Ep #57: Matrescence: The Word Every New Parent Needs to Know with Dr. Ono Nseyo

The transition from preconception to pregnancy to being a new parent and having a baby is such a tremendous one, and I don’t think it’s talked about enough in our society. So today, we have an amazing guest who’s going to talk to us all about that transition, which apparently has a word for it. It’s called Matrescence. Stay tuned.

Welcome to Parenthood Prep, the only show that helps sleep-deprived parents and overwhelmed parents-to-be successfully navigate those all-important early years with their baby, toddler, and child. If you are ready to provide the best care for your newborn, manage those toddler tantrums, and grow with your child, you’re in the right place. Now here’s your host, baby and parenting expert, Devon Clement. 

Hello and welcome back to the Parenthood Prep podcast. I’m so excited because today we have a guest that I’ve really been looking forward to talking to. She is actually a fellow podcaster, Dr. Ono Nseyo. And I was recently interviewed on her podcast, The Golden Hour. And I’m really excited to have her here today to talk about some stuff. 

So her background is as an OBGYN, which of course is very relevant to my listeners as well. And your podcast is all about the sort of transition of birth, postpartum, pregnancy and all that stuff and how it connects. And I’m really excited to talk to you today about that because it’s something that is just so noticeable when you work in this space, that it is just not really recognized or supported. 

You know, one of the things, we talked about this when I was on your podcast, so sorry if you’ve already heard hers and you’re hearing this again, but, you know, you spend your whole pregnancy being cared for by your OBGYN and creating this relationship with them. And then the baby’s born and it’s like, bye.

Ono: Yeah. It’s like, see you later. No, you’re right. You know, you have this amazing connection with a great OB doc or a midwife and they’re seeing you regularly towards the end, you’re seeing them weekly. And suddenly someone hands you a newborn who’s incredibly needy and justifiably so. And they’re like, there’s no book for this, figure it out on your own. We’ll see you, you know, at six weeks, make sure that nothing’s falling apart. I’m obviously over exaggerating and then they let you go. 

And I kind of personally feel like an OB, that’s one of our biggest failures in our large and fractured healthcare system. And that’s what inspired me to make my podcast. It was like, I need a place to appropriately vent. My husband, I think was getting annoyed with me coming home from work and being like, oh my God, we can do so much better because it’s a massive transformation from pregnancy to postpartum. Let alone preconception through postpartum, right? 

I think especially you, you see it as you supported, you know, at this point hundreds if not thousands of families. You’ve been in the trenches and you recognize how epic of that journey is when you bring that newborn home. And for me as an OB, I only get a glimpse of it at the office, but I know not only from the deep connections I’ve had with patients, but, you know, the friends and family members I’ve gotten to see and support through it, that it’s so much more than the two or six-week visit that the healthcare system says is all you need. There’s much more to that.

Devon: So much. And, you know, now, not only are you parenting this baby for the first time or the second time, you’re juggling multiple kids or whatever, but your body has been through such a tremendous change, trauma, like whatever you want to call it. Like, you did this huge thing. And I feel like a lot of times, especially my clients that are first-time parents, they are just blown away by the recovery of it all. So what does the preparation for that currently look like?

Ono: Yeah, that’s great. Yeah, let’s talk about how it currently is versus my dream state. So you have this epic transformation that you’re referring to. We talked about it pre-recording, but Matrescence, right? Matrescence was a term defined by this incredibly intelligent anthropologist, Dana Raphael in the 1970s to represent this massive transformation that your body goes through starting actually in pregnancy through postpartum that is hormonal, that’s biologic, that your brain, they show MRI studies that show that your brain is changing, right? 

That you physically are changing, your hormones are fluctuating. There’s the hormones that you have in pregnancy, a lot of estrogen and progesterone. Once that baby is gone, you have massive withdrawals of those hormones, but then oxytocin goes up so that your uterus can cramp down, so that your body can produce breast milk, right? All these hormonal shifts that you and I remember our teenage tween times, right? 

