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Katie: Welcome back to the "7 Domains of Women's ������ο��Ƶ." I'm Katie Ward, I'm a women's health nurse practitioner and professor at the College of Nursing, and we're here today talking about the intellectual domain of the fourth trimester.

The intellectual domain is always fun for me because it feels like the place where I get to geek out a little bit on the things that I like to think about. So if you haven't listened to the physical, social, and emotional domains of the fourth trimester, I hope you'll go back and catch those. We're going to cover a little different angle this time.

And with me to help think about the intellectual domain is my co-host always, Dr. Kirtly Parker Jones from Obstetrics and Gynecology.

So I'm going to start by telling you about a picture I'm looking at. I've had the privilege of traveling to Rwanda and Uganda, where I've had a chance to view mountain gorillas. And I have this picture of this mother with a baby kind of riding around on her back like it's riding a horse.

That's how most of our primate cousins . . . They carry their babies all the time. Part of it is the moms are carrying them, and part of it is those babies do not let go. So babies stay absolutely positively attached to their mothers 24/7. Mom doesn't put them down. Mom doesn't give them to anybody else to hold. As they get old enough to move around, mom is never far away. So they don't trust anyone else to take care of that baby.

But humans are different. We share our babies. And in fact, that's one of the key insights that one of my heroes, Sarah Blaffer Hrdy, talks about, is human mothers literally cannot provide all the calories that their babies need from birth to independence.

And so human babies have evolved to be completely irresistible not only to their mothers, but also to other caregivers. They have those big eyes, and they smile and they babble, and they are interactive and designed to recruit help from anybody that will provide it.

We call this, where other people provide care in place of the mother, cooperative breeding. So this is a system that didn't just solve the calorie problem, but it actually created a feedback loop that is part of what made us human.

So, babies who could read social cues and charm multiple caregivers, while keeping an eye out for their mom, those babies survived better. And communities that shared ������ο��Ƶcare could support those slow-developing, calorie-needy babies. That kind of allowed for our complex brains to develop and for communication to develop and for humans to have such long lifespans.

So we call it human nature, our ability to cooperate and communicate and read each other's minds and build trust. And this all emerged from the fundamental need of sharing the work of raising ������ο��Ƶren. So it's something that's really unique to our species, and it's kind of driven by these cute babies.

This all worked out really well when we were traveling in small bands of hunter-gatherers. These are groups of related individuals. Somothers would be with their own mothers, they'd be with their partners, but they'd also probably be around sisters and cousins.

And what's happening, I think, for a lot of people today is there's this real mismatch between the world that we evolved in, these small groups of related people who stayed with you all the time, and who you felt safe sharing ������ο��Ƶcare with, and kind of our modern expectations that mom should have this maternal instinct to do everything, but they have to do it by themselves and do it alone.

So, this nuclear family that we kind of think of, and we talk about it a lot lately as traditional, is actually kind of a historic blip. For most of human history, women worked alongside other family members. They were in fields and family businesses. They were in extended households, and ������ο��Ƶren came along and were cared for by that whole community.

This kind of 1950s image of "Leave it to Beaver," stay-at-home mom in suburban isolation, it's not even the world that we live in today. It was a little blip in a timeline, and it's now become a standard that we're having a hard time recreating. And it actually was really working against our cooperative breeding design.

So that's the lens I want to look at today in this intellectual domain, is kind of this evolutionary lens. Thinking of some of these challenges in the postpartum period, they might've been things that were adaptive in a different environment, but we're trying to raise our babies in what's an unnatural environment for our species.

I want to talk for a minute about something. It's a phrase we hear. It's called "mommy brain," and it's real, but it's kind of not what you think.

During pregnancy and postpartum, you're being bathed in a complex hormonal cocktail of oxytocin and prolactin that are there to help you nurse your baby, vasopressin, some other hormones that we don't talk about so much, galanin. But these are all working together to sort of reorganize your brain for motherhood.

Kirtly, I know you know a lot about this.

Kirtly: Well, it's just been a big interest. Certainly, since people have developed really very sophisticated imaging techniques of the brain, we can actually look at the brain before people get pregnant, when they're pregnant, and after they're pregnant, and some of the big hormones, estrogen and progesterone during pregnancy, which are very high, plus all the other things that the placenta makes.

So these very high levels of hormones change the brain. And it's really some pruning parts of the brain, meaning there's some loss of some areas during the pregnancy itself. The gray matter gets a little bit smaller. Gray is the cells of the brain.

