kira Yakubov:

And it's just replaying this dynamic over and over that maybe that person doesn't even recognize it's unconscious, right? Like you said, I think we had a great childhood. But really, it's all of these kind of beliefs or narratives that we have that are resurfacing again, and getting stuck in this kind of cycle with your partner. And now you're in very stressful situation, huge transition. So you are not necessarily relying on the same coping mechanisms that you might have before,

Nicole Bolognini:

right? Or it's hitting this painful wound, right? Like, if you had a highly critical mother, always told you everything you did was wrong. And then your partner tells you, hey, you know, when you fold the laundry, can you fold it this way? It doesn't matter how loving they said that? Sure, it may hit that wound of I'm not good enough for my mother, and it may trigger a very defensive response or retreat, right, like running away from this, I don't want to deal with this. So I'm gonna back away from this relationship. It's just starting to bring to the surface, where's the pain? They're like, why is this so painful? And how do we manage it differently now as a couple.

Kira Yakubov:

And so I know that kind of what we were discussing prior is thinking about for medical professionals to screen, right? Screen women after birth a little bit more to recognize that this is an issue coming up. What are some of your kind of suggestions or recommendations for whether it's medical professionals or for women to advocate to see the screen? Do they need this help? Like, are they struggling in a way that warrants like additional counseling or support for them?

Nicole Bolognini:

Sure. Yeah. So I always think if you feel like things are not right, or you're just feeling off, go talk to a therapist, it's not going to hurt you, it's probably going to help you adjusting to having a baby is pretty much hard universally, for many people that are like, Oh, this was great. This is gonna be challenging. There's that's why people always say, Why is there no instruction book, in terms of screening, you know, prenatally before baby's born? We often aren't screening for anxiety, depression at all. And we should be because many times it crops up in pregnancy, but we are doing medical appointments every month, and then every two weeks or every week until that baby is born. Yeah. And then we don't see that woman again until six weeks after she had that baby. So where is the screening in that window? That's where postpartum anxiety and depression are most likely to come up in that six week window. So some pediatricians will screen at the babies first visit the hospital here in New Jersey, it's a law they have to screen in the hospital when a baby's born. I don't know if that's the case in Pennsylvania, to be honest with you, but important in that process is relationship because many women I work with will tell me Yeah, I lied on that screen. Like I was not about to tell this nurse that I just met. How awful I feel. How do I know she's gonna judge me? How do I know how that's gonna go? Or I don't want to talk about it with her. I don't know her. Yeah. So I think it's really important that ongoing providers like the OBGYN the doula the regular therapist that was seeing that person before are actually not just handing out that that screening whether use the GAD seven or there's the Eaton Burg, postnatal depression screen, you can use you can use the PHQ nine, not just handing the paper but saying, Hey, listen, it's really common one in seven women have postpartum mood issues. Now, if something's bothering you, even if it's not going to show up on the screen, let me know I want to hear about it. And I want you to have help because it doesn't have to be that way. You can actually enjoy this postpartum time. So having some of that dialogue and that conversation with women in normalizing it is a big piece of this. When I was postpartum, I struggled with postpartum anxiety. And some things were said by providers that I was just kind of like, Oh, that is not something you should be saying to women, like, Hey, if you just go on more dates with your husband, you'll be happier. We don't want to tell women that because that's like the last thing they feel like they can do right now. Or some women handle motherhood better than others. This isn't about you're not handling it well or you're weak or there's something wrong with you. This is really about how your brain is wired, how you handled birth, whether you have a pre existing history, there's so many other factors here. It's not about personal weakness or personal strength.

Kira Yakubov:

Wow. I mean, you like you said it seems like really normalizing it and having that be a huge part of the process for medical providers to have sounds like additional training or just being able to be a little bit more empathetic. For this person who's experiencing this new thing through the, like the beginning to the end of it and afterwards to

Nicole Bolognini:

write, right, just treating it like any other postpartum complication, this is the most common complication of giving birth is having postpartum mood issues. And so ideally, I would love to see your OB, call you two weeks, and then three weeks after you give birth and do a screening and check in on you. I don't think anyone's gonna listen to me about that. But that's what I would like to see is that, you know, or we're sending those screenings electronically, and we're sending some information out to women saying, Hey, this is what happens postpartum into a lot of women. If this sounds like you, here's some people you can call, right, here's some providers that we trust, because you trust us, you've trusted us to bring your baby into the world. That's a really important relationship. And it's a really useful relationship, in terms of screening.