Adolescence, how awkward we felt, how emotionally we felt, how our parents couldn’t stand us because we were all over the place. But imagine going through those transformations when you’re growing a baby and bringing that baby home. And so the current state that we have in our healthcare system does not appreciate, I don’t think, my personal opinion, does not fully appreciate that massive transformation hormonally, emotionally, physically. And so that current state of preparation…

Devon: Well not just the healthcare system, but I think society as a whole.

Ono: Yes, society.

Devon: For family members, your job, your friends, like even if they’ve been through it, but especially if they haven’t, like you’re just expected to go back to being the person that you were before you were pregnant. Like it’s wild.

Ono: Yeah. And the expectations, right? We have so much of this snapback culture, you know, I think you and I probably talked about it on our podcast together, but social media, there’s the good and bad and ugly of social media, right? I think you and I are the among the good, right? We’re using our social media powers for good. 

But some of the unintentional bad, I appreciate that people are not going out there trying to hurt or harm others, but we create this space of like shame and guilt when people are posting like this is me, you know, at nine months postpartum, this is me three months postpartum, right? That unrealistic like snap back, body back, whatever imagery that’s put out there. 

This concept of like, well, this is how I parent and this is the perfect way to parent that again is put out there on social media, which makes someone feel like, well, I don’t, my baby’s not sleeping or I’m not doing it that way and am I doing it wrong? Right? All these things can get into someone’s head, but you’re right, it’s not just the healthcare system, it’s society. It’s society having this kind of unfair expectation of what it looks like to make that transformation.

Devon: And I think not just the physical, but also the emotional. Like you mentioned all these hormonal changes, everything. Like your brain is different. You said that. Like your brain is changing. You’re becoming a different person. And it’s like if you’re not, you know, if a new parent is not like blissfully happy and just like so glad to have their baby that there’s something wrong with them and like it’s a problem. 

When really, you’re on this like emotional roller coaster of so many changes in your life, in your routines, in your – I’m actually like a little bit torn about the like snapback idea because I don’t think people need to like get their body back or get their sex life back or whatever. But I also don’t think they need to just be completely subsumed by their new state as a parent, as a mother especially or a birthing parent especially, because there is still that spark of like, you are a person and you are your own human and you have this identity that you used to have and you used to like and interests and hobbies and things like that. So like I want to help people maintain their identity within their new, you know, existence.

Ono: Yeah. No, I appreciate you saying that because so much of like this epic shift, this roller coaster ride. It’s funny how like kind of how all of us in birth space use a lot of the same analogies. I often say that like first two week or three week postpartum visit, I’m like, it’s been a whirlwind to say the least, right? Like you just imagine like the up and downs is there’s this concept of identity shift, right? 

This idea that if we’re talking about like a first-time mom, there’s a person I knew before the baby and the person I am getting to know post-baby. And you’re right, like you don’t necessarily have to stew in this like darkness, this morning, but you also have to go through it to find self-love, acceptance, to recognize that you’re an evolving person, that this is a new iteration of you. Learning how to love your new body. I had a podcast guest on last, I think a week or two ago that I interviewed who was explaining to me that with her first baby, she didn’t look at her body, right? 

She wasn’t ready to like accept those physical changes. It was too overwhelming for her. But with her second pregnancy, she learned and reflected a lot and recognized that those physical changes were her battle scars if you will, like points of pride of saying, look what my abdomen did. Like it held this baby for nine months. Like, look at my vagina. It pushed out a baby, which is a pretty big feat. And so she was able to change her perspective of those physical changes that normally made maybe turned into like body shame or not feeling good about myself and not being ready for myself and being like, no, this body, this amazing body did great work, right? 

