How Do I Support My Partner When a New Baby Arrives?

Listener 1 00:00:00

What thoughts, advice, medical treatments, awareness is available to individuals, couples who have a non-birthing parent who's struggling with anxiety, depression, postpartum?

Dr. Ruta 00:00:10

Welcome to So Glad You Asked, the show where real moms bring us their toughest questions. I'm Dr. Ruta Nonacs, a perinatal psychiatrist at Mass General Hospital with over 30 years of experience supporting the mental health of moms and helping them navigate the emotional highs and lows and the often unexpected challenges that come with planning a family, pregnancy, and motherhood.

Allie Hales 00:00:32

And I'm Allie Hales, a mom of four. I know what it's like to scour the internet wide awake at 2 AM with a million questions, wondering if what I was experiencing was normal. That's why we created this show. It isn't just for real moms, it's by real moms.

Allie Hales 00:00:47

We spend so much time preparing the nursery, the birth plan, and the hospital bag, but how much time do we spend preparing the partnership? When a new baby arrives, the spotlight is rightfully on the mom and infant, but just outside that spotlight are the partners, the aunts, the grandparents, and the friends holding everything together. They're often the first to notice when the baby blues feel like something more. They're the ones stepping in for the 3 AM feeds so Mom can sleep. And yet, here's the part we don't talk about enough: support systems can feel the strain too. Partners are vulnerable to anxiety and depression, but many feel they don't have the space or the permission to struggle because they didn't give birth.

Allie Hales 00:01:26

We're broadening the definition of partner and focusing on the health of the whole team. We're talking about how to have the hard conversations before the positive pregnancy test, how to set expectations, share the emotional load, and recognize when a partner may also need support. Because when one person is struggling, the entire family feels it. And when everyone feels supported, everyone does better. Joining us is Dr. Sheehan Fisher, an Associate Professor at Northwestern University, member of the board of directors at the Maternal Mental Health Leadership Alliance, and a leading expert in perinatal mental health for both parents. He's here to help us move from surviving as individuals to thriving as a team. Dr. Fisher, we're so glad to have you here.

Dr. Sheehan Fisher 00:02:08

Thank you, thank you for having me. Glad to be here.

Dr. Ruta 00:02:10

Thank you.

Dr. Ruta 00:02:12

So, as we start our discussion, I'm struck as a sort of a clinician and someone who works with moms that we have a pretty broad definition of partner on one hand in terms of who can serve as a partner, but on the other hand, it's kind of one-dimensional and and kind of like plug-and-play, but we don't really attend to what partners need and want. And I'm wondering if you could help us broaden how we think of partners and what they need.

Dr. Sheehan Fisher 00:02:44

Well, I think it's important to incorporate understanding the value of partners. If the person's the other parent, like as in like the parent who's also raising the child, like they're there to raise the child, to be able to be a team player and adjust into this new role for both of them and really supporting the well-being of the child. Whereas other partners who are maybe in more of a support role are coming in, maybe don't necessarily live in the home, but are trying to help support the family to ensure the child's well-being. So I think that it's important for us to start thinking about that, especially given that historically in the US, we think of nuclear families. Like a lot of us move around the country, we only have each other, like it's only the two parents, they don't have the community. We've gotten away from really thinking about the broad view of what a partnership can be across community supportive family's well-being.

Dr. Ruta 00:03:32

And I like that you mentioned the team because on a team there's different positions and different roles and probably before we start thinking about pregnancy, we have to figure out which role everybody's going to play.

Dr. Sheehan Fisher 00:03:47

Yeah, so it's important to talk about that ahead of time, just especially so that everyone isn't operating based on assumptions, but really has an opportunity to think about it and to make the decision collectively. One of my concerns is that in our society, we have very gendered-based ideas and norms about who will do what roles. And honestly, like our policies, our hospitals, they enforce that. Like hospitals mostly will automatically put the mom as the point of contact rather than asking the family who will be responsible for the child's medical health. So it's prescribed versus chosen, and I think that's something that we need to think about early during pregnancy or before.

Dr. Sheehan Fisher 00:04:24

How do we want to split the roles in an equitable way and make that choice together versus society imposing it upon you?

