Ask Dr Jessica Zucker, PhD about Psychological Needs of A Mom or Mom-to-Be

Dr. Jessica Zucker is a psychotherapist in Los Angeles specializing in women's health with a focus on fertility, prenatal and post-partum adjustments, and transitions to motherhood. Jessica works with adults, couples, mothers and daughters, infants and mothers, and developing families. She comes to the field of clinical psychology with a background in international women's reproductive health, mindfulness-based stress reduction, and psychoanalytically-oriented clinical training. Jessica is a writer with a keen interest in female identity development, mother-daughter relationships, and issues surrounding the body. Dr. Zucker trained at New York University, Harvard University, and the California Graduate Institute.
Ask Dr. Jessica is an interactive forum dedicated to exploring pertinent issues related to pregnancy, birthing, postpartum, and motherhood.

www.drjessicazucker.com

Tags: depression, partum, post, post-partum, prenatal, psychologist

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Hi Jessica,

Our baby is almost 5 months old. We had a wonderful at home birth with no complications. Not sure if this is your expertise but really need some help in this area... When my husband and I try to have intercourse it is very painful. It hurts about an inch in and on the 'side walls' if that makes sense, so it has nothing to do with any tears on outside. My husband's convinced that I just need to warm up with some foreplay but honestly I don't see how we would have the time to do foreplay and really I'm not ready for it to feel good but I don't want to be in so much pain either. I thought it may be vaginimus, however when I just use my fingers trying to find where it hurts, even then it hurts and I'm completely relaxed.

I've been told that OBGYN isn't that skilled in this area and need to meet with a pelvis specialist - do you know what these specialists are called?!

Thanks!
Dear Dr. Zucker,

I don't even know where to start. I am not really one to bear my feelings and emotions on a public forum, but I've yet to really find any answers to the questions that I have.

I had a wonderful, happy, and relatively stress-free pregnancy, but my experience in the hospital and the birth of my son was very difficult. He is now 16 months old and his diagnosis (so far) is that he has multi-cystic encephalomalacia. His condition was completely unexpected, and we've only recently been learning of the full spectrum of his disabilities. It seems like for the first 9 months of his life every doctors appointment brought more heartbreaking news. For all the difficulties that we've been through, I feel as though I only love him more and more each day, but sometimes I feel lost in my own emotions and I want to feel some sort of resolutions to these feelings.

Now my husband has recently been talking about wanting to try to have another baby, and as much I do want to have more children (we always planned on having a big family), I find myself afraid without any explanation for my feelings. I must not be the only mother that has been through a situation like this?


Meagan
Dr. Zucker-I am a labor and delivery nurse and I am really wanting to try and make the whole birth/labor less traumatic for mothers. I was just curious what sort of issues you see with women later down the road that relates to their birth/labor and how I could help alleviate that to begin with as their nurse. Thanks, Rachel
Hi Chelly,

Thank you so much for your post! It's so important to explore these kinds of issues in a way that allows you to know that you are among many who experience post-partum sexual discomfort/pain/change. I would suggest the following: consult with your obgyn to discuss the myriad of potential physical issues, experiment with mindfulness or relaxation techniques to learn if this helps in any way, and lastly I would urge you to really trust your body and your bodily reactions to intercourse. In other words, forcing sex numerous times when it's particularly painful does not necessarily seem like the cure for getting through the discomfort. It sounds like you are exploring the possibilities and will soon return to an enjoyable sex life. No need to be convinced to distrust your body, rather I would suggest working with it-attempting to understand what's really going on and how you can comfortably find your way back to a sexual life that you love.

Best of luck,
Jessica

Chelly said:
Hi Jessica,

Our baby is almost 5 months old. We had a wonderful at home birth with no complications. Not sure if this is your expertise but really need some help in this area... When my husband and I try to have intercourse it is very painful. It hurts about an inch in and on the 'side walls' if that makes sense, so it has nothing to do with any tears on outside. My husband's convinced that I just need to warm up with some foreplay but honestly I don't see how we would have the time to do foreplay and really I'm not ready for it to feel good but I don't want to be in so much pain either. I thought it may be vaginimus, however when I just use my fingers trying to find where it hurts, even then it hurts and I'm completely relaxed.

I've been told that OBGYN isn't that skilled in this area and need to meet with a pelvis specialist - do you know what these specialists are called?!

Thanks!
Dear Meagan,

Thank you so much for writing in and for sharing the challenges you are going through with regard to your son's struggles with multicystic encephalomalacia. Indeed, I do work with many women and families experiencing various unexpected pre, peri, and postnatal difficulties and a majority of them express the same sentiment that you are- fear of entering into the vulnerability of pregnancy, childbirth and parenthood (again) after a traumatic situation/experience. Of course you are feeling apprehensive about getting pregnant again right now and it makes so much sense that you feel "lost in your emotions" sometimes. Trauma reverberates and inevitably leaves parents feeling lost, without a compass, afraid, confused, etc. Your emotions might shift constantly and that too is a normal part of ongoing trauma. If you want emotional support from members in your community, it might be helpful to inquire about a local group for parents dealing with similar challenges. Or if you would like to talk one on one, psychotherapy is an option that may allow you a space to explore what you are going through.