Not everyone’s going to wake up like 10 days postpartum immediately feeling that. No, it’s like it’s a transition for a reason and we’re all allowed to have our journeys. But I thought that was a really thoughtful way of appreciating the physical demands of having a baby, right? And recognizing that what an honor it is for those who can even conceive, right? Not everyone can even do that. Let alone be able to have a baby, a healthy baby successfully, vaginal or C-section and being able to still love yourself, love your body after all those physical changes.

Devon: And it changes so rapidly, I think you’re like a little bit shellshocked by it, which also gets me thinking about like the birth process. I think that there’s this mentality that, you know, the faster the better, like if you have a long labor, that sucks and like, oh, I hope it just happens really quick. I’ve had clients who had super quick labors and were really kind of traumatized by it because everything just happened so quickly and changed so quickly and it was too fast. And they didn’t have time to, especially if they it happened a little early, you know, when they were like kind of not quite mentally ready. I mean, whoever is mentally ready, right? 

But like, so there’s not a universal fast is better or like vaginal is better than C-section or this or that. Like it just really depends on how it goes for you and what your experience is like. But I think I love that there’s a name for that. I’d heard that word, but I didn’t I didn’t know what it meant because it’s so true. You are becoming a different person, just like when you go through adolescence and you go from being a child to being more of an adult, not quite an adult. You’re still a child, and that and that’s a long process too that I think we don’t give enough credit to. So in the healthcare system, people see their doctor again two weeks if they have a C-section, six weeks if they don’t, and they just don’t have that support in between.

Ono: Yeah. It’s also recognizing that postpartum doesn’t end at six weeks, right? Where did that six weeks come from? That six weeks probably came from, okay, the most likely complications that are going to happen immediately after birth, preeclampsia, excessive bleeding like hemorrhage, uterine infection, mood disorders most likely will reflect themselves or present themselves in those first six weeks. 

And so some really intelligent medical providers who are leads of ACOG and heads of the Midwifery Practice groups and insurance companies probably gathered together and said, okay, these are the time marks. I know something that I really appreciate about practicing in California is that probably in the past five years, they went from it was six weeks for everyone, maybe two weeks for a C-section, but that wasn’t necessarily done consistently to California kind of passing laws that said, okay, no, everyone gets two appointments, even women with vaginal deliveries, but like that was a huge deal. Wow, everyone gets two appointments.

Devon: Two appointments? Oh my goodness. What a boon.

Ono: I know. And by the way, Devon, those two appointments are still just 20 minutes. Is 20 minutes enough time to, yes, talk about the medical, physical things that we have to check the boxes for, so bleeding and blood pressure, etc. But is 20 minutes enough time to actually talk about identity shifts and the feeling of shame and ambivalence and all those things that are really part of that journey? No. 

And so I find myself as an OB, I know I have to check my boxes. That’s my job. I can’t miss hypertension. I have to make sure someone isn’t having excessive bleeding. Make sure their C-section or vaginal tears recovering well. But then there’s that part of me that still knows that person in front of me maybe is only telling me like the very surface level what’s happening to them, that they feel like it’s a rush to kind of do a deeper dive into like the actual iceberg underneath the surface if you will of what they’re experiencing. 

And also knowing that it’s not just six weeks. I’ve had moms come see me a year postpartum just for the routine annual exam. So like I’m due for a pap smear. And we’re chit chatting, we’re talking like how things been and then next thing you know, they’re sharing with me that like they’re depressed and like they’ve gone back to work. They’ve been back to work for a while, but like they’re feeling a lot of guilt about leaving the baby and you’re recognizing, oh no, this is postpartum depression. It’s yes, you had your baby a year ago, but you are experiencing postpression and it’s not just like a six week thing. It can present itself at three months, six months, a year out. 

And so I think that there is like this medical concept of “postpartum” at six months, but that’s why I think that term Matrescence is much more realistic and applicable because Matrescence not only acknowledges the long-term transition postpartum beyond six weeks, but also acknowledges what’s happening in pregnancy. 