Allie Hales 00:04:31

I appreciate that you said that because I remember after our first child was born, my husband was like, okay, well, we had some issue come up with our newborn. He was like, okay, well, what do we do? And I was like, I don't know. I've never been a parent before. I don't know what we're supposed to do. And I think for us trying to figure that out, we didn't do a lot of this work earlier on like you're suggesting, and I think it's so important because when you do get into it and you haven't had those conversations, makes it a lot harder to divide labor and like figure out how you're going to do this in an equitable way. So, I think, what do you suggest for involving partners early? What do you suggest people do as their team? I also like what you said about how in the U.S. we move around a lot and it's not that you're living close to your family all the time and sometimes it is just you and your partner. How do you have those conversations before the baby's even born?

Dr. Sheehan Fisher 00:05:26

Well, one, I would want to put the onus also on the fathers or the non-birthing parent to bring up the conversation versus it being something that the mom has to organize everything, but more just that there's a common discussion about what do we both want? What do we see?

Dr. Sheehan Fisher 00:05:40

Where are our strengths and our weaknesses? To your point, we shouldn't think anyone's innately able to be a parent. It's something we fight against when people think, well, biologically one person should be more evolved or better at parenting than the other. Like if you've never raised a child before, you've never raised a child. So both of you are learning and the burden shouldn't be on one person to have to then think through, okay, how do we figure this out versus it being a team player? Like how do we work together on this? And if there's strengths in one area, then that person might take the lead there. But of course, even in the areas of weakness, then cross-train. I always suggest everyone should know how to do everything.

Dr. Sheehan Fisher 00:06:14

So it's not once again like cherry picking where one person picks what they like or are good at versus let's see what feels like an equitable split across the board to ensure that works and keeping that as an ongoing dialogue because after like parental leave, after the child gets a little bit older, at different stages, you're going to have to readjust and and renegotiate how that will actually look for that split of responsibilities.

Allie Hales 00:06:35

I like the term cross-train. That's a great way to view it, for sure. Okay, another question that we were thinking about also is, you know, sometimes partners aren't fully aware of another person's mental health or history and anxiety or mood disorders. So how does that affect the team later on when, you know, maybe someone's mental health has been really great for a long time and then birth brings up things that the team hasn't experienced before?

Dr. Sheehan Fisher 00:07:05

Yeah, I think that's an important point. That's actually a protocol I have where I usually, a lot of my patients are moms, probably more moms than even dads. And what we do is usually bring the partner into at least one of the sessions to do a run-through. To be fair to them, like they're not psychologists, they're not mental health professionals. So it's good for them to learn about all the things that could happen in the postpartum period. And I usually do the preface that this may not actually happen. The person may not develop psychosis, for example, they may not develop OCD, but these are the things that do exist and based on the person's history, these are things that may be more likely to happen. And giving them the tools, letting them know what the symptoms look like, what to look out for.

Dr. Sheehan Fisher 00:07:43

Even things to look out for that's not in the DSM as a way for them to be the eyes and ears because in my experience, they do care, they actually do want to make sure they support their partner, but they also trust their partner. So if their partner says like they're fine, they try to like back off and not overly like intervene or they may question, well, it seems a little odd of you, but maybe I don't know, like maybe that's just a normal part of postpartum and therefore they don't know when to step in or not. And especially given that we have high suicide risk in our in our country, it is important also to train them to know what to look for there too and feel empowered to intervene if they have concerns about the person's well-being.

Dr. Ruta 00:08:21

I think that's a really, really important point because I help moms with sort of making decisions about medications during pregnancy, and I always get concerned when there's not a partner there, and I definitely want them to come early on so we can talk about those things. The other thing that I've noticed and I want to get your take on how to manage it is that sometimes when the partner says, I think something's not going right or, you know, you're depressed or you're way too anxious, um mom feels attacked or criticized. And one of the top ten things not to say to your partner is, “Have you taken your medication today?” What do you suggest to partners about how they might negotiate that kind of tender moment?

