Latest / Bump + Thrive / The Motherhood Mental Load with Dr. Julie Brownley: Hormones, Identity + Finding Yourself Again

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The Motherhood Mental Load with Dr. Julie Brownley: Hormones, Identity + Finding Yourself Again · Bump + Thrive

• Lauren Seib: Today on Bumpin' Thrive, we have Dr. Julie Brownlee, a reproductive psychiatrist, an expert in women's mental health, and my cousin. Hi. Thanks for being here. I'm so excited to talk all things. Julie Brownley, MD, PhD: Okay. Lauren Seib: reproductive women's mental health. you know, I think it's a big area in which I'm, you know, I feel like half the time I'm in this room with clients. I'm someone shrink talking through things. So it's nice to have a real professional here to discuss you know, postprime depression and how our hormones are impacting us on a daily basis when it c comes to our mental health. So to kick off, I just wanna ask you why did you choose women's mental health and what Mm-hmm. Julie Brownley, MD, PhD: Yeah, so I actually started off in medical school kind of playing around with a lot of different women's health areas of medicine and originally thought I was gonna be an obi guyne, but then I had a kid in medical school. And I was like, do I really wanna go down this road of like the intense residency program that comes with OBGIN. So I decided it was a hard no. And I ended up exploring other fields. Family medicine was another one where they have some expertise tracks in women's health. and long story short, I ended up landing on psychiatry because I just felt Like it was where I belonged, and it was not what I expected. I kind of thought I would end up practicing a larger realm of medicine. And then what I realized later was I get to be the person who's doing all of the background checks on somebody's medical care because I'm hanging out, actually talking to this patient, and I'm taking their physical symptoms and their mental health symptoms really seriously and deciding. I'm not going to take this at face value. I'm going to do a deep dive. This job is the most fun job in the entire world. And the coolest part about reproductive psychiatry is that we're actually treating women as though they are whole human beings with this hormonal milieu that is constantly going up and down our entire lives, starting at puberty. Where there's this crazy erratic burst, and that's when our 12-year-olds start losing their minds. Lauren Seib: Yeah. Julie Brownley, MD, PhD: So much fun to watch. Excuse me. So this starts happening, and lots of women tolerate that really well, and others do not. Lots of teenagers think they tolerate it really well, but they in fact do not. everybody around them is like, ooh, it's about time. and they're not really having that introspection to be able to get there yet, that they're having swings in either mood or anxiety, irritability, and on and on and on. I mean, the list is forever. And then the physical symptoms as well that come with it that can be pretty uncomfortable or even impairing. So that's a fun part. And then there's this perinatal time frame for those women who go down that path, which is a full roller coaster ride. Really fun fact. If you do super well in pregnancy, you better double check how you're responding to the ups and downs. Because the women who go up here and they're trending Up nice and smooth with these hormones, and they feel good despite the fact that their life is changing, that they're uncomfortable from pregnancy, that they're having these pregnancy symptoms, that they're planning for this big additional transition. Even if it's second, third, or fourth kid, it's still big, right? Like you're still dealing with all of these things. You've got pressures relating to finances, partnerships and parenting, and then you've got these shifts that come with making plans with work. And obviously the list goes on a million miles from there. and then there's this postpartum crash, right? and if you've been doing really well here despite all of the stressors. You've got to ask yourself, why was I doing so incredibly well in pregnancy? But like life was less pressured here, and I was really rocky and up and down. you really do then have to start questioning like what is that pre-menstrual time frame looking like for you? And I always recommend tracking, and actually if you have. A daughter also suggesting very early on, once they get their period, like get to the tracking. and it is it can provide them with a ton of insight, but it can provide adults with a ton of insight who don't realize. So then you've got your crash. Lots of women coming off of this huge progesterone plummet, really have A difficult time managing that hormonal shift, which for a number of different biological reasons really shifts the way that our brains work. Again, for some women, totally tolerable from a hormone standpoint. And for others who are vulnerable for whatever reason, they really struggle. and then later on, Sleep deprivation, new person that's hanging on you constantly, maybe breastfeeding, maybe the stressor is relating to that. All of these layers of stress that come with that postpartum period, isolation, oof, that's a huge one. and so as you're coming out from that, right, in those first six weeks, there's a tremendous amount of vulnerability. And so people will see things like depression, anxiety on and on, right? And wondering, especially with their first kid, what's normal, what's not normal. So that's one that we'll probably get to dig into in a little bit. But then there's also perimenopause, which is a new hot topic. And I'm so grateful. It's so good. It's so Lauren Seib: So buzzy. Yeah. Julie Brownley, MD, PhD: good because we've been telling women. This is a no big deal part of their life cycle. And sort of going, like a hot flash or a night spell, like kind of get over it. or there's nothing really we can do. I think the shifts in our stance on hormone therapy has really helped to change the conversation in popular culture and on social media. And so we're seeing some really big changes. That I absolutely love. So I've been doing a lot of deep dive there, which I think naturally as a physician, you're drawing in people around your age range actually because they look at your picture and they're like, ooh, I want, I feel like I can relate to that person. And Lauren Seib: Mm-hmm. Julie Brownley, MD, PhD: also your own personal experience of going through life, you become more interested in things that you're Witnessing either in yourself or in your friends. And so naturally I find that our attention starts to shift through our career. I was talking to another reproductive psychiatrist, Dr. Lindsay Standeven, about this. And she was like absolutely seeing how going from an obsession around perinatal psychiatry to this kind of shift in thinking about. Perimenopause psychiatry. So long story short, never thought I would land here. Never. Never saw myself as a psychiatrist. Love this job. Love working with women every single day. It's like a roll of the dice. What's gonna happen next? The patient who comes on