Let me know if I can be of help in finding local resources for you.
Thank you for sharing,
Dr. Zucker

Meagan Riggs said:
Dear Dr. Zucker,

I don't even know where to start. I am not really one to bear my feelings and emotions on a public forum, but I've yet to really find any answers to the questions that I have.

I had a wonderful, happy, and relatively stress-free pregnancy, but my experience in the hospital and the birth of my son was very difficult. He is now 16 months old and his diagnosis (so far) is that he has multi-cystic encephalomalacia. His condition was completely unexpected, and we've only recently been learning of the full spectrum of his disabilities. It seems like for the first 9 months of his life every doctors appointment brought more heartbreaking news. For all the difficulties that we've been through, I feel as though I only love him more and more each day, but sometimes I feel lost in my own emotions and I want to feel some sort of resolutions to these feelings.

Now my husband has recently been talking about wanting to try to have another baby, and as much I do want to have more children (we always planned on having a big family), I find myself afraid without any explanation for my feelings. I must not be the only mother that has been through a situation like this?


Meagan
Dr. Zucker,

My husband and I are going to be trying for our second baby soon. Ever since I started menstruating, I've been irregular, my periods coming every 30 to 46 days. It was easy to conceive our first baby because I had been on hormonal birth control for a few years and when I went off my periods came every 28 days, just like when I was taking the birth control. Since my son was born 9 months ago, I have not been using any hormonal birth control and once again, my periods are irregular. So my question is: how do I know when I'm ovulating? Is it just a guessing game? I don't really want to use those kits that tell you when you're ovulating, is there an easier (and less commercial) way to tell?

Thank you for your help!

Bonnie.
Dear Rachel,
Thank you for your thoughtful question. It is refreshing and very insightful that you are considering how to make women's experiences of labor and delivery less traumatic. It would be a much safer system to navigate if more people were thinking about how women were feeling throughout the birthing process and how their memories of labor and delivery may impact post-partum adjustments. Here are some thoughts:

* Many women and couples that I work with report that their experience was nothing like they had "planned" or "pictured". Expectations of how the birthing process will unfold is tricky because birth is one of the first important moments in parenting- a moment when new parents may realize that their ideas of how the birth should take place may or may not be possible based on a myriad of issues. Women have expressed to me that their dreams were dashed (i.e. they hoped for a home birth and ended up with a c-section) and wished they had understood their expectations more clearly beforehand. Feelings of shame/regret/depression/anxiety may emerge as a consequence of not meeting a hope/goal that was established prior to laboring.
* Many new mothers have spoken about feeling alienated by hospital staff members who did not seem to take them seriously (i.e. they created a birth wish list stating they did not want an epidural and felt the nurses did not exhibit respect). Birthing mothers want to be informed and part of the decision making process during labor and delivery.
* Those who have experienced sexual abuse may have traumatic memories emerge during the birthing process and may benefit from support during and after delivery.
* Overall, creating an atmosphere of comfort, safety, and choice will allow for a less traumatic labor and delivery

Please feel free to ask me further questions.
Best of luck to you,
Dr. Zucker

Rachel Leavitt said:
Dr. Zucker-I am a labor and delivery nurse and I am really wanting to try and make the whole birth/labor less traumatic for mothers. I was just curious what sort of issues you see with women later down the road that relates to their birth/labor and how I could help alleviate that to begin with as their nurse. Thanks, Rachel
Bonnie,

I highly recommend the book _Taking Charge of Your Fertility_. I used it, as did many of my friends. It helps you learn to track your cycle by taking your temperature (in your mouth) daily (and other signs); so it doesn't matter if your cycles are irregular, you can still tell when you're ovulating. It's a fascinating way to get to know your body. I wished I had read it years ago.

Pam

Bonnie Pankratz said:
Dr. Zucker,

My husband and I are going to be trying for our second baby soon. Ever since I started menstruating, I've been irregular, my periods coming every 30 to 46 days. It was easy to conceive our first baby because I had been on hormonal birth control for a few years and when I went off my periods came every 28 days, just like when I was taking the birth control. Since my son was born 9 months ago, I have not been using any hormonal birth control and once again, my periods are irregular. So my question is: how do I know when I'm ovulating? Is it just a guessing game? I don't really want to use those kits that tell you when you're ovulating, is there an easier (and less commercial) way to tell?

Thank you for your help!

Bonnie.
Dear Jessica,

I'm not even sure exactly what to ask. I guess I am wondering whether there tend to be certain characteristics or traits in some women that make it harder for them to "get over" their birth experience than others? I know my labour experience wasn't nearly as bad as those of some women I know, and yet they don't seem to obsess about their deliveries. Yet, I'm really struggling. I've talked to a psychologist a few times, and while that helped some, I feel like I'm overlooking some key aspect that is the essential problem, and that if I could just identify it, I could heal a little. (Maybe that's just wishful thinking though.)

