“Rattled and the Power of the Postpartum Brain” – with author and psychologist Dr. Nicole Pensak, PhD

Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OBGYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. Nicole, Dr. Pensak, PhD, author, podcaster, celebrity. Thank you for coming in person, and talking about your book. I really appreciate it.

Dr. Pensak: Thanks for having me. I’m a big fan of the podcast, and I’m just happy to connect with you in person. I feel like so much more happens in person anyway.

Dr. Fox: I agree. I agree. And we were talking before that we’re both authors now, and we published our books at the same time.

Dr. Pensak: Yup. The same pub date. I was really excited about that.

Dr. Fox: It’s like having the same birthday as someone.

Dr. Pensak: Exactly.

Dr. Fox: That’s exciting. So, I guess, we’re going to talk about you. We’re going to talk about your book, which I read, I liked, I’m endorsing. I think it’s terrific. It’s called “Rattled: How to Calm New Mom Anxiety with the Power of the Postpartum Brain.” We’ll talk about the book, but I guess, for our listeners, can you give a sense, like, who are you? Right? What’s going on? Who are you personally, professionally? Whatever you want to say. Open-ended question.

Dr. Pensak: Okay. I love this question. So, I am a mom of two. Right now, I have an eight-year-old and a five-year-old. I’m married. I’m a clinical psychologist by trade. I kind of got started out in academic research, and did that whole thing. But now, I have a private practice, and I write and I do some research as well, some consulting for research.

Dr. Fox: How do you decide to get into psychology? Full disclosure, I’m married to a psychologist. My daughter’s in school to become a psychologist. I’m surrounded by psychology. So, I’m just curious. They’re mostly with youngins, with children and adolescents. I’m just curious how you got into that line of work.

Dr. Pensak: We’re going deep. Right?

Dr. Fox: Good. This isn’t a puff podcast. We’re getting in it.

Dr. Pensak: Exactly. So, I mean, I think, personally, anyone that gets into psychology has a colorful background, like childhood and everything else that goes along with it. But when I was in college, I was a journalism major, and I was really interested in the who, what, where, when reporting, and different stories and whatnot. And then eventually, I just became way more interested in the why and what drives human behavior. I took my first intro to psych class and I was like, okay, this makes sense. This is for me. And I kind of always envisioned myself being, you know, a clinical psychologist treating patients and really getting in to understand their motivations and the human psyche. You know, I was fascinated by Freud early on. I did a lot of psychoanalytic reading, which is kind of far from where I am today. But it really gave me a solid passion, right, for understanding what goes on in our brains and our minds.

Dr. Fox: And then within the world of psychology, you seem to do a lot of mental health in women before, during, and after pregnancy. Was that something you always knew you wanted to do? You just kind of fell into it after time, or maybe just from having your own kids, or how do you get into that, like, let’s say, niche of mental health?

Dr. Pensak: Right. So, initially, I started out working in medical psychology. So, I worked with patients with very severe medical illnesses, everything from burn injuries to liver transplant to traumatic brain injuries, cardiovascular illness, stem cell transplant. And then I was working in these academic research centers. I was developing my program of research and an evidence-based intervention to help caregivers of patients with these advanced illnesses, like cancer, cope with stress. And I was sort of in the top of my research game, ready to, you know, do the whole thing, R01s and whatnot.

And then around the same time, I noticed that, you know, over time, after working with patients with cancer, and advanced illness, and palliative care, I became fascinated with a different type of patient, the silent patient in the room, the caregiver. And that’s where I saw a great need professionally. And so, my research really focused around that. But around the same time, personally, I actually became a mother. And I sort of had this epiphany when I became a mother. I was like, okay, mothers are really the ultimate caregiver, but we don’t have a lot of support for mothers in pregnancy and postpartum. And then I actually went through postpartum twice. The first time was in 2017. It was more mild. And I got through it with, like, you know, just weekly therapy. But then the second time was 2020. And my son was in the NICU for five weeks. Two weeks after discharge, we were on lockdown for COVID. My husband was on the front lines of treating, you know, medical patients, and he was getting updates from overseas. And I was basically terrified going through this postpartum crisis.