that I'm like, this person's rock solid. This gonna be easy. We're gonna just have a good old time. And then everything's kind of unraveled for whatever reason. And then the people who have historically struggled and had a lot of ups and downs, when they show up and life is good, it's the best feeling in the entire world. Being there for patients who have had a nosedive for various reasons, the best feeling in the entire world. So it's been just this incredibly joyful experience that I've had been gifted with with being able to take part in every single day. Lauren Seib: That's amazing. And you're a mom of two, which definitely Julie Brownley, MD, PhD: Mama two. Seven year old boy, twelve year old girl, hence the twelve year old girl. Of so much fun. Just one of the best experiences ever for me has been getting to witness my kids growing and changing every single year, every single month. I just my seven year old's By himself in another room right now. He's so independent and he's so chill. And I was like, Hey dude, I'll give you 20 bucks if you solve the Rubik's Cube 10 times today. And he's like, Yes. My goal is to get him to be really fast. I don't know why I want that so badly, but I just do. Lauren Seib: It's a cool party truck. I give you I give I give you that. Like that's a cool party truck to have. Julie Brownley, MD, PhD: Right. Yeah. and then and then my daughter is off in California just having a good old time living her best life. and when she comes home, I'm sure we're gonna be hearing all kinds of fun stories about that trip. But yeah, she's starting to navigate the hormone shifts and it's been great because she leans on me and trusts me and tells me all the things. And I get to be that person who can handle them with ease because I do it nonstop every day. Lauren Seib: That's great. That's that's a big benefit and good good mentor, mama mentor to have in your corner for sure. I'd love to go back a little bit. I have a lot of people in my life navigating this, a lot of clients recently talking about it. kind of about that like postpartum depression versus blues. I think there's a little bit of Julie Brownley, MD, PhD: Mm-hmm. Lauren Seib: a disconnect, a lot of misinformation out there to just kind of be like, what does that what for you is like? that's That's postpartum anxiety. Like, what does that what does that actually look like from a clinical standpoint versus like I'm just crying at night because like I'm looking at this beautiful little miracle? You know what I mean? I think there's a lot of Julie Brownley, MD, PhD: Mm-hmm. Lauren Seib: questions about that. And I have fond memories, just a personal note, of you checking in with me after I had my first, and it was during COVID. And like you were saying before, like super isolating. So for those listeners who maybe can't connect from a personal standpoint now, like how can we benefit? How can we support those maybe going through? this chapter as well for others. Julie Brownley, MD, PhD: Love it. So we'll hit let's hit the baby blues versus postpartum depression. I think honestly, I the more I think about baby blues and that terminology, the more I feel like it is an incredible disservice from a public health standpoint. Because why did we call that, why did we decide that we were gonna call that some entity and give people a reason to sort of go? It's normal to cry all the time or to feel really down and depressed or to feel completely disconnected from everything going on around us or you know, whatever the case may be. Baby blue is kind of what that term means is when people's hormones shift, they're going to potentially have some mood lability is is the term we use. Ups and downs that are a little bit more extreme or more oscillating a little more quickly than usual. this might be laughing and crying, this might be crying and crying, this might be just feeling overwhelmed or having times of going, my god, my whole life has just changed forever. these kind of moments. I think especially new parents will have a lot of, but women in general with that hormone plummet are going to have potentially a little more oscillation. So we've all heard that sort of, if you're crying because a Charming commercial comes on, then that's just baby blues, right? if you're holding your baby and getting misty, that's baby blues. I don't know. It doesn't feel like blues to me to have some tears here and there. I think we kind of know what it feels like to have times of like higher emotion. And so I think maybe if we can think of the blues as being more of like an up-down and really thinking of it as emotional lability rather than blues. Because blues to us means like I I don't know your interpretation of it, Lauren, but I hear that and I think, somebody's blue, they're down, they're sad, they're they're not happy, they're crying, they're, you know, and I don't know, isn't that doesn't that what it convey feels like that's what it's conveying, is that you're sad. I think when somebody's persistently sad, that's a problem. And it may not be a medication problem like requiring medication intervention, but it might be the kind of problem where that person needs additional support, either from friends, family, a therapist, the church, where whatever wherever those places are that they receive support to sort of wave the The flag and sort of go, hey, I think I'm in need of some additional support. The other big one is sleep. And if people aren't getting enough sleep, their mood can really dip. People become sad, down, irritable, exhausted. Lauren Seib: Mm-hmm. Julie Brownley, MD, PhD: And so sometimes the interventions are more lifestyle interventions and social supports. And Other times it really is mental health professional. So either a therapist who you can sit down and talk to, or a psychiatrist who you can sit down with, talk about symptoms, and potentially end up taking a medication either for short term or more of a long-term picture. And I feel like there's some stigma and difficulties surrounding that step relating to medications, but There are so many things to think about leading up to that that sometimes can be, I don't want to say an easy fix because our society does not make this simple for women. but I do think that there are steps that can usually be employed to really get that additional support from women or for women. yeah. So that that would be the I guess the the kind of big picture. if your anxiety is spiking up, that's another one, right? We talk a lot about postpartum depression. We have a skill that we use in Ob-Gayn offices, that six-week mark, where you're supposed to write down like how crappy do you feel? And if you hit a certain number, you're supposed to be counseled to or be referred for additional support or whatever. That all almost never actually happens the way it was meant to. Like Lauren Seib: I remember checking that off. I'm like, this is the weirdest, like, what am I supposed to say? Like I'm crying for help right now? Like, I don't know. It felt really off for me. I remember that both times after having my kids. And I remember being like, seriously, they're not