And I think what I’ve learned as an OB, I learned that term actually from one of my podcast guests, Molly Normand, who’s an awesome therapist outside of LA. And a lot of people in the maternal health, mental health space are aware of it, right? That it’s often spoken about amongst therapists, but this is like a new term for me as an OB who I was training at some of the best institutions. I’m not here to humble brag, but I went to Stanford undergrad. I went to UCSF for medical school residency, and that was never brought up in my curriculum. 

And so I’m finding as I do my own self teaching that as much as this is a terminology that is known in the maternal mental health space, OBGYN doctors don’t know enough about it. Midwives don’t know about it. So I feel like I’m on this personal crusade that as you mentioned, Devon, like beyond just like the clinic space, like culturally, socially, we need to normalize this conversation and have people appreciate that motherhood is a huge deal. It’s a big effing deal. And I think that there’s like this misconception of because everyone’s done it, right? Generations before us and generations after us, it’s like this like, yeah, you just do it. Have a baby. Duh. Like I think that society we’ve come to appreciate more and more the complexity of it, but there’s many there’s many more layers to it that isn’t as simple as what tends to be discussed. So I’m glad that we are having that discussion right now.

Devon: Yeah, and I know the maternal and postpartum mental health space has really grown a lot in the last decade or more. You know, when I started out, postpartum depression was sort of like just beginning to really be talked about. I was fortunate that I was starting out in New Jersey where actually our governor at the time, years and years ago, his wife had gone through like some really serious postpartum psychosis and things like that. So it was really important to the state administration at that time to create initiatives to educate and train and get the word out. 

So in New Jersey, we were kind of at the forefront of some of that postpartum mood disorders, but you know, it was just the term postpartum depression. Nobody talked about anxiety. Nobody talked about OCD. Nobody talked about psychosis. Nobody talked about like you just said, you might feel okay or just chalk it up to like adjusting to having the baby, and then six months or a year later, you’re like, wait a minute, like I’m not myself. 

I have heard that story time and again from friends, from people that I know who are parents just saying like, my kid was three and I realized I was still suffering from postpartum depression and anxiety and whatever else. So what have you seen on the OB side in terms of mental health addressing potential issues, educating clients, providing resources, that kind of stuff?

Ono: Yeah, you’re right. I think we’re getting better, which I’m really, really grateful to be practicing in this generation rather than the latter, right? And that because of a lot of advocates like similar to probably the governor of New Jersey and those who either experienced postpartum depression anxiety directly or had a loved one. There’s a lot of been a lot of systemic or systematic rather changes. 

I can only speak to our practice, but something that we do early on is like recognizing that those who come into pregnancy with a history of depression or anxiety or OCD or bipolar is actually having history of bipolar disorder is your highest risk factor for having postpartum psychosis. So as rare as postpartum psychosis is, being someone who’s been affected by bipolar disorder really does increase your risk. 

And so as an OB or midwife, I think most of us who are trained well recognize that we need to identify those patients early on. So part of that very first OB visit, the reason why it’s twice as long as normal visits is because there’s so much to cover. But that is also getting to know your patient.

Devon: And you mean sorry, you mean the very first visit when you’re newly pregnant.

Ono: Newly pregnant. Yeah, exactly. Very first newly pregnant appointment. Although that’s a good point, Devon, and I’ll do a quick aside is that sometimes we have an opportunity when patients come to see us for what we call preconception visit. So patients will say, hey, I’m planning to get pregnant or we’re about to start trying. You know, here’s my medical history, here are the medications I’m taking. Like any thoughts about, you know, what to anticipate in your pregnancy. 

And that’s a really important time for any OB doc or midwife to really take time that you usually don’t have in a different visit type to like slow down and say, okay, so you have a history of depression, you’re taking Zoloft for example. And you can talk about the safety of Zoloft in pregnancy and talk about, you know, the recommendations continue it and pros and cons, etc. But what I was referring to otherwise is that first new OB visit. 