Kira Yakubov:

Absolutely. And for them to have like referrals ready to be able to provide these recommendations for, for them to see somebody, right, because even finding a therapist is really hard, right. And if you're a new mom, and you're exhausted, and you have a million things going on, probably don't have the brand like the time or energy to search for somebody and reach out and call and all of these millions of steps to get the support that you need.

Nicole Bolognini:

Exactly. And as you know, people call they don't get calls back. They people don't have openings, they don't take your insurance, whatever it is, it can be really, really stressful. That is something I really recommend that women outsource. So if you are struggling postpartum, and your husband is worried ask him to make those calls, I get calls from husbands, I'm always happy to talk to them. Of course, I have to talk to mom eventually. Sure. But it's you know, going through all that process of like finding the right provider, if you're overwhelmed, that's a great thing to ask someone to help you with people will always offer almost always offer when someone has a baby, what can I do to help and we all just go Oh, it's okay, we're good. But I really encourage people to take people up on that, like, what can they do to help? Like, can they vacuum for you? Can they make phone calls? Can they schedule the appointment with a pediatrician asked for help. If you if you can think of an idea if you can assign a task. Most people are really, really happy to do that.

Kira Yakubov:

Okay, that's good to know. And so do you feel like the partner also experiences some postpartum depression or anxiety or anything else, that they're not the ones maybe having the child or having that hormonal change, but it's still a huge life changing stressor?

Nicole Bolognini:

Yeah, absolutely. So we see a huge number of dads that also struggle postpartum. For dads, a lot of times, they feel like they've got to take care of this family. And so they don't want to complain, right, and I want to add to my, my wife just gave birth that was so difficult, I'm not going to ask her to support me emotionally. There's also a change in that relationship between the partners right now mom is so focused on this baby, that for dad that can feel really lonely. And this, of course, happens in same sex couples too. So just because the birthing parent has the hormonal shift doesn't mean that the other parent can also experience a lot of postpartum mood issues, postpartum distress, even trauma, we definitely have seen partners traumatized by seeing their partner go through, that felt like threatening, so really important that whenever you have a big life change, whether it's adopting a child giving birth to a child, or all of those other things that happened that have nothing to do with children, to remember that it's normal to have an adjustment period. But if you're not recovering from that adjustment period in two or three weeks, then there might be something else going on.

Kira Yakubov:

Okay, so everybody needs support. Everybody needs help and support to get through this major life transition for them, even though it's a very happy and beautiful moment. Right, like we can have these mixed feelings and contradictory emotions coming up.

Nicole Bolognini:

Yeah, absolutely. I mean, isn't it true, we all need support at some point in life, right, like, nobody's getting through this alone. So this is a time where accessing that support is really important.

Kira Yakubov:

Yeah. And do you also work with individuals where let's say they may have had some miscarriages or they're having a difficult time getting pregnant and like what that journey looks like?

Nicole Bolognini:

Yeah. So that's part of the perinatal experience right I'm miscarriage is still a pregnancy, women still experienced postpartum issues after the loss of a child in addition to the grief and the loss. So infertility similar in that there is just so much grief around that whole process and and often frustration, and often medical trauma, right your body is put through if you are going through IUI IVF treatments, your body is put through a lot of stress. And a lot of times that medical trauma also kind of can get dismissed because it's like, well, this is what you want. You don't have to do it. But you may not feel that way about it right. And so being dismissed in your emotions because especially for the woman who's going to carry that child, there's just a lot of strain put on your physical body In addition to the stress of all the scheduling, and you've got to be at disappointment at this time and just stay, and you cannot change that appointment, and so you've got to find a way to get there and snow storms you got to get there. And during COVID, right, we've had so many women that experience so much stress around just getting pregnant.

Kira Yakubov:

Wow. That's sad to hear that some medical professionals might say like something so insensitive, like, well, this is what you wanted, or you asked for that.