gonna even ask me this in person. I'm like writing it down because like they don't wanna handle you know what he mean? It was there's a disconnect for sure. Julie Brownley, MD, PhD: There's a huge disconnect. Like, why isn't your Obi Gain asking you some question? I mean, I personally hate scales. There are definitely psychiatrists out there who use them and use them religiously, like every appointment, they'll have the patient put and whatever, eat two each their own, right? Lauren Seib: Yeah. Julie Brownley, MD, PhD: But going into an Obi-Guyne office. And rushing through a physical exam and how's your baby doing? And then, let's just have you fill in this sheet and not really ask you about how you're doing. And then what do they do with that number? And what is the cutoff? And what does it mean? I mean, for me, those questions can be interpreted in a lot of different ways. And a lot of women are kind of uncomfortable writing these things down onto burst just. Lauren Seib: Yeah. Julie Brownley, MD, PhD: Awkward and like not the way that I would want somebody to assess my mental health. Lauren Seib: Right. Julie Brownley, MD, PhD: so I do think that is not ideal, but then also the referral part of the picture. So say somebody hits that mark. Okay, what's next? Like, are we really going to help this person get support? I've had patients who've come to me six months postpartum. Who had raging scores on those scales and they were not referred. And they would tell me, yeah. And my score was horrible on that thing in the Obigaina Lauren Seib: Yeah, yeah. Julie Brownley, MD, PhD: office. And I'm like, well, did they offer you some additional support or referrals? Nope. Okay. I'm not really sure why we're doing that then. There is a new scale that's being used in the postpartum setting in Obigayana offices that. Assesses for postpartum anxiety. And that scale again, I think has some of the same issues that the depression scale has. People don't want to fill it out, or people do. what does it mean? Are they underestimating their own symptoms? Like half the time, women are sitting there going, is this normal? Is this not normal? Am I overreacting? Am I just like everyone else and just having normal? So why we're doing that to leave a woman sitting there going, I'm not really sure. Is it four out of five or is it three? It's like really weird. Lauren Seib: Right. And I feel like too, it's like the whole In the postpartum space too. It's like that six-week appointment is all you really have, right? Until you have your next annual visit, Obi-Gine stuff, right? So it's like, I I feel like at that six-week mark, I was like, all right, I'm sleep deprived. I'm like every other girl that I know going through this, like whatever. And it wasn't until like a little bit after that that like I noticed the anxiety came up, right? So it's like, what Julie Brownley, MD, PhD: Mm-hmm. Lauren Seib: am I supposed to actively while having a newborn? Your six weeks, you know, are through. So your your partner's most likely back to work. So now I have to go actively It's just like an extra step to go reach out to either your Obi-Guy get referred or find someone like you who is rare. I mean, that's why I'm so excited you're here and you do virtual, so we can get you out there to support, you know, to help support women because it's it's, I feel like like my what I do, like we're not a dime a dozen, right? Like we're definitely specialized. but I Julie Brownley, MD, PhD: Yeah. Lauren Seib: remember like the anxiety really peaked like after that. And I'd love to discuss a little bit more like the breastfeeding hormones too, because I know for me the hardest part postpartum both times was at six months, which is when I stopped breastfeeding both of my children. And that plummet hormonally, I was a hot mess. Like, talk about anxiety, talk about depression, talk about mom guilt. you know, I went back to work postpartum both times really soon thereafter because for me, I just knew mentally. That would help me. people think I'm crazy. I went back postpartum three, three weeks postpartum both times, but in a very different, I know I kind of was like go me, but in a very different capacity. I could see one client a day and I was like, I checked that box. That like filled my cup. I feel like I have purpose, right? Outside of changing diapers and being a cow for my child, literally. But I think Julie Brownley, MD, PhD: Yeah. Lauren Seib: that that plummet from breastfeeding, those that hormone shift knocked me on my ass for lack of better words, both times. so also like I don't know if there's any misconceptions around that or if that's like I don't want to even say normal, right? Because that's like it's so different per person. But if you can maybe kind of hit on the breastfeeding aspect and the pressures and all that too, I think that would be a really interesting angle to kind of take this conversation. Julie Brownley, MD, PhD: Yeah, this is a topic that I get really psyched about because I feel like we are not talking about this enough, except for in the context of breastfeeding is the only way to go, and you've got to do that for the health of your child, and it's gonna change the outcomes for your kids' brain and for their growth and development. Okay, those are overstatements. beyond words overstatements. Now, there are plenty of nurse practitioners and psychiatrists who would come down on me with a hammer for saying this, which is sh shocking because it is so insanely oppressive to women who are struggling to tell them you have to breastfeed for the health and sake of your child. That's nuts. That's completely nuts. And there's an incredibly well-conducted study that looks at this very question using a very different study design, far better controlled, closer to gold standard. You can't randomize women to breastfeeding and not breastfeeding. You can't do that, right? Women either select by self-selection to breastfeed or not to. You can imagine taking those two populations of women That there are very different characteristics and qualities to that population as a whole compared to this population. I mean, how much support do you need to breastfeed? What is the level of education? What is the level of income? What is the level of work demands, right? Some some people don't want to go to work three weeks later, but they have to. So what does that look like when it comes to outcomes for children? Right? We know that, and this is a sad truth, that when broadly speaking, from a statistical standpoint, there are certain demographic features and other factors at play that are like you know higher levels of finance, certain race and ethnicities, certain covariates like, are you taking medication? Aren't you taking medication? What is the substance use history? Like, right? All of these Lauren Seib: Ahead. Julie Brownley, MD, PhD: things are going to play huge roles in how our children turn out. Huge. Now, step back. We have just said that this population of women are equal to this population of women. And now we can tell what breastfeeding does or does not do for our child. Nope, absolutely