So when you are pregnant, and that visit is a really good time to identify who has a mental health disorder. And I’m open with those patients I say like, hey, it looks like you have a great mental health team. You have a therapist, you have a psychiatrist, you may or may not be on a med that you’re stabilized on. But I’m really honest with them where I say, I hope that this pregnancy is smooth for you. I really do. But you are higher risk of either having exacerbation of your mood in pregnancy, but especially postpartum. 

And so what we’ll do is we’ll check in throughout the pregnancy. If anything changes acutely, please let me know. I’ll add on an extra visit or postpartum. Those are patients who I especially am worried about, right? Because we talk about like sleep deprivation, we talk about the new demands of motherhood caring for a newborn, let alone the tensions of your relationship changing with your partner and your family members and everything else in between. That’s huge for anyone, let alone someone who has a history of depression and anxiety. 

And so those patients are patients where I say, I don’t know what’s going to happen, but we should be prepared and we start talking about postpartum plan. One of my favorite things to do with my patients who, again, already have anxiety or depression is talk about the postpartum plan usually at like the halfway point in the pregnancy, so around 20 weeks or so, saying, okay, how often you seeing your therapist? 

Oh, well, we really haven’t been checking in because I’ve been doing great. All right, well, I want you to reach out to your therapist and if they don’t know you’re pregnant already, please let them know. And I want you to check in with them within like a week or two postpartum. And you and your therapist might decide you only need to check in once a month, everything is fine. Or you might decide after that first postpartum check in, oh, we need to check in with each other like weekly, right? 

Because the worst, the worst is when you are in the trenches, when you are already just like steeped in exhaustion and depression and you can’t take yourself out of that like pit of darkness. And that’s what depression is. It’s a lack of activation energy. You’re not motivated. So how unfair is it to ask that depressed postpartum exhausted mom to like connect with her therapist or psychiatrist at that point. 

That’s why I really think my role and the role of any OBGYN and midwife is to be proactive and empower our patients to be proactive so that when they get to the other side, if you will, referring to postpartum as the other side or just the continuum of that trajectory, they can feel that much more prepared.

Devon: I think that is so huge and so important and I’m so glad to hear that doctors are taking that proactive approach because I think it applies even to, you know, what we do, newborn care. We get people and I would say in the last – over the course of the time I’ve had this business, they have been so much more proactive reaching out earlier for care instead of calling us when the baby’s three weeks old and they’re like absolutely drowning, being proactive about it. 

And sometimes we get people who, you know, aren’t sure if they’re going to want support or need support or how much support they’re going to need and they’re always like, well, you know, when can we decide and this and that. And I always say, at the very least, just plan to have like one visit with us in the very beginning, whether it’s the first night you come home and overnight, I love for people to do that to have somebody to like kind of meet them at home from the hospital and get them through that first night on their own or just something in the in the first couple of days, just as like a touch point, like a let’s see how it’s going. 

And maybe it’s going great and we’re like, cool, you’re doing amazing. You don’t need help. Call us if you want sleep training, like whatever. But honestly, that very rarely happens. More often than not, they’re like, oh my God, we’re so appreciative for this help and support because we did not know what to expect. And now we feel more prepared to figure out, you know, what support we do want going forward. 

Same thing with like breastfeeding support. People are planning on breastfeeding. I say connect with lactation consultant now, when the baby’s born, make that appointment for like day two, day three, when you’re home because the number of times I’ve been up with somebody in the middle of the night, texting every lactation consultant and I know, can you see my client tomorrow? And they can’t, you know, they can see them in two days or three days, but meanwhile, we’re already struggling. 

And you’re right, like doing it when you’re, I mean, not that your brain is normal in pregnancy either, but doing it when you have a little bit more brain power than you do in those first few days or weeks after having a baby. I mean, I think that’s tremendous. Something else I’ve noticed is if I’m talking to a prospective client lately, the last few years, they have been saying, I am on medication for anxiety. I have a history of depression. It is on my radar to be aware that I am at a higher risk for that or I know that my mental health issues are triggered by lack of sleep. So it’s really important to me that I have someone, you know, helping so that we can get sleep and all that kind of stuff. But, you know, I think also people who don’t have that kind of history need to be aware that it can happen.