White matter, which is connectivity, which speeds connectivity in certain parts of the brain, increases. And those parts are making the brain work more efficiently, especially in areas of social context and awareness of the environment.

And then the brain after birth gets more neurons. Now, this is much like what happens at puberty, and the brain is rewired, especially in areas during pregnancy that is associated with social connection and bonding.

Now, not all women have the same amount of change, and the changes are small, but they're part of the remodeling of the brain that happens several times in a person's life.

We're just beginning to explore this process. And I could only wish that I had the same kind of scan before medical school, and then after I finished my residency and fellowship. So there were 11 years of high stress, high function, high input. My brain was remodeled, and probably the same way it was without the benefit of the scan after pregnancy.

Katie: Yeah, it's like your brain is reorganizing to be focused intensely on infant survival. So I think your brain maybe knows what it's doing. It might feel like you're kind of scattered and forgetful, but it's really like getting a new processor that has a distinct job.

Kirtly: And there's something called situational awareness, that ability to read the environment both physically and socially, that I think is enhanced in a new mom. Men might be better at location awareness, where they are, but women might be able to tell you all the things you passed on the way to get there, or might be better at socially reading the room.

There's some evidence that when men and women are compared in tests for situational awareness, women are a tiny bit better. And whether we're born that way or socialized that way, we don't know. But the difference is small and probably greater between individuals than between sexes. But it's part of a new mom's brain, always looking out for what might affect the safety of the baby.

Personally, I never had fear of heights until I had a baby. I was more aware of what might happen after our son was born. Have any of you walked out on Angels Landing in Zion Park?

Katie: I have.

Kirtly: Well, once I could do it, and then I couldn't. And I couldn't stand to see my kid next to a cliff edge. That was a brand-new thing for me.

Katie: And it's such a perfect example of how the brain reorganizes for threat detection. We don't get chased by lions anymore, but falling off a cliff is kind of a real risk.

But there are other positive changes too. I think mothers develop an enhanced multitasking ability. They maybe get better emotional intelligence. The threat detection, like Kirtly described, and perhaps heightened empathy.

So this mommy brain isn't really losing function. It's just gaining new capabilities that serve the incredibly complicated job of keeping a helpless human alive. But I think it's hard when you're also trying to maintain a demanding job at work, too.

Kirtly: Right. And there are other ������ο��Ƶren in your home, and you're trying to do everything by yourself. Maybe you've got help, and maybe you don't.

Well, I want to emphasize something from Sarah Hrdy's work about why the intense focus on babies and their face and the mirror focus in the baby's brain is so important.

When you smile at your baby, the smile center for that baby lights up, and it makes them smile. So these are called mirror neurons. It's so important for the development of emotional intelligence and how we understand each other.

Moms and dads, if they didn't have this drive to look at the baby, and not just moms and dads, but other caregivers, and the baby to look back, and smile at the baby and the baby to smile back, and talk to the baby and the baby to babble, the baby's brain development may not go as smoothly.

We are so social. We read each other's faces. We learn that in the first couple years of life, and it begins in the fourth trimester, that this is a critical importance in the ������ο��Ƶ becoming a social person.

It's why moms need to stay away from their phones while they're breastfeeding their babies or just bottle feeding their babies, or dads or other caregivers too. They need to be looking and chatting with their babies.

Katie: Right. I worry about this a lot. Our babies were kind of designed to be held and staring into our faces and interacting with us. Certainly, you need a car seat and it makes sense to put your baby in a car seat. But what I see so much is babies are in this car seat and for the sake of not taking them in and out of it, they get carried into the store in their car seat with a little hood over it where they can't see anything, and then we put them back in their car seat. I just feel like babies are not getting that face-to-face time.

Kirtly: Now they're in the back. When I had my kid, he was in a car seat, but he was right next to me in front. They don't let you do that anymore. So I could chitchat with him. I mean, he could look over at me, and I could look over at him. I know it probably wasn't safe. But anyway, they're in the back all by their little baby selves.

Katie: Yeah. Covered with a blanket over their face.

Kirtly: Oh, geez.

Katie: And a stroller. And that face-to-face interaction is building the baby's social brain.

One of the things I think that I do like that I'm seeing is that fathers are getting more involved in caregiving than in previous generations. I certainly see my son as a much more involved caregiver than my father or grandfather. And I think that's encouraging, because fathers are biologically capable caregivers too.

They also experience hormonal changes during the fourth trimester. Fathers' testosterone decreases, and their prolactin increases. And so when they're hands-on caregivers, they have maybe some of that same daddy brain and plasticity going on as well.