Dr. Sheehan Fisher 00:09:17

It's a hard one partially because it's a society issue that we put so much pressure on moms to be perfect that anything that suggests that they're not perfect seems like a personal affront. And so that, you know, that's a bigger thing that we can't change overnight, but part of it is being aware of that. Like understanding that, hey, this person feels a lot of pressure, so I wouldn't necessarily say as frankly as I would in another situation when they're going through this during the postpartum period or beyond. I do think that them coming in with the therapist or psychiatrist early on though comes bridges that gap.

Dr. Sheehan Fisher 00:09:49

Of course, only with the mom's permission, that allows them to know like, hey, this my professional is trained them, giving information and therefore I'm okay with them being a part of this team versus feeling like someone's inserting themselves. So I think that being like a foot in the door makes it much easier later on to carefully bring up certain topics and gives the opportunity to express or for the mom to tell them, if you notice something, please express it this way. As a way to make sure that it might even tailor to what feels best for them as an individual.

Dr. Ruta 00:10:21

That's a really great point. When I think of a perfect system, I always think we kind of have this very binary system where mom is sick or mom is well, but it's really a spectrum and I think all parents struggle. It's not just the ones with depression. Why can't we just say, you know, it really doesn't have to be this hard. Can we do something to help you?

Dr. Sheehan Fisher 00:10:48

That is actually my passion. Like the hard part of being a clinician is that we only can help people usually when they have a diagnosis, which means they have to already get to the worst point and then we can help them. But honestly for perinatal mental health, like the mental health part, there's so much that everyone would benefit from learning and understanding about how to make the experience better rather than having to wait till you get to that threshold of actual pathology or illness.

Allie Hales 00:11:12

Yeah, I love the preventative lens on it. How far out do you suggest people start planning? Like at what stage do you have these certain conversations? At what stage do you talk about division of labor? Like are you starting, you know, when you're thinking about getting pregnant, when you are pregnant? Like, at what point do you discuss each thing?

Dr. Sheehan Fisher 00:11:35

I would suggest doing it pre-pregnancy. One, it's nice to know if you're on the same page before you actually bring a life to the world because you might have to figure out other things. But when it comes down to it, at minimum during pregnancy, you need enough time to really talk about it, practice like I said the cross-training. You don't learn overnight. Like let's say someone doesn't know how to cook. If he has to learn how to learn that, he needs to learn those skills and that might take time or how to swaddle a baby or what it would look like to have equity in the home around house chores and things. So like it really the earlier the better. So I do prefer people talk about it before getting pregnant.

Dr. Sheehan Fisher 00:12:08

But usually in my case, we see people at least during pregnancy and usually around like the second trimester is when I bring in the partner and try to have that conversation so they have at least six months to be able to start to work on these things, get prepared. But it's almost like any other new job. You want to get onboarded and you want to do it in a way that feels fair. One of the things I will highlight is that many relationships are egalitarian up to even through getting married, but once you have a baby, you see the split. And it's okay if that's your values, but if you're not choosing that and society's imposing that upon you, that leads to a lot of resentment on both ends.

Allie Hales 00:12:41

I had a question for you. So when we're talking about partners versus extended family how do you navigate if you have multiple people on your team? It’s a great problem to have, but how do you figure out who's doing what?

Dr. Sheehan Fisher 00:12:57

Well, it depends on like everyone organized it as they see fit. Like if it is you and your partner or if you're the core, then you all should be working together to organize the team versus all the pressure being on the mom to figure out who's going to do what. But then you can figure out how do we divvy that up and have conversations about responsibilities. For example, I know it's becoming more popular I think in the past five years or so, when someone comes to visit postpartum, they have to pick up a chore as soon as they come in the door. Like some way to kind of make sure people understand we're not hosting you, we're not entertaining you, there is responsibility. But in a more systemic way, you can have conversations with family and friends about, hey, who's going to help out with babysitting so we can have a break and have time to ourselves, or who's going to come over and help out clean up a little bit or who's going to be in the delivery room. Different things that are important to do ahead of time. Otherwise, you see this especially with grandparents or other family members where they might feel like they're not allowed in and feel upset about it versus they might come in too much and not necessarily be welcomed and having that negotiation is important ahead of time.