Ono: It’s one thing when there’s the patients who know about their history, know that they already are on medications for depression, anxiety. I think it’s the other for those patients who are completely blindsided. Because it’s that much more of a shock like that, okay, I already knew that, you know, taking the newborn home and being a parent is going to be hard, but now you’re adding this like unexpected mental illness to all my stressors. 

And so I think something that’s really important that again, I don’t know if all practices do, but it’s built in our practice is halfway through pregnancy, everyone gets a postpartum, it’s called the postpartum depression scale, but you don’t have to give it postpartum, you can give it in pregnancy. And it’s an important check and it’s an important time for us to say, you know, because patients are like, why am I filling this out? I feel great. Like life is great. I like my nausea went away. I have energy again. Like this is the high life of my pregnancy. 

But it’s like again, time for an OB doc or midwife to say, hey, the reason why we do this is that you are great right now and you’ve never had a history of depression, anxiety, but something can happen. I think I think there’s so many different concepts of preventive health care, right? That term is thrown around a lot. Preventive health care in terms of reducing risk for hypertension and stroke and all these other big things. 

But preventive healthcare can exist in obstetrics as well. It can exist in maternal health as well. And I love that you already work with your clients to kind of come up with what sounds like the ideal postpartum toolkit, right? Have your lactation consultant already like connected with. Have a mental health provider that you can have on speed dial just in case, right? Pelvic PT, like there’s all these things I think about that are ideal ways to support the postpartum person.

Devon: And really what’s better than like lining that up and hearing from them like, oh, everything’s great. We’re good. Like why not do that? You know? That would be great. It’s often times not the case, but people seem to like – they’re hesitant about like having a lactation consultant because what if things are going well? Then they’ll just tell you things are going well and they’ll that’s nice to hear.

Ono: Yeah. Agreed. And something you and I talked about is you had asked me earlier about like the current state, right? The current state is the two appointments only postpartum and the kind of wishing and hoping that things work out and maybe not finding until a year later that things were really tough. But to me, like the ideal state is um that doesn’t exist yet, but somehow creating like a super web if you will, like a super network of all the specialists that you referred to and you are doing this, right? Inherently Devon, like what you do and what your amazing company does is you are like the magic piece that puts all these things together.

Devon: It is you know, but realistically not we’re not available to like not everyone has access to this kind of care either financially or where they are geographically or whatever. So you, the doctors are the ones who are really seeing everybody.

Ono: Yeah. No, and you’re right. Like we I think we also talked about this on our podcast episode is that there’s the privilege to be able to hire a postpartum doula or to be able to hire a night nurse. And my real dream is that the government, that society recognizes that postpartum and motherhood and Matrescence is this massive epic transformation that deserves all the support possible, which means that the healthcare system is built for that. 

That means that everyone goes home with like, okay, this is your assigned lactation consultant. This is your assigned therapist. This is your assigned pelvic PT. Everything is booked out for you covered by your insurance, right? That’s the ideal. And if I have to just go on like thousands of podcasts for the next, you know, 10 plus years, like, you know, calling that to action, I will because that I want that for everyone. 

I went into medicine because of health disparities. I went into medicine understanding that there are women who are underserved, and populations that don’t get the care that economics and socioeconomic status and privilege could get them. But realizing that everyone deserves that. Like that’s a human right.

Devon: Absolutely. And I mean, I think back to, you know, my mother talking about when I was born, when my sister was born 40 years ago, you stayed in the hospital for a week. They took care of you for a full week after you had that baby. Like it’s still not enough, but like you got to recover. You got your meals brought to you. You got your family members to visit you in the hospital and then get kicked out when it was time to go. 