And so, at that point, I was like, okay, if I’m this expert in treating mental health and working with caregivers, helping them manage their stress, and here I am going through my own crisis, what’s going on out there? Right? And so, I then shifted my focus to, like…basically, I started my Instagram, drnikkipensak, and just started getting the word out of free virtual support for mothers during COVID, because no one could come in person.

And then after, you know, I got through my own postpartum doing treatment and whatnot and what I prescribe in the book, I went from really rock bottom to thriving in a short period of time. And then as an academic researcher, I went back to the literature to understand, okay, what really happens during this time? What happens to a woman’s brain? And I feel like I uncovered a story that’s not being told, but that everyone needs to hear. And that’s where, you know, my…the book just came pouring out of me. And I wrote, “Rattled,” because I was like, I need to get this information to those that need it most, the mothers. I’m used to publishing in academic journals, and nobody’s reading it unless you have insomnia, which I would recommend. But I was like, I want to get this information out there in a way that’s translated in an understandable, relatable, digestible way to the masses, because there’s so much noise out there. And, really, I wanted to promote evidence-based treatment and solid scientific guidance.

Dr. Fox: It’s so interesting that you just said that because we’ve never met before. We didn’t prep before this podcast. We didn’t have, like, a session. We didn’t exchange notes or anything like that. But you literally described the exact same reason why, at the exact same time we started this podcast. So, not because I didn’t go through…you know, I didn’t have a baby myself or anything like that, but the exact same thing you said that I’m used to publishing a medical journal, but nobody reads them. And the people I care about, patients, people, don’t read them. Right? Why would they?

And so, everyone’s sort of looking for other ways that people can get this information because it used to be you would get it from your doctor or you would get it from, you know, whoever, your therapist, you get it from your professional. Right? But people are now used to getting it themselves and with some help from their professionals. And so, you decide you’re going to, you know, use an Instagram account. You write a book. You know, we decide here we’re going to do a podcast. Eventually write a book, you know, sort of the same… It’s just fascinating. That’s sort of like a digression. But when you’re talking, I’m like, you’re like…it’s, like, literally talking to myself, the same concept.

Dr. Pensak: Yeah. I’m glad to hear that. I mean, we have a shared mission, I think, of getting high-quality information and treatment out there. And I like that we’re thinking in different creative ways because I think we have to adapt, and no longer should we keep our research just, you know, tucked away for our peers. They don’t need it. Right?

Dr. Fox: Right. I would say, like, you know, you could spend a year working on a research project and if, like, a hundred doctors read it, you’re like, yes, you know? What’s that going to do? Like, it’s cool and it’s interesting. It’s sort of flattering or something, but it doesn’t really do anything, probably. So, what’s it like writing a book? What was your experience with putting pen to paper, and doing this?

Dr. Pensak: For me, you know, I’ve always been a writer. I’ve always…

Dr. Fox: Right. You’re a journalist.

Dr. Pensak: Yeah, a journalist. But just creative writing has always been, you know, part of me and my process. And writing the book was the easy part for me. It was very gratifying. It just came pouring out of me. I felt like I had to write this, and it just kept going. I remember, you know, I had really small kids at the time. We were locked in for COVID, and I would be writing a chapter, like, while I’m drying my hair, right, or it’d be the middle of the night and I’d be, like, sending myself a voice note while my husband’s sleeping, you know, so I don’t…you know, I had to be…I had to just do…just write. And it was…I loved it, actually. Yeah. It was amazing.

Dr. Fox: That is fair. So, who is the audience for your book? Meaning, who is it that should buy? Is it every couple, every woman, anyone who’s pregnant, anyone who had a tough pregnancy? Who are you trying to get to read this book, is what I would say.