Dr. Ruta 00:13:55

Yeah, I tell moms that they should be in control of the schedule or it should be both parents, but I feel like sometimes there's like 36 people on day one and that's frankly overwhelming. And the other thing I've noticed is that everybody sort of gravitates towards the baby. And maybe the mom wants to be with the baby. Maybe she wants someone to take out the trash. So, I see moms taking out the trash, cooking dinner for the guests, and not with her baby. So I think the conversations early and often are really important.

Dr. Sheehan Fisher 00:14:34

And it's also important to stagger it. I think that's one of our norms in our society during the first couple weeks everyone comes as a way to show their support and then they disappear. So a lot of times when I work with moms, the first few weeks they are like , “Oh, this is easy, this is not that bad.” And then all of a sudden, like all the supports disappear, the partner goes back to work, and then it really hits them. So I always encourage kind of staggering it during the leave time so that there's people coming at different stages and even staggering it down as you start to transition back to work. So like finding ways of being purposeful in the design of your support system.

Dr. Ruta 00:15:06

I don't know what the paternity leave situation is in Illinois, but they recently expanded it in Massachusetts so that it's longer, and I wonder if you have any advice that you give the non-birthing partner on how to use that paternity leave.

Dr. Sheehan Fisher 00:15:25

Yeah, I mean it depends on the rules whether they can break it up over the year. Some people get to do a week's here, a week's there. So sometimes if they get like, like we don't get that that much many times people talk about like two weeks or so, but some companies allow like three months. I took three months when my daughter was born. So you are able to kind of either spend the whole time all together as a family, or I've seen other cases where the mom took the first three months and then the dad took the second three months as a way to stagger it. So like there's different ways to to work with it, but I think that's important to to figure out because sometimes I have had moms who are like, I want to go back to work. And therefore they're able to make that switch with their partner where their values are. They love their kid but they want to get back to their work, their job, and therefore the partner can be the one maybe staying home longer if they have that availability. So, I think there's a lot of ways to do it, but the point is to do it purposely.

Allie Hales 00:16:15

Love that. One of the things we wanted to ask too, so you know, when the mom is the one that's struggling, the partner often feels like they have to be the rock. Like they can't have any cracks. And then how do we give partners permission to admit, you know, they're also exhausted or also anxious or well, not wanting to burden the mom with those feelings?

Dr. Sheehan Fisher 00:16:36

Well, for one, if we're talking about partners, especially if they are male identifying, they struggle with their emotions in general. Like as a more general thing that they struggle with sharing their emotions, being aware of it. But then that also sometimes closes the door where the mom then doesn't feel comfortable sharing because he seems like he's a rock, he's fine. So actually opening communication between the both of them allows them to know we are both not perfect or impervious as to save from the stress and to be honest about it. And yes, the goal is not to overburden on either end, but to actually be a team once again around each other's mental health. And knowing that you're not alone in the experience, which is a common experience for many moms.

Dr. Sheehan Fisher 00:17:13

Also, of course, for the dads, they have to be aware of how they might manifest it. This is the thing that we don't talk as much about in perinatal mental health is that depression in the traditional form isn't as socially acceptable to men, whereas men are more likely to engage in masculine depression, which includes hypersexuality, aggression, even substance use. So ways that they might cope with their emotions, not realizing they're dealing with depression or anxiety, where they're masking it through these other different types of behaviors that don't look like mental health disorders. So it's also important to be aware that change in behavior might be an indication that he needs support.

Dr. Ruta 00:17:49

I think also the point you make about people responding to these things in different ways, we're not going to talk about it today, but in terms of infertility and pregnancy loss, there's always like it affects one, but you know, the other person doesn't seem to be affected in the same way. And again, more communication.

Dr. Sheehan Fisher 00:18:10

Yeah, and especially around depression and loss, what we see is as societies that we tend to crowd around the mom, support the mom, understandably, but then once she gets better, we leave. And then usually that's when the dad falls apart because he's been spending so much energy trying to make sure she's okay that by time that's done, he's actually aware of his own emotional experience, but now all the social support systems are gone.

Dr. Ruta 00:18:31

And I think there's something that is being talked about more is is this postpartum depression in dads or in adoptive parents? What are your thoughts about that topic and what might be causing the problem?