Nicole Bolognini:

I think people get it a lot from family members, honestly. I mean, people working in the IVF, you know, reproductive technology community, they kind of get it and are a little more sympathetic, but you'll get family members who will say, Well, you already have a kid like, why are you doing this to yourself, because you're trying for a second with, you know, fertility treatments. Or you could just adopt a you don't have to do the app. And again, we're really dismissing people's experience when we sort of either give them the silver lining, or tell them, you know, why are you not solving the problem the way that I think you should solve the problem, right?

Kira Yakubov:

Yeah, just questioning their judgment or just feeling really just being really insensitive to their emotions never

Nicole Bolognini:

aligning right, not aligning with what that person's experience is.

Kira Yakubov:

Yeah. And so is that something that you also help individuals work through is like families, how they deal with how other people speak to them or treat them through that process? Whether it is they're like struggling to get pregnant, or they are pregnant? Or post alone? Everyone has an opinion on how to be a parent.

Nicole Bolognini:

Yeah, so I'm a big proponent of like, come up with your canned response. Right. So one of the ones that a lot of the moms they work with get is like, when are you going to have another baby? And I just say, it's really hard in the moment to think of how to respond to that, because it can be an upsetting and distressing question for any number of reasons. So I'll say, you know, like, what could be your canned response? It can be snarky. It can be like, what are you going to have another baby. But it can also be like, actually, we're just really enjoying our time with this one. And we're, you know, we're not really talking to anybody about our plans to have another child. So people can kind of come up with their script. And then just keep saying it. And eventually, a lot of times those family members that will ask every time they see you, they know what you're gonna say. And they'll stop asking, hopefully. So that's one of my strategies. But yes, we definitely need to talk about in therapy, how to deal with relatives, and how to deal with friends that are maybe well meaning or hurtful in their comments.

Kira Yakubov:

Sounds like setting boundaries, and just having your go to responses. And I like the snarky one. You know, it makes people not asked again, or just a step back to think about, like, probably shouldn't be asking this personal question to someone that you don't really know what they're going through or struggling with.

Nicole Bolognini:

And it's always okay to just say that to like, I'd rather only answer that question, or that's too personal of a question, or I, you know, not discussing that was people. I think a lot of times, you know, there's this kind of sense that we have to protect everyone's feelings. But if our feelings are being hurt, we can set a boundary. And it's okay to do that.

Kira Yakubov:

Yeah. And so are there any kind of, I don't want to say common things that you see, but may not be as common for everyone else to recognize, like some of the struggles or things that come up for moms while they're going through this process.

Nicole Bolognini:

So I don't know if there's any like, main things, I think the experience can be different for a lot of people, bigger things we see with anxiety, depression, or not enjoying things you used to enjoy. not enjoying things at all, feeling like even when you do sleep, you don't feel rested, feeling just a high level of anxiety, high level of panic and anxiety. And panic doesn't have to be about the baby, I've seen a number of women with anxiety about what's happening in the world, right. And it's not about the pregnancy or the baby, but it's like the you know, the world is horrible right now. And that's what my anxiety is about. And that could be postpartum related. Because now your, your view of the world has shifted. So it manifests differently for a lot of different people. But when you don't feel like yourself, when you feel like you can't enjoy things, when you feel like you can't take your baby out and try new things that you wanted to try that you thought you were gonna do, because it doesn't feel right, or does it feel safe? Those are some signs, then to get help.

Kira Yakubov:

Yeah. And so what kind of made you focus specifically on perinatal? Right, I know you you kind of mentioned some of the different experiences. Why was this something that was kind of special for you that you wanted to really focus in on.

Nicole Bolognini:

So I went into this in large part because of my own postpartum anxiety. I have three kids. Every time I had postpartum anxiety, it's just the way my brain works. And I felt like and I was handed, you know, therapists, business cards, who were not specializing in those who are not trained in this and I felt like, oh, I don't know, am I going to waste my time going to talk to this person, they're not going to get it. Or they're going to kind of just be like, well, you know, just go take some more walks, right? Like, that's not enough when you're going through that. And so I really felt kind of alone because of my history kind of working with attachment and bonding. I thought how important it is for moms to be okay for parents to be okay because kids are never going to be okay if their parents aren't okay. And That's what made me go on to get the credential the perinatal mental health certification, because I was already working with young families and parents of young children. And now I was like, let me get this certification and really connect more with people in that postpartum period and make sure that they are getting the help they need, and they feel understood.