But we have these cultural ideas that mothers are naturally better at this. And even with more involved fathers, the mental load, I think, still falls disproportionately on mothers. Who's having to remember the pediatrician appointments and tracking the milestones and managing the social calendar. And this, again, sort of goes against our design where human infants should be getting this care from multiple adults.

So we're getting better at some things, and at the same time, I think we're putting a lot of pressure on both mothers and fathers, where we're getting away from some of our evolved experience and what we should be doing.

We have Jamie Hales, who's a licensed clinical social worker and a perinatal mental health certified therapist. She's currently working with the Huntsman Mental ������ο��Ƶ Institute to develop maternal mental health programs for the hospital. And she serves on the board of Postpartum Support International, the Utah chapter. We talked about those in the last episode.

As both a mother and a clinician, Jamie is passionate about research and advocacy for women's mental health. We're really grateful to have you here today, Jamie.

You work a lot with parents, and I'd love to hear from you about some of the things that you see going on for moms in the fourth trimester and how you help them manage that.

Jamie: Yeah, absolutely. One of the things I wanted to jump back to was this whole idea of mental load, the evolutionary versus societal factors. We know that some of these things are very much part of that evolution, but I think societal factors have a large factor that come into play with this.

So as we're talking about mental load, it does seem like at this particular moment in time, there is still a lot of emphasis that mom is going to be the one that does this.

So we see it all the time, like you were kind of saying before. Moms are managing the social calendar. They're keeping track of who's had what vaccinations, what's going on at school today, who had a bad day, who is struggling with their friends. I mean, the list just goes on and on. And all of those things are wonderful and so necessary, but also can be extremely stressful for parents, especially if you feel like you're managing that kind of stuff all by yourself.

One of the things that I've really used a lot in my practice . . . If you're familiar with the work "Fair Play" by Eve Rodsky, I think that that has been a really great tool for educating not only our moms, but their partners on what the mental load actually is. And also, it gives some really practical ways that we can work on balancing that workload and adapting family roles to what it looks like now in a more modern society.

Katie: Yeah. Boy, I remember that when I was raising kids. We had five of them at home at once, and my husband would get up early and go to work. And he had to leave very early, so he would just tiptoe out of the house and leave. I would get up and make sure the dog was fed and the dog had gone out and the kids had their lunches packed and everybody had a ride to school, and there was a list of chores for when they got home. I just remember thinking, "This is not fair."

Kirtly: Well, remember, in some cultures and the hunter-gatherers, the older mom was there with the babies, or it was the teenage daughters. So, there were other mothers.

And there are grandmothers and fathers who by virtue of happenstance or a sick mom or, God forbid us, a dead mom, a mom that died for some reason, who are doing this and can do this.

So it's not meant to be a slight on those people who've picked up the reins and done a phenomenal job, because they have the capacity and the neuroplasticity in their own brains to mother. We all can mother.

Jamie: Yeah, absolutely.

Katie: Jamie, tell me that reference you just mentioned again.

Jamie: There's a book, and actually kind of a fun card deck called "Fair Play" by an author named Eve Rodsky. I really enjoy using that one in my practice. I recommend it to pretty much all of my new parents and also people who have been parenting for quite some time.

Katie: Thank you. We'll put a link to that in the show notes for today. Thank you for sharing that.

Jamie: Yeah, you're welcome.

Katie: I mean, I think the mental load is one thing. And then I think also people's kind of changing identity. How do you integrate your pre-baby self with being a mother?

Jamie: Oh, yeah, absolutely. So earlier, when you were talking about some of the brain changes that happen in puberty, it brings me back to this idea of matrescence and this idea that we almost go through yet another form of puberty as we become moms.

We definitely have to reorganize our priorities around our ������ο��Ƶren when we have them, but prior to that, our priorities may have been organized around other things. Maybe we spent most of our time thinking about work or things that we enjoy, having hobbies. And once we have kids, there is a somewhat normal process that will change and that we'll have to focus differently.

When I'm working with families, I really like to talk about perinatal wellness planning, because having an identity and having a life outside of just motherhood is an incredibly important thing.

We'll always be mothers once we have our kids. It doesn't matter if they're 50 or if they're 5 months old, we're still mothers. It's a part of us. But at some point, we will have to reorganize yet again on our identity and shift into whatever new role we're going to have.

Whether that's a return to some of the things that maybe we had to mourn losing when we first had our kids, whether it was our hobbies, or even just our freedom to move about without having to worry about launching an expedition with a diaper bag and 500 snacks, we do get back there.