Dr. Sheehan Fisher 00:18:49

Yes, dads do experience postpartum depression. We made the assumption that they don't have hormonal changes, which we've learned is not true. They actually go through hormonal changes a little bit delayed, but hormonal changes around the testosterone about three to six months postpartum that can continue on, puts them at higher risk of depression. And even for moms, like we know there's genetic risk, we know there's a hormonal change, but also a lot of it is environmental. A lot of the stress has an impact on moms' mental health, and as fathers are getting more engaged in the home, they're experiencing similar stressors too. So we are understanding that they are at risk for depression during this time. And there's even literature for those who are adoptive parents and other family dynamics, when they have a child, it does have an impact on their mental health.

Dr. Ruta 00:19:30

And sleep deprivation happens usually to both parents, not to just the mom.

Dr. Sheehan Fisher 00:19:36

Exactly. Sleep deprivation, like the work-life balance stress, like the financial pressures, like so many things that come along with the postpartum period affect both of them. And that's even when there's a healthy child, much less if the child was in the NICU or has other health issues, it takes a toll on the whole family.

Allie Hales 00:19:51

I was wondering if you could talk a little bit more about that. Like we've heard a lot of research about how mom's mental health affects the whole family, but just curious if you could speak a little bit to how a partner's mental health affects the whole family too.

Dr. Sheehan Fisher 00:20:03

Yeah, this is my big plug always is that as a field, we've focused on mom's mental health. Makes sense. But I did a study a while back that showed that when you had both mom and dad in the home, looking at the trajectory from postpartum up to three years later. After accounting for mom's depression, basically saying like after we already know the impact of the mom's depression on the child, once we account for that, the father had their own unique impact on the child's mental health. So when it comes to that clinically, it means that if we spend all our resources only on getting the mom well and we don't address the dad, the child is still at risk. And this is really important for us to consider when we're thinking about the family’s health.

Dr. Sheehan Fisher 00:20:43

Both parents have an impact on the family and we know if the father's depressed, of course the mom will be at risk for depression too. So I always say this, preach it, whether it's to an OBGYN or to pediatricians, even if your target patient is the mom or the child, you still should care about the father's mental health because it will impact your target patient.

Dr. Ruta 00:21:01

And if you are a non-birthing partner and you feel like you're struggling with these issues, I think a big challenge is where do we have those people reach out for help or find even information because I think it hasn't been out there in the past.

Dr. Sheehan Fisher 00:21:19

Well, I think Postpartum Support International has done a great job putting information out there around father mental health and non-birthing parents. So there's really a lot of information and even resources available online. Unfortunately, there's not many specialists out there, so we are trying to do more training for other mental health specialists to learn how to engage and support fathers’ mental health specifically. But otherwise, I would say go to your PCP, at least to get evaluated, and then if not, go to a psychologist or psychiatrist. And that's the goal is like you may not need help, but at least you have someone assess you to determine whether that's the case or not and give you the options.

Dr. Sheehan Fisher 00:21:55

Sometimes people fear that if you go to the doctor automatically you're going to be almost like locked away or you're going to be forced to take medications. Like no, you still have agency. They'll give you your options and you can figure out based on their recommendations what's the best step to move forward as a starting point. And I think that we do though need to do a lot more for non-birthing parents broadly, getting away from the heteronormative dynamic of how we understand family units. There's a lot less resources even there when we think about queer families, but we need to do more to support them too.

Dr. Ruta 00:22:24

And I think the point I would like to make is that sometimes just seeing someone can be helpful to have someone who thinks about mental health to say, “This is a really hard time and you are suffering and what can we do about that?” So just the act of seeking help can be helpful.

Dr. Sheehan Fisher 00:22:44

Absolutely

Allie Hales 00:22:46

I mean all super important parts and I'm just really amazing to hear your perspective on it and just how holistically you approach it because I do feel like there aren't enough resources out there and being able to hear you talk through what is available and it's okay to go in and I had the same fear, you know, if I talk to someone about it, like what will happen? All these things will happen, it'll be this big waterfall I can't stop. But it is important to take that step if you're, you know, considering doing that, it's worth, you know, being evaluated and seeing how everything's going. So I appreciate you saying that.