Dr. Pensak: So, the book is really tailored for parents of littles, and expecting parents. Right? Or parents who are…or, you know, expecting parents, parents who are…people who are considering starting a family. I think that that’s really good for, like, proactive mental health care and planning. But really, I wrote the book for any parent, any family. I have grandparents reading it. They’re saying it’s helpful because they’re part of the support system. And they can understand more about what the mother is going through, what the parent…what the father is going through. And so, if you have kids 4 and under, that’s your…that’s who the book is predominantly for.

Dr. Fox: I guess, the cleaner question I would ask is…and you answered this, is it’s not meant solely for people who struggle with mental health or struggled with mental health when they had their kids. Right? Yes, this book is very helpful for them. But it’s also…mentally says I read it for people who don’t know what’s going to be when they have their first kid. Right? Maybe they’ve never had any issues in mental health in their life. Maybe they’re the lucky ones. Right? And then what to expect sort of when they deliver, what’s normal, what’s not, sort of what needs to be addressed, what doesn’t, things like that, I guess, is really the message, that anyone should consider reading this book.

Dr. Pensak: Yes, basically. Yeah. It’s not just about mental health. And I think that…you know, my publisher and I actually went back and forth about this because I do have postpartum, you know, in the title. But postpartum is really just everything that comes after you have a baby. It’s not just about postpartum, you know, depression or anxiety. But I talk a lot about just the neurocognitive developmental phase of becoming a parent and becoming a mother and matrescence.

And so, in the same way that we have a lot of preparation for and supporting parents who are raising teenagers and adolescents, like, we understand that that’s a challenging developmental phase for kids. There’s so much information out there. I feel like the lay person is really familiar with that. I really want to do that for, you know, everyone to understand what parents go through and what mothers specifically go through in terms of this developmental phase of becoming a mother, now known as matrescence.

Dr. Fox: Yes. Let’s talk about that because that’s definitely not a term that a lot of people are familiar with. It is interesting that you mentioned in your acknowledgments and your thank yous, Dr. Vernon, who I also had a talk about her book. And she talks about…from a different angle, obviously, but that’s in there and that term matrescence, which is not really known to people. So explain, what is matrescence?

Dr. Pensak: Well, first off, I love Dr. Vernon, and the episode was great. So, definitely listen to that. Oh, you had two episodes with Dr. Vernon. Yeah. So, that was wonderful. And her book is great as well. And so matrescence is really just the developmental phase of becoming a mother. You know, everything changes, your brain, your biology, your hormones, your psyche, your identity, your relationships. And it’s just that whole process of becoming a mother in this phase.

Dr. Fox: Right. And what I think was really interesting about the book and what you start with, and it’s in the title, is that you discuss a lot of the research about the maternal brain, that actually something changes in the maternal brain after she delivers. Right? During pregnancy and after she delivers. I want you to talk about that a little. Like, what are we talking about? And you don’t have to give away the whole book so people can still buy it.

Dr. Pensak: Sure. Sure. I’ll give you [crosstalk 00:12:45]. Okay. A teaser.

Dr. Fox: A little teaser, a little taste.

Dr. Pensak: So, I mean, basically, the brain changes rapidly, fine-tuning and priming itself for new learning. There’s a lot of synaptic pruning, which means that the brain basically gets rid of what you don’t need for caregiving and tending to the baby. And so, it becomes actually more efficient. Right? And so, some parts get smaller, some parts get bigger. And it’s basically just all to really prime you up for new learning and to attune to your baby.

And so, you know, the reason I wrote “Rattled” was, like, okay, so, our brain biologically pulls us to take care of the baby. And your brain is in a prime state for new learning. So, let’s also get in there new learning for the mother. Right? How to think about this, how to learn stress management, but also, like, how to think about things, and your identity changing and, like, you know, all the challenges that come up unexpectedly, and the relentless problem solving that happens. So, you get…mothers get a biological push of, like, these changes that happen to become a mother. There’s also, like, a lot of experience dependent neuroplasticity and brain changes that happen from interacting with the baby and solving every 24/7, you know, relentless challenge that comes up.