And if we don't figure out how to integrate these parts of ourselves or maintain things that bring us joy and fill our cup, it can make that transition out of early motherhood also really difficult because we can lose sight of ourselves. So it truly is recreating this new version of yourself yet again, and it's incredibly important.

Katie: And I think that's where kind of recognizing that we're designed to share our ������ο��Ƶcare with multiple other people. It's good for our babies and it's good for us, and it's a thing that we can keep doing. We get to participate in ������ο��Ƶcare in our community as our own ������ο��Ƶren grow up, and becoming menopausal grandmothers ourselves, we still get to participate. Yeah, there are multiple opportunities.

And you're right. The identity changes, but I think that shift of thinking of ourselves as part of a big community instead of being the person that has to do it all is probably . . . it seems really helpful to me.

Jamie: Yeah, I totally agree.

Katie: Socially, I think we're talking about it a little bit more, at least I'm hearing about it, fathers getting more involved. I think that's been a little bit of a cultural shift, but I think socially we still sort of make assumptions about what dads can contribute. And so I think that's a change I'm seeing that I like. I see more guys wearing their babies in a snuggly or wearing them out and pushing strollers more.

Do you talk to patients about that? It sounds like the fair play gets to that a bit, doesn't it?

Jamie: Absolutely. One thing that I've found pops up quite a bit in new parents is sometimes we'll have a little bit of maternal gatekeeping that happens, partly because we've been socialized to say like, "Well, moms just know how to do this. It's instinct. They've just got this."

Sometimes they can get to a point where when other people do try to step in and help, there's a little bit of that gatekeeping to do it exactly the same way or to, "Oh, I'm not going to have you do this because you don't do this every day, so you may not do it the right way."

So sometimes we have to actually work to help our moms let go of a little bit of control. And at the same time, it is good for our kids to have access to different caregivers and different styles of doing things. I think we benefit from learning from different caregivers.

Just in general, I think the emotional load of having kids can be pretty huge, but the more we can allow ourselves to spread that around, probably the better that is for us on not only a social level, but also an emotional level as well.

Kirtly: Well, that's a shout-out for good daycare. I think many, many working moms don't have their moms or aunties or sisters or someone in the neighborhood, but they do have ������ο��Ƶcare, and good ������ο��Ƶcare where someone is holding onto the baby and talking to the baby and the baby bonds with the community in the ������ο��Ƶcare situation.

High-quality ������ο��Ƶcare is part of this village. And women shouldn't feel guilty about having their babies in ������ο��Ƶcare, because that's another way that kids are hearing different voices and seeing different faces and people who are used to kind of just looking and talking to babies.

Jamie: Absolutely. Alloparents are so important. Whether it is ������ο��Ƶcare, extended family, friends, we need these people in our lives.

Katie: Yeah. Jamie, some of these things that we've been talking about, like vigilance, do they become concerning? Are there things that you watch out for if moms are worrying too much about certain things?

Jamie: Worrying about our kids and keeping them safe, like Kirtly described with the whole Angels Landing situation, that makes a lot of sense, right? We want to make sure that our kids are not running in the road or sticking their hand on the stove or doing any number of things. So we do become, I think, a bit more vigilant about what our kids are doing.

Now, it can move from being just more aware and vigilant into being hypervigilant or having really intrusive thoughts about any type of harm coming to their kid. That's a pretty common thing to come up when you have a new baby.

When things get to a place where the intrusive thoughts are really running the show and you're having to change your normal daily behaviors to accommodate them, that's typically where we start to get a little bit more concerned.

One thing that I have found can be extremely helpful to moms, especially sort of in the early stages of this, is just some psychoeducation, frankly.

A lot of the time when they're experiencing this, they start to get this concern that, "Oh my gosh, I am the problem. There are all these dangers, and I am the big danger. I have identified myself as being a problem." And letting them know that some of this is just an overabundance of good parenting can really help them to be like, "Oh, okay. This happens to other people. This is my brain saying, 'Ah, there are all these threats. I'm just trying to keep my baby safe.'"

But from there, we have to really focus on reminding them, at least at first, that they are not actually the threat and that they need to talk through this with people.

Often, they'll shut down and be really concerned, like, "Oh, I can't say these crazy thoughts in my head to anybody else." But what they need to learn is that sometimes when we give those thoughts a lot of power and we reorganize our lives around them, it actually really supports the issue.