Like she talks about it like it was a vacation. You know? And now they go home practically five minutes after the baby comes out and it’s like see you in six weeks. So we have had something like that in the past, you know, historically. So it’s not like this is a new concept. You know, certainly she wasn’t being visited by a therapist or whatever, but I talked about this on my NICU episode. I think sometimes when your baby’s in the NICU, it’s like a silver lining that you have those nurses with you. 

You have that support. You’re going home at night and getting sleep. You’re pumping and having all this output because you’re using this like amazing hospital pump and you’re not trying to like make yourself lunch while you’re trying to pump, while you’re trying to take care of your baby and everything else. Like when things happen that you get an opportunity to be cared for longer, the outcomes just seem so improved and so significantly better.

Ono: Agreed. No, I mean, you’re right. We have president, right? Like that’s wonderful. I didn’t I didn’t realize that your mom had the fortune of a five-day postpartum state.

Devon: But I think that was that was the norm back then.

Ono: Norm. Yeah. And we also have can look outside to other cultures, right? So I’ve had guests on before who in Asian cultures, they have this concept of the postpartum hotel. I think that there are now are a couple that there is one in New York, I think a couple in LA, some in the Bay area as well. But it’s this concept of recognizing Matrescence even if they don’t necessarily use that same terminology to recognize that postpartum person that needs that support, needs a place to stay and physically recover, have extra help to help feed their baby, all these different things that again is can seem to be a luxury, but in other cultures is built in and is expectation. I think we can learn from that. 

I think another thing that would be a huge win for like future state, dream state, if you will, is thinking about paternal leave, right? So how can you expect someone to fully recover emotionally, physically, mentally, if they’re supposed to go back to work at six weeks. Oh, but you had a C-section so you got eight weeks. I mean, again, like that’s not realistic. But then I talk to my good dear friends who one of which who had both of her kiddos in Germany, another of which who had her kids in Finland, and these are countries who get it.

Devon: Oh, Finland is a dream. Sweden, Denmark, oh my gosh.

Ono: Yeah, all those countries. Canada. And it’s this idea of prioritizing family, prioritizing women, prioritizing birthers, recognizing that making that decision to start a family, to grow a family is a massive transformation for everyone involved and parental leave…

Devon: But also, having time with your partner not having to go back to work is tremendous.

Ono: Parental leave is a big one. And I think that again, we can go to other cultures, other societies for a strong example of what can be done. I think as our society continues to appreciate more and more what a massive transformation Matrescence, postpartum is, how much more support postpartum people deserve beyond the networks that you and I try to connect our patients to, the more likely we are going to be able to move the needle to like big societal, political, policy changes like that too.

Devon: And I know even in countries that are not quite at the Scandinavian level, like England or Australia, you get home visits from a nurse or a midwife, like checking on you. I don’t know how often, they come a lot though. I know in Australia, I don’t know if they still have it. I’m sure they do, but when I was when I was living there, they said that there’s like centers. You just like pop into. 

Like they have groups, they have support groups, they have this and that, but it’s all covered by like the health program, the national health insurance. You get your baby weighed, you get you can see a lactation consultant, you can just hang out. Like it was just this like normal thing to do to have that support system built in. 

And here, that stuff is available and it is happening, but sometimes it’s hard to find or it’s hard to get to or maybe you live in a rural area and you don’t have anywhere close. Like certainly online support groups and things like that exist. But again, when you’re in that state of just brain fog, baby fog, sleep deprivation, you’re not looking for, you know, support groups. You’re just crying to yourself and trying to survive. Just trying to survive and going out of your mind. So if that was all just built in and like so accessible, I think it would be tremendous and the healthcare system is the place for it to start.

Ono: Yeah. I mean, Devon, the real dream is to create like a think tank of people like you and me, right? People you – no, I’m not joking.

Devon: Yeah, no, it’s incredible.

Ono: To create the ultimate like think tank of people like you and me who not only have been exposed to different ways to support birthers and their postpartum journey, but are passionate and advocates where we get together and we and I don’t think any society should live in a silo. Like I think there’s something beautiful about like learning from one another, learning from other countries and cultures, right? And integrating that in. 