not. And that's how the studies have been conducted. That's how we've generated these huge overstatements, interpreted data in a way that is totally and completely incorrect, right? These are associations. Their associations, and those associations can be with breastfeeding, but also could be with any of these other number of variables that are protective to children, growth, and development. So for me, when you look at studies like this. Right, self-selected populations, there's no randomization. you can try to control for some of these variables, but it's very hard in general to do. That data is you have to take it for a grain of salt, right? When the WHO came out and said you should breastfeed your child for two years for their health, we have to remember what the WHO is. It's the World Health Organization. world health. And so what we're looking at are developing countries with filthy water that's contaminated with things that are dangerous. I don't mean filthy, but it they can be contaminated with microorganisms, right? There are things in the water that are dangerous for babies. If you were living there, this would be a very different conversation. Because you mix formula into that water. And feed it directly to a baby, you are risking their health and wellness. Okay, they you can die from contamination from these microorganisms in the water. So WHO has a very strong stance, obviously, on this. And also from a physical perspective. Buying formula can be a hardship, right? Particularly in developing countries. So we're gonna go ahead and encourage certain women in certain countries more than others because the safety of the infant actually is at play. Now, it's probably just as hard in developing countries as it is here. The pressure is different, very clearly different. So here, We have clean, fresh water, right? We have access to things like formula. Not not everyone, right? But the vast majority of people do have the capacity to make formula work. Those who don't, that's a different story. And you know, thankfully there are organizations like WIC and other organizations that can help support moms who do not have the means to access things like formula. Long story short, right, when you look at these two populations in a more clear, standardized way, you do not see the outcome differences. So if you take a mom who had one baby who was breastfed and one baby who wasn't, and you look at the outcomes for those two children that have lived in the same household, presumably under very similar circumstances. as far as demographics and other covariates, what you see is that the children are exactly the same. Exactly the same. It is about the home environment, the community environment, factors like again, substance use, smoking, things like that, food, access to healthy, you know, food products. These are all the things that define the growth and development of children. Breast milk is not. Breast milk is a wonderful thing if it works for mom and baby. If this is a bond that's built, yes. People can argue things like antibodies. Are we changing like the immune system? Maybe. But what are the true defining factors for the trajectory of these children? And it's not breast milk. The pressure is insane. The amount Lauren Seib: It's so insane. Julie Brownley, MD, PhD: of pressure on women. Lauren Seib: Breast is best, all of that. Yeah, it's so tough. And I feel like it's not spoken about. Like it there was a very big like shift. It's funny. I feel like my mother's generation didn't breastfeed a lot. Like I feel she was like, wait, you're breastfeeding? I will never forget it. And then I was like that crazy competitive, like logged every single ounce I did like create I pumped for five months because my daughter would would not latch properly. Like I w put myself through the ringer. And then with my second, I'm like, well, I did Julie Brownley, MD, PhD: Okay. Lauren Seib: six months with her, so I have to do six months with him to make it even. Like the the games we play is so are so challenging and put like you said, the pressure is just uncanny. So it's like, why, why are we doing this? And that's why any woman who comes in here, I'm like, the reason why I ask, are you breastfeeding? is simply to know some movements don't feel good when you're breastfeeding. I'm not gonna make you do a burpee if you your milk Julie Brownley, MD, PhD: Mm-hmm. Lauren Seib: just can't. In as you walked in my door, right? Also, which we talk about, Danielle, my business partner who's currently on Matt Leave, she has had her baby Friday. she and I spoke, there's a lot of interesting research coming out about muscle mass and breastfeeding and how it's harder for your body, if not next to impossible, to put on muscle mass when you're breastfeeding, because your body's doing, in its mind, far more important things. Julie Brownley, MD, PhD: lot. Mm-hmm. Lauren Seib: So it's interesting to hear that and it's I hope this gives some women a little bit more grace because there is such a Julie Brownley, MD, PhD: Yeah. Lauren Seib: stigma and pressure. Julie Brownley, MD, PhD: Such a huge stigma and pressure. When it comes down to it, right? I mean, you're talking to a woman who breastfed for five years of her life. so it's not that I'm anti-breastfeeding. It's not that I don't see the benefits from a bonding perspective, right? But the biological benefit really is. far more limited than what we talked about. So I do hope that that relates to women that it's okay. If you are sleep deprived and desperately need sleep and you're pumping in the middle of the night or you're breastfeeding all night long, your partner can't take half the night because you know, you're required for sustenance, then you really put yourself in a pinch. Right. And that's not a woman's fault, right? Like they get to make that decision, but I think the pressure is so extreme. So I talk to women a lot about, hey, it's okay to either pump, right, and give your partner a bottle to feed in the middle of the night so that you can get consolidated sleep. And I always say early on, like in that first 12 weeks, at least four hours of consolidated sleep a night. You need Four solid hours, put in the earplugs, go to a different room, lay down and get four solid hours of sleep. And oftentimes when women are breastfeeding, that's impossible. Lauren Seib: Yeah. Julie Brownley, MD, PhD: And so asking yourself, like, what are the modifiers here? And I've had women tell me, I let my partner feed a pumped bottle, but then I wake up to pump. in the middle of the stretch where the partner is feeding the bottle. And I'm like, why are we doing this to ourselves? Right. So when women start feeling really unwell, anxiety's high, depressive symptoms, things like that. Again, first stop is lifestyle factors. Can we help this woman get sleep? Can we recruit a neighbor, a family friend, someone from the church, mom, stepmom, whoever? To come in and do a couple of shifts a week so that mom can lay down for four hours and sleep. Right. And sometimes that is without breast milk involved, right? And when that happens, I give women permission. It's