Dr. Sheehan Fisher 00:23:22

Absolutely. And I think that's what usually– so a non-birthing parent joins the session with the birthing parent, at least lets them know that, oh, this is not what I see on TV. Usually that's the foot in the door and usually they actually want to work with me afterwards. I can't do it obviously, but I'm like, “Hey, this is good. Like I can refer you to someone else,” but it gives them that foot in the door to realize what they fear is not actually true.

Allie Hales 00:23:42

It's such a powerful shift to realize that the support system isn't just a tool for the mom, it's a group of real human beings with real limits. In this next segment, we're moving from the theory of teamwork to the honest, unfiltered questions our listeners have about what happens when the partner is the one who hits a wall. So, our first listener audio asks, what advice or medical treatments are available for couples where the non-birthing parent is struggling with postpartum anxiety and depression? It feels like all the resources are for the mom.

Dr. Sheehan Fisher 00:24:15

Yes, and unfortunately most of the resources are labeled for the mom and marketed that way. There are people who specialize in understanding both parents' mental health and so it is actually a good model to go into either couples therapy or individual along with a partner when needed to actually help it to be a united team to address the non-birthing parent's mental health. So that is something that I think is very useful, and I think it gets away from the clinical model that tends to be one-on-one, which is also a very American way of viewing it, like supporting people that you individually are responsible for your well-being only versus being a team effort. And I wish we did more of that type of intervention, but it does exist.

Dr. Ruta 00:24:55

Can you say something about what's the ideal time to intervene with couples therapy? Because I feel like we wait way too long and then you have people shouting at each other. So, what can I tell my patients about the optimal time?

Dr. Sheehan Fisher 00:25:11

So if it's about addressing an individual's mental health, then it might be like when the person's struggling some, but if we're talking about addressing the family unit, like the relationship, I think that's earlier the better. I think that people look at it once again as once there's like a big problem, usually people come, I'm also a couples therapist, people come in like when they're near divorce. In any other type of medicine, come in early. Like you come in when you have prediabetes and when you have a spike, not come in when you have full-blown diabetes. The same thing comes to couples therapy. It's actually way better and more effective to come in when you have some bubbling issues that need to be addressed and you can work together on it than waiting until it gets worse.

Dr. Sheehan Fisher 00:25:47

And especially in the perinatal period because postpartum, like you said, everyone's sleep deprived, they're not their best. You're not going to be at your best skill. So one part of my protocol is even learning communication skills during pregnancy to work on that early on so that when you hit the fire postpartum, you're ready to go versus trying to learn it as that is all going on at the same time.

Dr. Ruta 00:26:09

I wonder if it would be more palatable if we called it coaching, because I think that the therapy, especially couples therapy, has a valence that people don't like. But if we were just coaching them to be better parents, it might be more palatable.

Dr. Sheehan Fisher 00:26:24

Yes, and I do coaching too, partially for the reason I mentioned earlier, getting away from only being about something that's diagnosable or something that hits that line. So many couples, so many individuals would benefit during the perinatal period of getting expert support without it being about treatment of a medical condition.

Allie Hales 00:26:39

Thank you. One of the other questions we got is for a single mom or someone without a traditional partner, how do they onboard their community, like aunts or friends, to play this clinical role of monitoring mental health?

Dr. Sheehan Fisher 00:26:54

Well, I think I really support that just in general is that we have to get away from even just once again American view that you have to have two parents married, like this traditional view of things, versus if you are a single parent and you have your village, your community that based on who you trust, who can keep confidentiality, to bring them as a part of that team so you unite. I think that we're getting away from starting to get away from those models where there's only one size fits all to start thinking about like, hey, even whether I'm partnered or not, who's actually in my community and who can I utilize? And I think that is an important part of moving forward for accommodating all family styles.

Dr. Ruta 00:27:33

Another question that we got was, sort of building on your wisdom, what are two or three preventative communication strategies that couples can use during pregnancy to set themselves up for dealing with unknown challenges that might occur during pregnancy or the postpartum period?