Dr. Fox: Right. I thought one of the examples you gave is very interesting was this idea that a lot of people after they deliver, they’re, like, a little forgetful. Right? There’s this mommy brain type of thing that happens in pregnancy, too. And people always, like, lament that. And they’re always like, oh, my God, I can’t remember this or I can’t remember that. And, like, it was so easy for me to remember this stuff six months ago. And people think that there’s something wrong with them. It’s like a negative to their brain.

But what you did in the book is you sort of refocus it and you say, no, no, no, that’s your brain dropping the perfunctory, like, dropping what you don’t need so that you can do all the things you need to do. And then you sort of focus on, well, yes, you’re dropping that, but you’re also becoming the most attuned machine in the world to what your baby needs. And that sort of focusing almost on the positive aspect of it rather than what someone might think is the negative aspect of it.

Dr. Pensak: Yeah. So, I love talking about this. There was a great article in JAMA by Jod Pawluski. And she wrote, you know, mommy brain needs a rebrand. And so, I think that what we’re trying to say, what I’m trying to say in the book is I looked at the research, and what’s happening is that there are brain changes that take place. But mommy brain gets a really bad rap and the subjective experience of fogginess and forgetfulness, feeling interrupted, that’s very real. We don’t want to discount that. And that is an adjustment, and it’s an adaptation that mothers have to get used to.

But if you look in the research at actual objective performance on memory tasks, there’s really weak support for significant differences between mothers and non-mothers postpartum. And so, what that means is that, you know, the full picture of mommy brain is more complicated. And also, there are actually cognitive boosts that come with becoming a mother. And so, you get benefits to problem solving, and visual memory, and emotion regulation.

And so, we need to talk about all of that, and not just give the label, oh, like, a mom makes a mistake. And she automatically goes, oh, that’s my mom brain. And I’m like, well, actually, I think of mom brain as, okay, you figured out how to soothe your baby in the middle of the night. You know, is it the diaper’s too tight? Is there a rash? Is he colicky? Is the formula to concentrated? There’s, like, a million things to think about. And you solved it and were able to calm your baby. That’s mommy brain at work. That’s the brilliance of mommy brain.

Dr. Fox: Right. And then you were talking about maybe, like, sort of, you know, leveraging that. It’s like, you know, learning a new language, learn how to play the violin, something that, you know…you know, maybe we should be doing that, creating all these, like, superhumans [inaudible 00:16:44] deliver and really focus. But it is true because when brains are developing and changing, that’s the time when they learn best. Right? Young kids, adolescents, whatever it might be, as opposed to later. You get, like, another shot at new learning and adulthood.

Dr. Pensak: Right. And, you know, how I really emphasize this is that, you know, if you ever…if you’re feeling off, it’s an opportune time to be in therapy because you’re like a sponge at that point. You’re learning everything that it takes to take care of a baby very quickly. And so, if your brain is in a prime state of learning, I think…and this was my experience, and I do write about this in the book that my therapy, my treatment during this postpartum period, I think, went that much further because I was in this opportune state of, like, learning and feeling the brain power behind that. I mean, I wrote the book very quickly. I do think that it was partly that, too.

Dr. Fox: Yeah. Now, I mean…so, you know, I know, I would say our listeners know that things like postpartum depression, postpartum anxiety, very common. Right? They’re very prevalent. However you define them, whatever degree, it’s out there. Right? It’s pretty prevalent. And so, I guess, one of the main questions I was going to ask you is…so, the strategies that you’re discussing in this book and in your clinical practice, how might they differ from what people are, let’s say, typically hearing? Obviously, the worst situations, they don’t hear anything about it at all. Right? They just suffer. But then there’s, let’s say, the “typical treatment” or how it’s addressed or how it’s managed, however you say it. But then you’re discussing something maybe a little bit different. So, how does what you’re talking about differ?

Dr. Pensak: Right. So, it’s a couple of different parts. But I would say that you and I are actually aligned in how we talk to our patients and the public about this because, you know, in your podcast, I hear you say advanced planning. Right? And I think that’s one of the major components of this. I mean, we have a maternal mental health crisis in the U.S., and I think it needs proactive postpartum mental health care planning from the beginning. Your episode with Shari, you were talking about maybe starting even before, like, in the teens, when you start becoming of reproductive age. Right? Thinking about what that might look like. I thought that was fantastic.