okay. It's okay to combo feed. Formula is not toxic. Formula, the water in developing countries is toxic. Lauren Seib: Right. Julie Brownley, MD, PhD: In certain cases, but the formula is not toxic, right? And so giving our children sustenance while taking care of ourselves is central. You know what I love though? You asked this or you kind of posed this your own trajectory, which was I was doing fine, I was doing fine, then I stopped breastfeeding and all things went off the rail. That is a fascinating phenomena. That I see in so many women. So many. It isn't talked about. Well, I'm not really sure why we don't talk about it. I know that the studies are very limited on what from a mental health standpoint that phenomenon does. Okay. But essentially what we know from a physiologic standpoint is during the time frame of breastfeeding, there are Hormones relating to breastfeeding that feedback on our brain to suppress menstrual cycling. Now, not all women don't get their periods during that time, right? Like a lot of women are like, yeah, that I got my period back like three months later. Okay, you may have gotten your period Lauren Seib: Yeah, that was me. Yeah. Julie Brownley, MD, PhD: back, right? But the curves are not the same. The curves Lauren Seib: Interesting. Julie Brownley, MD, PhD: are suppressed. So you aren't necessarily getting that full up. And down that you would normally get during a non-suppressed time. Your libido is suppressed, whether you got your period back or not. You might have vaginal dryness. That might be happening whether you got your period back or not, right? Like you think about all the other things that you still see while breastfeeding. And they don't go away if you get your period back. And the reason Lauren Seib: Mm. Julie Brownley, MD, PhD: is there's so Of some of this signaling. So our menstrual cycles are kind of incredible. They can be an ovulatory, meaning you don't ovulate. And so that's a slightly different cycle. And you can have shedding of the uterine lining without having necessarily this full swing that you would normally have outside of the breastfeeding window. So we know that breastfeeding suppresses a lot of signaling. And when women stop, it opens up for typical hormonal axis to come right back into swing. What can happen for women who are really sensitive to higher levels of and it's often erratic during that moment where you know it can be weeks Lauren Seib: Yeah, yeah, yeah. When things are leveling back out. Julie Brownley, MD, PhD: of erratic signaling that isn't quite right. And so women, there's a subset of women. Not sure who they are, why they are, what, but there's a subset of women that go off the rails at this moment because Lauren Seib: Yeah. Julie Brownley, MD, PhD: of the hormone shift. Right? It's not a shift necessarily in your lifestyle. And in fact, it's often a lifestyle improvement because you don't have somebody attached to you or you're not like attached to pumps. And I still hear a pump and it makes me cringe. Lauren Seib: same. I it sends me. Sends Julie Brownley, MD, PhD: Yeah, I think that's Lauren Seib: me. But it's interesting you say that because I do feel like so my kids are back to back. I've talked about this on the podcast before. So Remy turned one and I got pregnant the next month. So they're 22 months apart. and I feel like those six months, kind of like you were saying, after I was done breastfeeding, that first month is really erratic, is a great way to put it. just very touch-go, guilt that I wasn't still breastfeeding, stoked that I wasn't. My body started changing really with the stopping of the breastfeeding. I mean, I was the classic, like I I put weight on breastfeeding because I just started working out again. I was just in an eating machine and I just couldn't really tip you know, that that aesthetic change that I wanted. But then kind of, you know, I had those six awesome months, so to speak, and I was like, I'm back at it. I feel like myself again. And then I got pregnant again. I'd love to talk to you a little bit about, you know, number two, number three, things that you see in your practice in terms of identity shifts. or commonalities because for me, that second pregnancy, while physically it was better, emotionally it was so much harder. I felt like I was missing out on my daughter and watching her. I don't remember, I feel like her second year of life. I was so like in a daze. I feel like I didn't feel like myself in my own body. I feel like my whole body shifted really quickly to be like, this again, right? Like Julie Brownley, MD, PhD: Yeah, yeah, yeah. Lauren Seib: And then I think too, there, you know, the sleep deprivation from so having a young child. There there was just kind of like I had that second and I felt the depression that time. So the anxiety was after my first the depression and like kind of like this, my god, I'm doing this all over again. I was just seeing the light of day and now I'm back in it. And I would have to say, to be frank, like I my kids are now both, whatever, almost four and almost six. Like if I have this moment of like, I would want another one. I we always wanted three. But I remember back to that feeling of getting home and be like, shit, what did I just do? Two in diapers, blah, blah, blah. So if we can talk a little like what do you see mostly in your practice and and is this common or am I just like I don't know like one in a million cases Julie Brownley, MD, PhD: No, no, no. This is so common. It's no, it's so, so, so common. Cause I think, you know, the messaging that we get culturally is, it's so much easier the second time. It's so much easier. having a third is like nothing at all. I'm sorry. You layer a third child into my household. Financially, it's a strain, logistically, it's a strain. Dividing conquer is no longer a thing. There are a million reasons. Lauren Seib: It's a man it's not man to man. You're playing zone defense. Julie Brownley, MD, PhD: Yeah, exactly. But also with two divide and conquer becomes now each parent is mandatory. Or you've got a major the demand of caring for an infant and a toddler is just so much. But I had mine five years apart. The demand of taking care of a five-year-old and a toddl and an infant. Lauren Seib: It's not a Julie Brownley, MD, PhD: Is a lot, right? Because they're in totally different life stages. Nobody's napping, everybody's this, right? It's chaotic. It's suddenly chaotic, right? It went from okay, that was super intense. And like, you know, everybody's so different, right? And the way that they experience it. But I see this all the time. Second round feels very different because you were dedicating your life to that baby. Your first is like your. This is somebody that you bond with very differently because that's dedicated time, right? And then second time around, right? You're being drawn from your first. They feel it, they see it. Even if they're two, they notice mom's like preoccupied. When they're five, they definitely notice that mom's preoccupied, right? And it's very, very hard to Get a balance between the two kids so that mom guild kicks