My twins are nearly a year old, and I still often lie awake at night thinking about the hospital experience, sometimes crying. I watched _The Business of Being Born_ last week and cried throughout. I can't figure out exactly what it is that I am hung up on that I can't move past. One of the things I obsess about is that my babies and I missed out on bonding after birth. The ironic thing is that my worrying about this now is making me miss opportunities to bond with them in the present. Of course it's too late to go back and change the hospital experiece, so I want to find a way to stop that experience from affecting my current opportunities to bond with them.

I could tell you more about my labour story if that would help, but I do just wonder whether there tend to be certain things about some women that make it hard for them to recover--and if so, what some of them are--so I can get some ideas about how I might try to move past this event that seems to be exerting so much influence on me and my relationship with the babies. I'm tired of being sad, and I don't want my babies to have a sad mother.

Pam
Hi Chelly:
We actually forwarded your question to a pelvic floor specialist aka "vagina doctor" named Isa Herrera who will be answering for you and will be hosting a forum next week!
xxAbby

Chelly said:
Hi Jessica,

Our baby is almost 5 months old. We had a wonderful at home birth with no complications. Not sure if this is your expertise but really need some help in this area... When my husband and I try to have intercourse it is very painful. It hurts about an inch in and on the 'side walls' if that makes sense, so it has nothing to do with any tears on outside. My husband's convinced that I just need to warm up with some foreplay but honestly I don't see how we would have the time to do foreplay and really I'm not ready for it to feel good but I don't want to be in so much pain either. I thought it may be vaginimus, however when I just use my fingers trying to find where it hurts, even then it hurts and I'm completely relaxed.

I've been told that OBGYN isn't that skilled in this area and need to meet with a pelvis specialist - do you know what these specialists are called?!

Thanks!
Dear Bonnie,

How exciting that you are ready to grow your family! Thank you for your post. As I imagine your obgyn or midwife has expressed, irregular menstruation is quite common. The good news is that you were pregnant with your first child not too long ago which means you were ovulating. Have you considered charting your ovulation through taking your temperature? Here is a link to a resource you may find useful:

http://www.ovulation-calculator.com/basal-body-temperature.htm

From a psychological perspective, I suggest taking some time to learn about your ovulation either through your temperature or if you decide to use a kit to chart it but also trying to be in touch with and understand your expectations around the timeline. Many people in my private practice report a correlation between stress related to stringent expectations around trying to conceive zapping the enjoyment around the process itself. Cultivating patience and a sense of ease during this time might yield a more graceful pre-conception experience overall.

Wishing you all the best,
Dr. Zucker

Bonnie Pankratz said:
Dr. Zucker,

My husband and I are going to be trying for our second baby soon. Ever since I started menstruating, I've been irregular, my periods coming every 30 to 46 days. It was easy to conceive our first baby because I had been on hormonal birth control for a few years and when I went off my periods came every 28 days, just like when I was taking the birth control. Since my son was born 9 months ago, I have not been using any hormonal birth control and once again, my periods are irregular. So my question is: how do I know when I'm ovulating? Is it just a guessing game? I don't really want to use those kits that tell you when you're ovulating, is there an easier (and less commercial) way to tell?

Thank you for your help!

Bonnie.
Dear Rebecca,

Thank you so much for sharing. This is a very poignant question. Simply by being as in touch with your desire to maintain a sense of health and awareness postpartum indicates to me that you have an increased chance of doing so! Postpartum struggles are often linked with a lack of perceived support and/or awareness around one's vulnerabilities as motherhood emerges (intermingled with hormonal surges of course), so bolstering resources preventatively is an excellent idea. I wonder what has helped you in your remission during pregnancy thus far. Perhaps it is in part related to a heightened sense of wanting to protect the life growing inside of you or a sense of increased health through creating life, realizing that nutrition is central to developing a healthy baby. I would suggest a couple of things in an effort to continue to take good care of yourself after the baby arrives-- (1) enlist support now (one on one counseling/therapy or through a support group) in an effort to continue to understand what the eating challenges meant over the years which may provide additional tools for you post-partum, (2) try to keep in mind your increased importance now that you are a mother. Your baby will flourish particularly if you are feeling energetic, engaged, and with health, and (3) your body and your baby learn from each other. In other words, the way you treat yourself impacts how your baby will come to understand the world and you specifically. Your health (both physical and mental) will have a long lasting impact on how your child comes to understand her/his own body.

I would be happy to help you find local resources if that might be helpful.
You sound like you're in a sturdy place of self care. This is phenomenal!
Wishing you all the best in health and motherhood.
Sincerely,
Dr. Zucker

Rebecca Lynn Graff-McRae said:
Hi Jessica,

I have a history of eating disorders (both anorexia and bulimia), and of related depression and anxiety. I have been in recovery for almost 2 years. I'm currently in my 5th month, and am on track in terms of weight gain and nutrition, and at the moment I feel more confident about my eating and my body than I have in 8 years. I'm concerned, however, that after the baby is born I will be at risk of relapse or post-natal depression - there are a few studies that support this, even in moms who have "gone into remission" during pregnancy. Is there anything I can to to minimize these risks, and to maintain my current attitude on healthy eating and self-care?

Thanks,
Rebecca

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