And it was nice to hear because what I’m…I’m not hearing a lot of providers say proactively plan your mental health treatment, including — and I’ll say this — a prescriber. Even if you think that you don’t need medication postpartum, you don’t want to have to scramble last minute to find a provider if they…if you need medication. Most likely, you won’t. But a lot of times you do.

And we have a maternal mental health crisis. So, whatever we’re doing now is not working. And so, we need to capture more of these women that are suffering. And I think a great way to do that is to set that up proactively because you don’t want, again, scramble last minute to find a doctor. Sometimes you have to wait months to get in. You don’t know who you want to work with. Right? That’s sort of like dating. And so, to have that all set up and have it streamlined, you know, you can basically make a call or set up the follow-ups, establish care before you have the baby. But then the provider can also educate you on your particular risk factors for potentially experiencing postpartum. Right? And so, it’s a much more tailored approach, and also, it’s a nice safety net.

And so, I think where we get into trouble is we do a lot of psychoeducation. These are the symptoms you need to look at. These are the…this is the checklist of postpartum depression and anxiety. And I’m like, wait, we need to take that off the mother’s plates. Right? And actually, the doctors, we want to do our jobs. We want to take care of the patients. So, you know, talk to a provider if you’re feeling off or you feel like something’s wrong, you’re not enjoying it as much as you think you should. I mean, there’s so much going on. People go to therapy for a lot less. And have an objective provider assess you. You don’t have to assess yourself.

Dr. Fox: Right.

Dr. Pensak: Right? Like, that’s a lot of work. And also, mothers will just white knuckle it. Right? So, I mean, more often we’re seeing mothers who basically try everything else before getting therapy or treatment. Right? They sort of suffer through it and they think, oh, this is part of becoming a mother. Right? This is the suffering. That’s, like, normal. It’s the mother martyrdom culture out there. Like, the greater the sacrifice, the better the mother. And so, yeah, I’m trying to dispel that. Right. And just take the onus off of the mothers. They don’t need one more thing to do. And I think we, as doctors, we want to take care of our patients.

Dr. Fox: This is sort of a bigger picture about mental health, because I think that there’s sort of…there’s, like, three kinds of people out there. There’s the kind where, no matter what, they’re not seeing anybody. They’re not seeing a doctor. Their leg could fall off. And they’re like, no, I’m staying home. It’s all good. All right. God bless. You know?

But then I think what ends up being the bulk of people is if there’s something physically wrong. I’ve got a welt on my forehead. My shoulder hurts. I’m coughing. I have a fever. Yeah, I’m going to go see somebody. Right? Whatever it is, I’m going to go to the doctor, go to urgent care. I’m going to, you know, ask a friend who’s a nurse. I’m going to sort of address it. But if it’s something related to mental health, no chance. Right? No way. And we’re just going to, like, suck it up.

And then, obviously, the third people who are…the third group is the ones that we’re, like, encouraging is you should treat your mental health like you would treat your physical health. Right? If you’re not feeling right and you know that it’s very likely or commonly happens after delivery or after a big life event, certainly a negative one. Like, why would you not seek out professional help just like you would if you had a fever or something? You don’t have to live like that.

And then, obviously, some people, their treatment or how to address it might be straightforward. Some people might be complicated, but that’s true with a fever. Right? You may have a fever [inaudible 00:22:36] the doctor and it’s like, you’ll be fine in a day. Don’t do anything. Great. That’s good advice. Or take some Tylenol or you need antibiotics or obviously give me something crazy. But you don’t know that unless you go where you’re going to fall on that line or on that spectrum, so to speak. So, it’s the same.

Dr. Pensak: Right. Exactly. Right.

Dr. Fox: It’s tough. Now, I want to do some specifics, things that just at least I put out…I got from your book myself, like, reading through it, which I thought was really interesting. And the first I want to talk about is you have a whole section on baby bonding. It sort of screamed to me that you’re passionate about this.