in, right? Also, your body, okay. So people, there's all kinds there, there's just so much happening with the body conversation that we that is out there. Number one, we are supposed to not care about our bodies. We're we're being told. You can be however you have to accept yourself exactly how you are. Why aren't you just comfortable? your body's changing because you're pregnant. It's this beautiful thing. Blah, blah. Right. Not everybody experiences it that way. And I feel like women do get shamed actually in reverse. So, like historically, women would be shamed for gaining weight and keeping it on and struggling to people would talk, right? I mean, this is I I remember this as a child in the 80s, overhearing conversations because someone was overweight, where they were being talked about negatively. Now we've got that conversation happening, which is despicable. We also have this conversation happening where it's like, you shouldn't care about your body. You shouldn't be so vain or preoccupied with your body. And it's like, okay, that's ridiculous. So many people feel actually centered and physically better, both like in their body, but also mentally when they're engaging their muscles, they're moving, they're active, they're yeah, me too. Me too. Lauren Seib: Yeah. Julie Brownley, MD, PhD: Right. Not everybody feels that way. That's okay. You don't have to, right? It it might sound absolutely horrible to get. back to working out three weeks after you give birth, right? That might sound terrible. Fine, it's okay. Nobody should have to do anything. And I don't want anyone to feel a certain way about their body or what they should and shouldn't be doing with it. But for those people who care about their body for so many different reasons, right? Maybe it is aesthetic. Maybe they look in the mirror and they go, I really feel Like not myself when I look in the mirror, it makes me feel a certain way, right? I'm not going to promote eating disorders or people having, you know, body dysmorphia sympt symptoms, right? Those are very different things. Eating disorders and body dysmorphia are things that people deserve to get support for. And my God, we could talk about that until the day is long. But I think it's okay to care about your body. To be distressed about your body changing is can be normal, right? If you're overwhelmed and obsessional about it, you can't let it go, that's different. Right. But to be unhappy that your clothes aren't fitting, that you feel like your body isn't doing what it was meant to do. Yeah, okay. You're allowed to want that. Right. And then to have back-to-back children, your body goes from containing a child to breastfeeding a child to being completely, you know, so many biological things that are dictating what your body is doing. Right. And challenges inherent to parenting make it so much harder for the average person to get to commit time to taking care of themselves in whatever way that feels right to them. So is it a workout? Is it nourishing yourself with good food? Is it taking a walk? Is it going to the movies? Is it going out with girlfriend? Whatever it is, right? So much more logistically challenging with the child. Then you go right into a second pregnancy, or even again, if it's years later, right? You're back in this phase of being, of containing a human and then of nourishing a human if you elect to breastfeed, right? And then your body just isn't yours. And so many women feel this sense of not having control. And that feels bad. Right. And so part of your experience relates to that. Part of it really relates to this relationship with your daughter and how that felt as it shifted. But then the logistics are insane. Right. Because you can divide and conquer, partner isn't always there necessarily, right? And when you divide and conquer, that means you don't get coverage for yourself as easily. So one parent really has to say, I take over, you go by. Right. And one of the things that my husband and I figured out is that if we don't cover for each other, it's we're toast, right? This Is so critically important. And I always encourage part people with partners to work this out early. It's like I hold down the four, you go once a week. You hold down the four once a week, I go once a week, if possible. This isn't always possible. Somebody come in and watch those kids for two hours, three, four, I don't know. It's up to you, right? But if you can pull that off, if you start out every other week, fine. Work your way up. Have the goal be I do my thing, he or they do their thing, right? And then we get a thing together. It's so ideal. This relationship being preserved, right? Connection here is so incredibly helpful. We lose that really fast. Also being independent people, we Lauren Seib: Mm-hmm. Julie Brownley, MD, PhD: lose it so fast. There's like an identity that our identity so easily disappears here. It's, I mean, if the connection with your partner is big, that can easily crumble. If your own independence is huge, that can easily crumble. Careers and how they're impacted. Because we're dedicating all of this time, right, to our kids, oftentimes there are spaces that have to give. Is it sleep? Is it self-care? Is it our career? Is it what is it? Right. But like there are only so many things we can do in a day. So stuff shifts and our identity can really be dependent on some of those other things, not just as being a parent. Lauren Seib: That's yeah, I think this like toolbox that you're providing is so kind of I don't want to say overlooks because I think we all know what will fill our cups, kinda like what I was saying before. However, there's a stigma right now, I feel like, that filling your cup equals selfishness. I've gotten that before. you n must be Julie Brownley, MD, PhD: Yeah. Yeah. Lauren Seib: nice to work out for two hours in the afternoon. Well, I worked my ass off all day. I have child care lined up so I can give myself those two hours back. Like I feel like I'm very much on the defense a lot of times. Julie Brownley, MD, PhD: Yeah. Lauren Seib: Conversely, I have moms I spoke to multiple this week. I've had some discovery calls where they're like, I haven't given back to myself. It's my time to like, I feel like it's my time to shine. Like I wanna feel good in my body again. I'm like, great, like I'll make it work. You want you're, you know, an hour away. Okay, well, we do virtuals. You want, you know what I mean? Like, that's why I my offers that I provide, and I'm and similar to you, being virtual, like, there's no excuses. Like I can, you you only need 20 minutes, great. Let's make best of that, those 20 minutes tomorrow. So I think there's like in terms of like providing a toolkit right now, so we we do know medication is an option, which is what you support people through. But if we're providing Julie Brownley, MD, PhD: Mm-hmm. Lauren Seib: other options right now, the other advice for women going through these shifts, whether just first time mom, just got pregnant, or maybe you just had number five, right? Julie Brownley, MD, PhD: Yeah. Lauren Seib: Sleep, we prioritize, yes. Moving our body. Julie