Kira Yakubov:

So it sounds like a really safe place with you and at your practice, that you have all this knowledge and training and expertise to specifically help people going through this,

Nicole Bolognini:

we definitely want to be there for people. And if we aren't the experts that can be helpful. We want to provide those referrals so that people can get connected with somebody who's really going to be able to help them. Yeah.

Kira Yakubov:

And so I didn't even realize that there was a certification for that. What is like, what does that entail? Is it kind of go through the process of the changes in our bodies and our minds and how to help specifically through that?

Nicole Bolognini:

Yeah, so Postpartum Support International has a perinatal mental health certification. And it's a great idea if you're looking for a postpartum therapists, or prescriber to look for someone with that certification because it is open to mental health therapists, prescribers and other people like doulas and other people in the field can also get the certification, there is a requirement to take a number of CPUs related to perinatal mental health, there is a test involved, so everyone that has that credential has passed that test. And there's an experience in peace, a certain amount of experience you have to have, and you have to, you know, attest to having done so many hours, which I can't recall how many hours it was now of work in that area in that field. And then we have CEU, as we continue to get to maintain the certification.

Kira Yakubov:

Okay, that's wonderful. I had no idea. I mean, it's not something I specialize in. So I didn't even realize, but I mean, it's great to know that there is a lot more training and specialty that goes into that for people who are looking for specific help with us.

Nicole Bolognini:

Yeah, and even for professionals who maybe don't want to specialize in this, but they're had some postpartum parents come in, it's great to just take one of those psi training. Yeah, we're a little bit more about the prevalence and the risk factors and some treatment options. Because they think a lot of you know, a lot of us in the field, do work with postpartum parents without that certification, because no common time to experience stress adjustment issues, mood disorders, those kinds

Kira Yakubov:

of things. Absolutely. And so I did want to touch on breastfeeding, because I know that there is a lot of myths about that, or a lot of shame or pressure around if a woman should breastfeed or she shouldn't, or at what point kind of to make that decision or to differentiate if that's good for them and their baby, kind of what your thoughts are what you've seen in your practice with that,

Nicole Bolognini:

you know, we know from research that breastfeeding is good for babies. And we know that that oxytocin release that we get when we're nursing can make us feel good. We know some, there's some research to support that. That research has been sort of exaggerated. degree because there are also many women who experience breastfeeding as painful and difficult and emotionally draining, or something that just isn't going to work for them. And so my emphasis with women is if this is something you want to do, working for you, 100% want to support you. If this is something you want to do, and it isn't working for you, how do we get you the help, you need to get to where you want to be, or to accept that sometimes things happen in that breastfeeding experience that we don't have control over. There is a lot of pressure on women that like, oh, well, if you're not making enough milk, you could have done all these other things. Or if your baby's having allergies, you could give up all of these foods, there has to be a line at which going those extra steps become so detrimental to moms mental health, that it outweighs the positive effects of the breastfeeding. So I really just tried to encourage families to look at the whole picture, not just what's good for the baby, but what's good for the whole family, and what's gonna work for them. And that's going to be very different based on who you are as a person who your partner is, what your baby is feeding, like how easy or hard it is for you to nurse like there are a lot of factors there. And so there's never any judgment, it's just what's going to make sense, I am more interested in developing a healthy attachment relationship between parents and children. And that can be done with or without their breastfeeding. It's not a requirement. And there is some I think sort of like belief like in Attachment Parenting that like this is a big part of attachment. But there are lots and lots of people with healthy attachment who were never breastfed. And it's just not a requirement to get there. It's great if it works. And it's a wonderful way for mother and baby to bond. But there are lots of other wonderful ways for mother and baby to bond to. Yeah,

Kira Yakubov:

I'm happy to share that because I know that there are a lot of women that might feel some shame around that or other people might give them their own opinions like you should do this instead. So I'm glad that there's a lot of openness around really like what are your specific goals and what's going to work for your family versus like this should be the first thing you try and if it doesn't work, then you go to something else. Right Absolutely. And so I heard um, that you might be more familiar with this, but actually heard that breastfeeding can be painful or difficult if the child if under their tongue, right, there's, I can't think of the name of like this part that attaches it that I never heard of. But I just heard of this through, you know, some of my friends and family members and things that they never knew they were never taught that this could be painful for them, if that's what's happening for the baby. And then not knowing until you know, they went to a doctor did more research and then figured it now,