So, our goal is to give them that little bit of reassurance, but also after that move into helping them figure out how to do things, like resume the baby care, and to really work through those type of thoughts on their own and show to themselves that they're actually okay to continue doing this.

Katie: Do you think this has gotten worse with this age of social media? I certainly feel like if I google my worst health fear, from then on, Instagram and Facebook sort of flood me with related links, and then I'm down the rabbit hole.

Jamie: I absolutely do. I think sometimes social media is great because if you get good content, then you can see, "Oh, okay. Well, other people struggle with this too."

I remember I had the weirdest intrusive thought with my son that I thought his leg was going to just fall off when I was changing his diaper, which I recognize now is the silliest thing ever. That is not how baby's legs work. He's not a doll.

But it worried me to the point where I was like, "I don't think I can do diaper changes or put my kid in his clothes. This is freaking me out." And obviously, I worked through it. He's 11 now. He . . .

Katie: Has both limbs.

Jamie: . . . can dress himself. He's okay, and he still has all his limbs.

But at the time, like, it was actually really helpful because I told one of the nurse managers that I worked with that this was a thing, and she just laughed and said, "Oh, yeah. You know what? When I had my kids 40 years ago, we didn't really do ultrasounds, and I just had this horrible intrusive thought that my kid was going to be born without legs. I couldn't even check. So I had to just wait until he came out and see how things looked."

So sometimes when we can talk about this stuff and laugh a little bit, it actually, I think, normalizes things a bit and it just helps us know that we're not struggling through these things on our own.

Now, on the flip side of social media, of course, sometimes you do get all of the worst-case scenarios. And I think that's the piece that moms end up really worrying about, is, "What will people think of these wild thoughts that are going through my head?" So hopefully we can strike some sort of balance out there between the two.

Katie: Yeah, absolutely. Thanks for sharing that story. That's adorable. But I think that that's such a good thing for people to hear, is that most everybody has . . . That is part of that brain change, is your brain is a little bit wired to be paying attention and it's not unusual to have some anxious thoughts that even include harming your baby yourself. These are thoughts that people have, but that doesn't predict that people are actually going to harm their ������ο��Ƶ.

And so I think, again, it's part of being in community where you have someone to talk to about it and say, "That's normal. It's okay."

Jamie: Yep. Absolutely. And it's usually quite the opposite. When you're having these thoughts, we are usually not actually much of a threat. And it's important to talk to people about that, so if there is an issue, we can help get you some help. But also just to let you know that chances are it's not really going to be a problem. I don't worry that much about these moms actually harming their babies. They just really want to make sure they're safe.

Katie: Any other sort of practical recommendations you have for mothers that are feeling overwhelmed in the fourth trimester?

Jamie: So even though I think culturally it's hard for us to ask for help and there's a lot of this narrative of, "You're a mom. You know how to do this. You've got to just suck it up and get through because this is what we do," it is okay to ask for help. We really need to encourage and normalize that.

Whether you have a really tight extended family, or you're utilizing friends, or you shouted out before regarding having high-quality ������ο��Ƶcare, we were not meant to do this in isolation. That was never the goal. So it's okay to ask for help. It's okay to plan ahead.

In fact, I really like to push the idea of doing some sort of postpartum planning to talk about how you're going to get some of these just very basic things taken care of, like your sleep, making sure you have food.

I love that we do meal trains right after people have a baby, but sometimes we need that a couple months down the road even still when things have dropped off and we maybe don't have as much support.

People need support throughout their parenting journey. We need time to be adults, and we need time to spend with our partners and to be good parents and to provide, but that means we're probably going to need some assistance to get all that done.

Katie: I love that. Thank you. Thank you so much, Jamie, for sharing your insights and ideas and suggestions.

I think that is what I like about this kind of evolutionary perspective, is kind of taking a step back and understanding that we truly evolved to raise our ������ο��Ƶren in community. It's not natural for us to do this alone or just alone with our partner. Babies are designed to get help from lots of other people. That is actually what makes us human, is that reaching out.

So I think it's that planning, but even just recognizing that living your life in your four walls with your television and your phone is such a deviation from really what makes us human.

And so whether it's family or friends or support groups or professional help, reaching out is actually the natural thing to do.

So thank you for joining us today on the intellectual domain. You can find more episodes in our series on the fourth trimester and all of the "7 Domains of Women's ������ο��Ƶ" at womens7.com, or .

And for this episode especially, remember that your brain in the postpartum period is not broken. It's trying to do a job that was meant for a whole village. So reach out to your village.