Brownley, MD, PhD: Sleep, huge. And actually, number one, sleep is 100% number one. Cause without sleep, our idea around sleep in every other context is you need six, seven, eight hours, six minimum, right? Like most people hear six and they're like, ooh, you're do you're sleep deprived. And then Lauren Seib: Yeah, yeah. Julie Brownley, MD, PhD: suddenly in the context of being postpartum, it's like, six hours, that's a luxury, right? So our our conversation around sleep really shifts. And it shouldn't. We should be finding ways to get moms consolidated sleep. Now, again, I'm not saying six hours is necessarily feasible, but can we get mom four hours of consolidated sleep and then another chunk? Hopefully, right? Hopefully we can manage to. get accumulate enough sleep, right? A lot of times that requires a partner and or other family supports or night nannies, which if somebody can access that level of support, my God, you know, what Lauren Seib: Yeah, I I survived postpartum with my first because I had a postpartum doula. And to know like, okay, tonight sucks, but tomorrow I have Denisha here who's gonna like handle things for me, like that got me through. Julie Brownley, MD, PhD: yeah, absolutely. If you are like able to access this and break up your week, even just a little bit by having somebody else take over that role, what a win. What an incredible win. But even if you can't access that, finding people who have already said, let me know if I can do anything, and you know that they can. Do between 9 p.m. and 1 a.m. because they're night owls. Take them up on it because they're actually saying it because they want to support you. So I like to think of things in terms of human history, right? In all of human history, two people were not in a house by themselves taking care of babies. No one did that in all of human history. Suddenly we're isolated in a house. We have two people, if we're lucky, right, supporting a baby that is the most demanding, crazy person in the entire world. Lauren Seib: Correct. Julie Brownley, MD, PhD: They're demanding all kinds of things of you. And we're just sort of going, right, you can do it. You can do it. I did it. You can do it. All of human history there was a community, a tribe. And going back, right? No one did this alone. No one. No one did this alone. No one did this with a partner locked away. This wasn't how it was done. It shouldn't be. Right. We've just changed society so much into single family homes, right? At least in this country, right? Single family homes. And, you know, we're isolated from our community. And friends are protected as fr friends and other family members. Like we we don't want to put upon people, right? But We are actually meant to live as a community, as a group, and support each other in the ways that allow moms to get the self-care time and the sleep. Two hours is nothing, Lauren. Like carving out that two hours for yourself is everything. Everything. So you can walk away feeling whole and like a human at the end of the day. That's a no-brainer. Lauren Seib: And then in terms of another like nutrition, right? We know that that supports the brain. Fueling properly. Julie Brownley, MD, PhD: Yes, yes. Lauren Seib: So I know for one, I had an interesting conversation actually with a guy the other day at the gym. It was really cute. And he was like, one of our dear friends had a baby, and he's like, What do you, what should I bring? Like, what do I, if I'm gonna go meet the baby, like what do I do? I go, shoes off when you walk in, immediately sanitize your wash your hands, bring a meal. And he was like, bring a meal. I Julie Brownley, MD, PhD: Mm-hmm. Lauren Seib: go, don't bring a present, bring a meal. Present, game on. Awesome. Like a little onesie, something cute, like what fine. He said, bring food. I remember having two clients supported me in a full week of meal prep. You know, it was a delivery service, they just paid and someone dropped food off my house. And that, like, to not have to a think about that from a mental standpoint of what am I eating, to two properly being fueled so my brain would work when I was lacking sleep was really supportive. Julie Brownley, MD, PhD: Mm-hmm. Lauren Seib: Any other tools, like any other things you you recommend your patients when it comes to this like crazy time? Julie Brownley, MD, PhD: Yeah, I mean, I I will say doubling down on the food and nutrition piece, women are underfueling in the postpartum almost like 100%. And I don't mean that like they're not eating enough necessarily. Many women aren't. But even those who are saying like I'm binging out or like I have all these food cravings, I'd be eating too much, or why am I not losing weight in the postpartum? Right. Okay, you're eating good. But what are you eating? Do you have protein Lauren Seib: Is it? Yeah. Julie Brownley, MD, PhD: to help you with like sustaining yourself during the day? Because you don't eat enough protein and you're going to have food cravings a hundred percent. Like you're setting yourself up. If you don't eat healthy carbs during the day that are going to have sustained sort of support from a blood sugar standpoint, you're going to crave carbs, the junk food kind, right? Like it's inevitable. So the other thing is, brains don't do well on highly processed foods. And that's what is easy for moms in the postpartum. Because they are often on their own and they are just trying to get by and they're exhausted and they just need something to be able to use. And so if that's in a package or thrown in a microwave, you've got to do what you've got to do, right? Absolutely. No one should feel guilty about just feeling themselves with whatever they can. But if you have the capacity to be able to get Better nutrition in that postpartum period. Energy improves, mental health improves, right? You're able to sort of harness the day and the binging, which doesn't feel good. It just doesn't, that is suppressed when you're getting adequate nutrition throughout the day. You're starting off your morning right, you're fueling yourself throughout the day. So It really is that I think women struggle tremendously during that time frame with nutrition for really obvious reasons. All the ones that we were already talking about, the demands are so high. It's so high. So I agree. If you want to support a woman and you don't have time to go over and say, I will stay up from nine until one with your baby so that you can sleep, not all of us have the capacity to do that. Yeah, do a meal service with nutritious high protein meals. What an amazing. That is incredible. And those women clearly had a ton of insight around what really helps in the postpartum. Because coming over and holding somebody's baby, nope. And talking to them and holding them hostage. Nope. I mean, of course we want socialization. But if you want to socialize with mom, take her out and tell her to leave the baby at home. Set it up. Call the partner and say, I'm taking her out. So you're gonna Lauren Seib: Mm-hmm. Julie Brownley, MD, PhD: need to cover, right? That's actually wonderful socializing. Sure, come over, hang out