Nicole Bolognini:

tongue ties. And also their lip ties and Buechel ties in the cheek that can definitely make breastfeeding more complicated. And some women because of either the shape of their breasts, or the shape of the baby's mouth, can nurse a baby with a tongue tie without an issue, and some cannot. just impossible. And there's different levels of severity to those. What I often if I work with someone while they're pregnant, and they're planning to breastfeed, I generally suggest, find a lactation consultant you like, before you have that baby, you don't need them, then you don't ever use them, but call them up. And one of the things I like to ask lactation consultants that I have worked with is what their approach is to not breastfeeding, right? Are they an all or nothing lactating? There, I don't refer to them. That's fine, if that's what somebody wants. But I'm looking for someone who's going to say, Okay, this is working for you, this isn't working for you, like, let's put all these pieces together, here's some strategies, some things to do, to get the most out of this relationship with your baby, whether it is I want to nurse a little bit or I'm okay with pumping or whatever it is. And I have a couple of lactation consultants that I refer to that I think, are really great with that sort of thing and kind of kind of understand the whole family and what's best for everyone.

Kira Yakubov:

So kind of on a spectrum, we're going to be creative, we're gonna figure this out. It's not just black and white thinking around it,

Nicole Bolognini:

right? Because for example, with tongue tight, you can get a tongue tie release. And for some moms, they want to do that because breastfeeding is that important to them. And that's great. If that's the decision you want to make. And for other moms, they don't need to go that far. And if they're pressured to do that, they may do it. But I want that mom to look at what's important to me. This is what I want to do. Do I want to get that tongue tie released? Or am I okay with not nursing and maybe doing some other type of feeding?

Kira Yakubov:

And so what do you mean by release? Is that like having in the baby's mouth having that like removed or?

Nicole Bolognini:

Yeah, so they can they either cut it, or they use a laser to open it up so that that baby has more mobility in the tongue to be able to breastfeed?

Kira Yakubov:

Interesting. There's so many things about being pregnant, having a baby. And afterwards, this whole process that I feel like is not common knowledge or not something that's taught or talked about enough that these are like things that, like women kind of go through after the fact. And after they're researching, they figure it out instead of having this information ahead of time or throughout the process.

Nicole Bolognini:

Yes, I think that's very true. I think that's why it's so hard to adjust to, right. Yeah, we just, we almost can't explain to people what it's like, if you think it's a good sampling of how parenting will be, because that continues a lot at once when you have a newborn, but there's always new surprises like I compare parenting like to that game, whack a mole, right? When you hit one mole, and then another one pops up, like that's a parenting like, as soon as you figure out how to get that baby to sleep. Now they're going to have some weird reaction to food or some other things going to happen and can be really stressful.

Kira Yakubov:

So constantly on your toes. It's a never ending cycle of new things popping up and kind of taking these challenges head on.

Nicole Bolognini:

Yeah, yeah.

Kira Yakubov:

So Nicole, what is coming up next in your professional life for your practice that you'd like the listeners to hear and know

Nicole Bolognini:

about? Yeah, so we just opened in December and office in New in, which is in Sussex County in New Jersey, where I have Jessica working, and would like to expand the hours there and bring on another therapist trained in EMDR. We didn't talk about EMDR. But it's one of the therapies that I do and I get people calling and asking for that. So I'm looking for to hire someone that does EMDR to expand the practice there, but just you know, continuing to grow continuing to be accessible to families as a support and advocating for good perinatal care.

Kira Yakubov:

Wonderful and where can people find you if they want to reach out to work with you or your practice?

Nicole Bolognini:

Yeah, so the best thing to do is probably go to my website, which is www.Skylandswellness.com Skylands with an S and it's all one word.

Kira Yakubov:

Awesome. Nicole, thank you so much. You have a wealth of knowledge. This was really awesome to have you on and have your insights. So thank you so much for being a part of this episode.

Nicole Bolognini:

Thanks, Kira. Was fun to talk

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Kira Yakubov, LMFT

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