Dr. Pensak: Yes.

Dr. Fox: So, tell me about that. I guess we’ll just talk about baby bonding and what are, like, the myths that are out there.

Dr. Pensak: So, I mean, we know that maternal instinct is a myth.

Dr. Fox: Yeah.

Dr. Pensak: And I think, when I was having both of my babies, I was surprised that I wasn’t in love immediately overnight. The baby came out and I was like…like, I knew I loved the babies. Right? But did I feel it? And I was sort of, like, in my head about it. Like, is this what it’s supposed to feel like, what not? It ends up taking, more commonly than not, time. Right? And so, from the research, it’s like, it can take months and really to get rid of the shame around that, and normalize that process. And so, I put some strategies in the book, but just to think about it in a way to be compassionate with yourself and to go easy on yourself.

Dr. Fox: Yeah. I thought that was a really good one because, again, it’s sort of like people find themselves in a situation, and it is what it is. Right? They feel maybe less bonded to their baby than they think they should or than they think their friend had or their sister had. And again, that could be wrong also. People usually assume things that are not true. And then, A, they have their bonding. And, B, now, they suddenly feel guilty. Like, all right, that means I’m a bad mother or there’s…you know? Like, whatever it is, which is just crazy. And so, I really like that you normalize it. Like, there’s a wide range of what people experience around baby bonding. And if it takes longer, that does not mean it’s a long-term issue or that there’s something wrong with you as a mother or something wrong with them as a baby. This is just a normal…it’s a normal process.

Dr. Pensak: Right. Exactly. I think mothers need to hear that a lot.

Dr. Fox: Yeah.

Dr. Pensak: Because they sort of have the feeling about the feeling. Right? Instead of just having the feeling and being like, okay, this is a process that takes time and to sort of be patient. And, like, this is what it is, and not pathologize it. Right?

Dr. Fox: Yeah. I call it the meta feeling.

Dr. Pensak: Yes. Exactly. Exactly.

Dr. Fox: Feeling about the feeling. And then you also did put in a nice…I’m going to make a plug for your worry chart, which I really liked for people who like charts and if A, then B, and, you know, sort of dividing, you know, I’m worried about things. And first thing is, is this something that I can fix or something that I can’t fix or, you know…and sort of…you know, like, worrying about the weather versus worrying about am I going to forget my car keys? Right? The first thing you can’t really fix, the second thing you can. And so, how to sort of address it, which I thought was really practical. And then another thing which is interesting was mom rage.

Dr. Pensak: Yes. Right.

Dr. Fox: Anyone out there maybe has experienced some mom rage themselves or in some others that they love. So, tell us about mom…like, what it is and what your thoughts are.

Dr. Pensak: I mean, mom rage is just this intense, overconsuming…I call it, like, once that action potential is fired, it’s just you can’t really stop it. It has to, like, run its course. Like, you have to experience the mom rage. And it really comes from feeling overstimulated, overwhelmed, hormonal changes, lack of sleep. And it’s a common experience with mothers. But I think that we don’t really understand that we’re going to feel so intensely and so angry, and so triggered at times. So, you know, I give some, you know, specific strategies in the book about how to cope with that, but also just to normalize that feeling, too, because it happens.

Now, of course, like anything, as a clinical psychologist, I’m going to look at, okay, how bad does it get? How often are you feeling it? Does it interfere with functioning? Is it getting in the way of your marriage or relationship or your ability to attune to the baby? You know, then we’re talking about potentially something different. Right? But in terms of the experience of this emotion, yes, it’s common and, you know, I would say, typical at times. But there are things that we can do to sort of, you know, make it better, make it less frequent. Right. And we want to look at that more closely to see what we can do.