with the baby, but make sure that you're doing something to support mom because it is exhausting entertaining. It is exhausting for mom. You know they're picking up around the house before you come over, right? You Lauren Seib: a hundred percent. Julie Brownley, MD, PhD: know they're changing the baby and themselves so they're not covered in spit up. You Lauren Seib: Yeah. Julie Brownley, MD, PhD: know they're like sweeping all the dishes into the right, they're running around to support you. If you can set up a situation where you're helping mom, that is the goal, right? Hey, I'm coming over. Don't you dare change your clothes. Lauren Seib: Yeah. Julie Brownley, MD, PhD: Change the baby, clean your house. I expect it to be covered in stuff or I'm going to be disappointed in you. Do not Lauren Seib: Yeah, I want I want the laundry in the dry like I I I'm doing the drying and the you know, the folding while I'm there. Like that is the kind of stuff that I look back and I had one woman who God bless you, Beatrice. I mean, she's someone I I knew from the gym. I will forever Julie Brownley, MD, PhD: Okay. Lauren Seib: idolize this woman who came in with two bags of groceries, with easy things in there for me to just pop in the toaster or whatever it might be. A cute little gift for my daughter to go play with to keep me, you know, just in my baby bubble. And she did my dishes and she went and folded my laundry. This is a mother of four. She's from Canada. She's she's my crunchy granola friend. And I I will forever change how I support women accordingly because that mo I will never forget that. She said, nope, sit, Julie Brownley, MD, PhD: Mm-hmm. Lauren Seib: you enjoy the baby. Or do you want me to take the baby? You tell me what you want. I'm gonna go do the dishes first. You decide, do you wanna go nap? What do you wanna do? Because it's about you. And that's where I Julie Brownley, MD, PhD: Love that. Lauren Seib: think the postpartum space needs to shift. And where I hopefully I come in helping women here feel good and strong, where you help women get this back going and feeling strong, because there's there's this still disconnect, you know, nationwide, globally, whatever you want to say, that it's all on us and like we're secondary. And that shouldn't be the case because the second I found myself, I put myself first, I hate to say and it sounds selfish. I I mean it it feels icky even saying it, but the second I did that, my whole family dynamic. shifted, my outlook on motherhood shifted, and I became just that much more empowered as a mom versus I'm the last one on the totem pole. Julie Brownley, MD, PhD: Exactly. It isn't selfish to take care of yourself. We go our whole lives taking care of ourselves. We have these things that we want out of life and we do those. We aim for them. We're doing us, right? And it doesn't mean that our focus doesn't in part shift on helping our children grow, be strong, healthy. Right. But in order to do that, we have to stay whole. And there's nothing selfish about it because, like you said, the ripple effect is that your relationship with your partner, if you have one, grows stronger, you find time to connect more easily, right? You physically can feel stronger if one of your goals is to do that, right? And it's so good for your brain, moving your body in whatever way you can, take a walk, right? Basic stuff can really help. You to feel like a whole person when you're filling your bucket. I know that's so cliche, but if you fill your bucket, you've got you've got water to give. Right. And your kids can feel the difference between you being ragged out, exhausted, drained, feeling totally disconnected from your body and your brain, and you actually being a healthy, whole human being. And one of the things that I love to tell moms is your kids are watching. If you don't want to put yourself first, fine. But your kids are watching you. Do you want them to give everything of themselves and drain themselves for other people? Or do you want them to know that living a full healthy life means taking care of yourself and doing things that feel good to you, that brings smiles and deep fulfillment to you? That's what they're learning. They're watching you, they're learning. And even when they're infants, they feel it because you being on edge and restless and anxious, and all of the things that happen to us when we don't take care of ourselves and find time. That so you can put yourself second if you want, but that actually means putting yourself first. So I always like to tell moms who feel that. I I can't do those things. Like I I really have to dedicate myself to my kids. I'm like, okay, let's do that by taking care of you so that you can come back to your kids cool. Lauren Seib: Exactly. It's it's like the flamingo, right? Like they they getting your pink back. It's they the flamingo moms turn pink once they start feeling back in their feathers. Like that it's and I I really do feel like the second I shifted my s my mindset and I try to promote the you know, really support women feeling that way too, you just feel all the more empowered as a mother versus bogged down by the diapers and lack of sleep, you know. Well Dr. Brownlee, we could talk all day. And I hope this is one of many conversations you and I have together. I know we focus a lot on the postpartum world today, but I know you cover all things women's health, like you talked about in the beginning. So maybe we can have you back on. But if you can live leave listeners today just like with one little tidbit, like what I wish women knew more of, or the strongest moms I know do, what's kind of one little thing that we can leave our listeners with to feel empowered in their motherhood journey? Julie Brownley, MD, PhD: I think it's exactly what we were just ending on. That note is actually perfect because when you take care of yourself in the small ways that you can, or in the big ways that you can, you are coming back home, being able to give as much of your best self as humanly possible. Without that care, you are losing all of that, not just for yourself. But for the rest of your family. So prioritize yourself as that hub. Prioritize yourself as the person who, when you're strong, you're the foundation. And everything can be built from there. So I I think that's really what it comes down to. And Lauren, I'm like just so happy that that ended up just naturally being where we landed today, because it is actually. Probably the most critique message. Lauren Seib: It's amazing. Well, thank you so much. I will make sure I put your links and everything into the show notes so people know how how to get in touch with you and to work with you because I know personally as as well as professionally, obviously, how amazing you are. And yeah, I I think this is the first of many conversations. Julie Brownley, MD, PhD: Okay. Lauren Seib: So thank you for thank you for spending your Saturday with me. Julie Brownley, MD, PhD: Thank you so much for having me. I'm always here and happy to jump back in. Take good care. Love you, honey. Bye. Lauren Seib: All right, love you. You too. Bye.