Dr. Sheehan Fisher 00:27:56

Well, one, I think one of the key communication skills which people don't always focus on is the listening side of it. To actually when someone is talking to you, before you get defensive, before you already have your rebuttal or what you're going to say, to actually listen to the other person and at least try to understand their perspective and incorporate that into your response. Otherwise, the person feels like you're rejecting what they're saying and you're actually missing out on actually truly coming to some type of middle ground or solutions if you're only thinking about your side versus their side. Another thing is to be able to actually try to communicate your emotions effectively.

Dr. Sheehan Fisher 00:28:30

Sometimes people express their emotions obviously out of anger or in the moment versus being more careful and being clear about, okay, this is what I'm feeling, this is what I'm looking for, this is what I want. Because although you might think that they know what you're thinking behind the scenes, they can't really read between the lines or do it accurately. So the more you clearly spell out what you need from them and what you're experiencing, it actually can build empathy from the other person versus them getting upset. And then finally, trying to make sure that when you're communicating, it is a certain level of mutuals, that we're not we're getting away from who's going to win the argument versus how do we come together based on understanding both of each other to solutions that addresses both people's concerns and also knowing like when to do it. Like sometimes people do it when the person's about to leave the house or on their birthday. That's not the time. Setting aside time will actually save you time. Even if you spend an hour communicating, you might think, I don't have time for that. Well, a fight usually lasts hours versus if you set aside an hour to actually talk and and carved out that time, you'd actually be way more effective and efficient in the use of your time.

Dr. Ruta 00:29:36

And no middle of the night discussions.

Dr. Sheehan Fisher 00:29:41

Choose wisely.

Allie Hales 00:29:43

Yeah. I mean, I think the communication piece is so worth practicing and just talking about how the best way is to move forward with that before the things come up because, yeah, after the baby comes, you are sleep-deprived and you are exhausted and you are stressed, and it's just being able to talk about them before obviously like takes a whole other component out of it that you don't need, you don't need like the crazy stress talking part. So, yeah, that's so valuable.

Dr. Ruta 00:30:13

Shifting gears slightly, I think we spend a lot of time, me as a clinician on this program, talking to moms about sort of all the traumatic experiences moms go through. And I think we don't talk about how those traumatic experiences, which might be seeing your wife, you know, nearly die or seeing your partner have postpartum psychosis, we don't talk about dad and how to help him through that grief. And how can we help him move on?

Dr. Sheehan Fisher 00:30:51

Yeah, I think that's something that we do need to be mindful of is that there are two people in the room, those two who are invested into the outcome. So even if one person might be more directly experiencing it, it doesn't mean the other person is not impacted. So the non-birthing parent witnessing and seeing that their partner or even their child might almost lose their life, it will have an impact on their mental health. And do we have space for that once again because their mental health will affect everyone else and of course it matters in itself. Like when my daughter was born, she had a stroke and that was obviously a very scary moment for everyone, but it's important to be aware of that. Like what does that look like as a family unit when your child's life might be at risk.

Dr. Ruta 00:31:29

I'm sorry to hear that you went through that experience.

Dr. Sheehan Fisher 00:31:33

Thank you.

Dr. Ruta 00:31:34

I think the other thing is, you know, people do have resilience and and they unfortunately go through these experiences, but they learn a tremendous amount, and I guess thinking about that traumatic event, how do you help a couple to think about growing their family after they've had some disaster or unexpected events?

Dr. Sheehan Fisher 00:32:00

Yes. One, I usually encourage them to take some time to make sure they heal. Like sometimes, for example, if they had a loss, they might immediately want to get pregnant again before processing the loss, and that can, you know, it's their choice, but it can make it much more complicated for how they even go through the pregnancy, much less when the baby comes. And so it is important to work with a professional to work through that trauma or that experience so that you are coming into the next phase healthy as possible and ready to to transition to, you know, supporting another child. Otherwise, it can get quite convoluted.

Dr. Ruta 00:32:32

And sometimes women feel or maybe the partner feels like one of the members of the team wanted the pregnancy more than the other and that can be very convoluted in terms of when it comes to asking for help.

Dr. Sheehan Fisher 00:32:48

Exactly. Yeah, but definitely also making sure because sometimes that can affect the relationship and therefore you have to work through some of those things too if there's any hurt feelings or resentments around the loss or complications that you might have experienced.