Dr. Fox: Right. And you have a section. It’s not really…I guess it is a section, but it’s really overarching in the whole book, this theme of from surviving to thriving. Right. So, they rhyme. So, that’s nice. That’s something you came up with your mommy brain, I’m sure. But let’s talk about that a little bit because, again, I think sometimes people feel they’re going to pick up a book or they’re going to listen to podcasts or going to go to doctor. And it’s sort of how do I survive, like, postpartum-ness? Early motherhood, whatever it might be. Right? And that’s valuable. It is valuable to survive something. But you really try to flip it and say it’s not just about surviving, but really taking this and, like, turning it the opposite direction, like, gaining from this. So, how doable is that?

Dr. Pensak: Right. It’s a great question. And I think that, you know, first of all, I want to say that just keeping your baby alive is a huge feat. And, you know, mothers, you’re doing a great job, and you don’t hear it enough. And so, I’m not trying to put more pressure that you…oh, it’s you can’t just survive. That’s not okay. You have to thrive. It’s more like, all right, this is a science-based road map that really looks at three parts. The first part is preparation, proactive mental health planning, getting you to sort of prevent crisis, but also think about the adjustment to parenthood and matrescence in the first part.

And then the second part is really how to cope with all of these emotional changes, relationship changes, hormone changes, you know, mom guilt, mom rage, mom shame, baby bonding. And then the third part is like, okay, once you’ve sort of gotten through that…and this may be, like, a year or two down the line. It doesn’t have to be like, oh, this is the six-month plan or the three-month plan. No. It’s sort of, like, you know, once you’ve…you know, you got your mental health taken care of, that’s first and foremost. But, like, you can’t really go beyond that until you have your mental health taken care of.

Dr. Fox: Right. It’s like step one, step two, step three.

Dr. Pensak: It’s like Maslow’s hierarchy. Right? So, okay, good mental health. That’s what we want, stability. Then you can work on, you know, okay, the mom shame, the mom guilt sort of, like, not the clinical stuff, but, like, just the adjustment and normal mom experiences and whatnot. And then if you feel motivated or you feel the pep or the boost, you feel like I got this, you know, I’m feeling more confident, which happens a lot. You know, the more you know, the longer you get into parenting, the more mastery you feel because it’s all trial and error.

So, the third chapter is really like, okay, how do we take this further? How do we really thrive in motherhood? And I look at post-traumatic growth. Right? So, it’s not just about treating post-traumatic stress disorder or traumatic birth experience or trauma from childhood. It’s about flipping that on its head and saying, how do we make meaning out of this and, you know, encourage more resiliency, nurture more resiliency in the process, and take it that much further to sort of benefit from all of the things that you go through as a parent.

I talk about the self-directed neuroplasticity, which is basically just the ways that, you know, what you do impacts, you know, brain changes. And so, therapy does that. Exercise does that. Even, you know, having a hobby or something that you’re interested in, a passion, you know, that’s going to help you feel like you’re thriving as well, and sort of just upping the ante and taking on challenges in that way, little by little to further go along with this neuroplasticity that’s already biologically in place. And already you’re becoming a master, a trial and error learning, and rising to every challenge.

So, I just feel like the mom brain is, you know, very evolved at this point, but we could take it that much further if we educate more mothers on what’s actually happening. But also we remove the roadblocks along the way, like the postpartum, you know, like, providing nurturance and support, you know, even division of labor inside the house, things like that.

Dr. Fox: Yeah. I mean, also there’s a…in terms of, like, the preparation, one of the things that sort of struck me was how difficult access is to mental health care in the U.S. And it’s a very complex topic. Like, why that is, you know, is it supplies, demand, is it cost, is it stigma? There’s so much that goes into it. But it’s also part of the reason you have to plan more, because it’s hard. It’s not something…like, you can’t just go to the corner store and pick up some you know, Motrin the same way. It just doesn’t work like that. It’s hard. It’s a tough thing. What kind of response have you gotten to the book so far? I mean, do you get…do people call you up? You know, I read this.

Dr. Pensak: They do.

Dr. Fox: You know, what are you hearing? What’s out there on the streets?

Dr. Pensak: I get emails from patients a lot or from readers a lot. And they say, wow, this part really resonated with me, or I loved your book. It changed everything. You know, just really nice reminders of, like, okay, because I’m in the…like, I gave birth to the book, and now, I’m raising it in the wild. And getting it out there is really hard. Right? And so, I’m working really hard to do that. And so, getting the feedback is…really keeps me going. And also when I do, like, book talks or events and I talk to people in the community and colleagues that have read it and that use it and recommend it, it keeps me going.

Dr. Fox: It’s very rewarding.

Dr. Pensak: Yeah. It’s so rewarding. And I just feel confident that it’s, you know, a great resource. And, you know, I’m just grateful for every reader. And please, you know, reach out to me if you do read it, because I love any and all feedback about it.

Dr. Fox: Yeah. It’s hard to put a book together because it’s a lot. It’s a lot of work. You have to decide what goes in, what doesn’t go in. How do I word it? How do I make it understandable? How do I organize it? How do I do it in a way that’s, you know, supportive and not judgmental? There’s all these things that go into it. And I think, you know, reading books is not how a lot of people consume information. They’re used to quick snippets, but quick snippets aren’t going to tell the story. Like, this is a complex thing, and it sometimes requires long form. And I think that the people who take the time to…you know, instead of scrolling on whatever it is we scroll on for three hours at night, you read a book for three hours a night, you’ll get through a lot of it, you know, and it’ll be very, very valuable. So, people can obviously find you by getting your book. Right? It’s everywhere you get books. Right? “Rattled.”

Dr. Pensak: And Audible. A lot of moms, like…or parents on the go.

Dr. Fox: Did you read your own Audible?

Dr. Pensak: I did read… Oh, no. Okay. Sorry. I read it. Like, I listened to it.

Dr. Fox: No. I mean, did you…were you the voice?

Dr. Pensak: No. But I got to pick the voice.

Dr. Fox: Oh, really?

Dr. Pensak: So, that was part of the contract. Yeah. So, I actually got to listen to different samples and make a recommendation.

Dr. Fox: Morgan Freeman is my…

Dr. Pensak: That would have been better. You know what? Next time.

Dr. Fox: Yeah. Meryl Streep read for me.

Dr. Pensak: Exactly.

Dr. Fox: All right. Okay. And then, I guess, how else can people reach you?

Dr. Pensak: So, I’m also on Instagram @drnikkipensak. And, you know, I do my best to try and update the content. But, you know, I do have my private practice that I take care of patients, you know, full-time, which I love. And I’m licensed in New York and New Jersey and 40 other states and…

Dr. Fox: Four-zero?

Dr. Pensak: Four-zero.

Dr. Fox: Wow.

Dr. Pensak: Yeah. Through PSYPACT.

Dr. Fox: That’s awesome.

Dr. Pensak: I know. It’s amazing. And so, I think, like, that, to me, is promising for the direction of mental healthcare. And I also think, with, you know, the potential of more support being accessible, you know, Postpartum Support International is a wonderful resource that’s free. And it has, you know, psychoeducation and whatnot and support groups. I say they have a support group for everything. And so, you know, you can even reach out to me if you want a recommendation for resources as well. I’m happy to help.

Dr. Fox: That’s terrific. Thank you so much. First of all, thank you for writing this book. Again, I know it’s hard to write a book, and people sometimes start and don’t finish. But you did it. You finished. It’s terrific. It’s out there. I read it. I really, really enjoyed it. I thought it was really helpful. I learned a tremendous amount that I did not know. And I’m in this world. Right? So, certainly, it’s…I think it’s valuable. And I appreciate you coming here to talk about it because it’s really interesting. It’s great to meet you. And I think a lot of people will benefit from your book, from this podcast, and from other ways to reach out to you, whether clinically or through Instagram or whatever it is.

Dr. Pensak: Thank you so much. And thank you for having me. And congratulations on your podcast. I love listening to it. And I appreciate that you’re just, you know, getting the solid, you know, information out there, and helping so many people. So, I’m just so happy to be a part of it. And thank you.

Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day.

The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health, and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.