Allie Hales 00:33:00

I was wondering if you could speak a little bit on advice that you have for recognizing when a partner is struggling and how to help. From a clinician point of view, because they're not checking in regularly with an OB necessarily or they're they might not go see their PCP all the time. So like how does that person get caught in the safety net? And then also, as the mom or the birthing parent or how do you recognize and support your partner when you see that they're struggling?

Dr. Sheehan Fisher 00:33:31

Well, if you have a good baseline of good communication and ability to talk about these things, one of the things to be aware of is you know your partner better than anyone else. So if you notice them just seem that they're different than normal and it seems like it's going on like for a few days or weeks, then it's time to at least talk to them and say, “Hey,” carefully, “I've noticed this little change, you know, you're doing great,” kind of a sandwich approach, like how great you're doing, “but I'm also noticing this little change.” And if they have a provider, then at least suggest that they bring that up to their provider or only if you have permission and you know, have that relationship where you can actually directly engage with the provider because sometimes the partner's going through so much, they actually need you to kind of be part of that team of communicating with the clinical team. So, there's different ways of approaching it, but I think the idea is that you don't have to necessarily have a diagnosis, you need to just be aware that, “Hey, you're not being your normal self, or you're really hyper-focused on X, Y, and Z in ways that doesn't seem normal. Or I see you wash your hands like five times, or I noticed that you seemed a little more irritable than usual, or need an extra nightcap, you drink a little bit more than normal.” These are things to kind of say like, “Hey, I'm noticing it.”

Dr. Sheehan Fisher 00:34:36

Let's just make sure everything's okay and talk to me about what you're feeling so they get the support they need. And making sure you are clear because I've seen this with fathers sometimes to not pitch it that they're weak. Because otherwise it really sometimes like you can see that type of perspective even perpetuating against fathers where like, “Hey, suck it up, be stronger.” And you have to be sure to be careful not to say that otherwise they will button up and not share much. So we have to be mindful of our language in general when engaging with one another.

Allie Hales 00:35:05

That's super helpful. And I think even just thinking about how, like in my personal life, how much my husband's had an impact on our family and strengthening our family while he's been strong and taking care of his mental health versus how hard it is when we're both struggling and just being able to have those conversations. I'm going to be using some of the tools you shared too and communicating better and recognizing when things are off, bringing it up in a sensitive way. I think it's just all so helpful and just so impactful on the family as a whole. So, just really appreciate all of your insights. It's really amazing that you're in this area that's so needed.

Dr. Sheehan Fisher 00:35:45

Thank you. I really appreciate it. Thanks for having me here.

Dr. Ruta 00:35:48

It's been our pleasure. Thank you.

Dr. Ruta 00:35:51

If you're the one holding the camera or the one rocking the baby so that mom can take a nap, this message is for you. Your mental health matters just as much as the person you're supporting. You can't pour from an empty cup. And you might be dealing with anxiety or depression, it's important to remember that this doesn't make you a weak person. You're a human being going through a massive life transition.

Dr. Ruta 00:36:17

As Dr. Fisher reminded us, the strongest teams are the ones that talk about the hard stuff early and often. Whether you're a spouse, a friend, or a grandparent, you're a vital part of this family's health team. Don't be afraid to ask for help for yourself as well. Thanks for tuning in. As a reminder, please note that this podcast is not intended to be a substitute for professional medical care. The views, thoughts, and opinions shared today are the speaker's own.

Dr. Ruta 00:36:50

Your feedback and questions drive this show, so feel free to send us an email at podcast@womensmentalhealth.org or leave a voicemail at 617-643-9232.

Allie Hales 00:37:04

You can find additional resources at our resource hub at sogladyouasked.org. This show is executive produced by Dr. Lee Cohen, produced by Mike Brown and Peri Barest, and edited by Mike Brown. This is So Glad You Asked with Dr. Ruta Nonacs and Allie Hales brought to you by the MGH Center for Women’s Mental Health and the J. Willard and Alice S. Marriott Foundation. Listen and subscribe wherever you get your podcasts.