And so like imagine this massive think tank of saying, okay, yeah, this is why I saw in Australia and this is how they do it in Scandinavian countries and creating something that can be, even though it sounds idealistic, but it should be the goal, right? It’s something that is available to all, whether it’s virtual options for those who live in more rural areas or at cost, you know, fully covered insurance options for those who are under insured, right? And everything in between, right? I think I believe, I believe in us. Let’s do it.

Devon: Well, as and as we’re talking about this, I had this idea that I was going to tell you about after, but I’ll just tell you about it now. I want to work with you to create a guide for people who are either preconception or pregnant. Here’s how to prepare because my thing is that people don’t prepare for parenting at all. Like they just think they’re going to have this baby and figure it out. And why wouldn’t they? That’s what we’re taught and they figured out everything else in their life so far. 

They’re smart, they’re educated and then they have this baby and they’re like, like when you said that preconception visit, I’m like, that’s when I want people to start listening to this podcast. That’s when I want people to – I want to create a class, like a parenting class for people who are not even pregnant yet, who are just thinking about it. People ask me like, how do you do this job if you don’t have kids? Like I was aware that babies existed. And a lot of people aren’t. 

I mean, obviously I’m exaggerating, but like they’re just like, how could you even possibly have considered taking care of kids unless you had your own? I’m like, because I did understand and I had that desire because I loved babies and kids, but like a lot of people don’t care about that. You know, they like their kids but not other people’s kids. And to just be able to think, what do I need to line up? What do I need to have, you know, what parenting things do I need to talk about or to think about? 

Everybody gets so focused on like the umbilical cord. Like that’s no big deal. That’s going to fall off. You don’t have to worry about it anymore. But like you don’t think about sleep. You don’t think about time management. You don’t think about who’s going to drive me to my doctor’s appointments so that I don’t have to drive there alone with my baby in the car and like when I’m still bleeding out of every orifice.

Ono: Yeah. And what’s so hard, Devon, and I appreciate you even thinking about teaming up with me to create like kind of this like preconception prep toolkit if you will. Because what’s so hard about my job is as I already alluded to, I have so many things that I have to do that like in my appointments by the way, so we talked about the two postpartum visits being 20 minutes, which is a luxury because my prenatal appointments are 10 minutes, girl. 10 minutes.

So imagine what like I’m going over genetic tests, I’m going over like ultrasound results, I’m going over all these things in 10 minutes and like somehow I’m supposed to like go over like and your relationship with your partner is going to change drastically. How are you going to prep for that? Like I can’t do that, right? So to me like one of the reasons why I’m doing the podcast and I feel honored to be on your podcast and build relationship with people like you is I have this concept and appreciation that, yeah, I have my nine to five. I have the healthcare system that I have the fortune of working within. It’s a privilege to be an OB doctor, but that system is limited. 

So how can we be creative and innovative and disruptive and figure out ways to support birthers and their families beyond what is currently built in. And so I love the idea of like creating this preconception toolkit, this in addition to like a postpartum toolkit and everything in between because yeah, the more prepared we can help people feel, the better the outcomes are. That’s like that’s the whole point of preventive care if we really broad what that definition is.

Devon: Absolutely. Absolutely. And it’s, you know, it’s something that I always talk about like I just did my last episode was about lazy parenting. Like how to simplify your life and not like go over the top about everything because it’s not actually good for your kids. They don’t like being over stimulated and exhausted and everything else. It’s like I’m not trying to shortchange your kids by having you do less. I’m trying to have you have a better experience with them. 

So by caring for yourself and by thinking about these things, you’re actually giving your kids, your baby a better experience of you as a parent. Well, it’s like I said on your podcast, which you loved. Self-care is not selfish. Like it’s good for everyone if the mother, if the birthing person is in better shape than a lot of the time they are, you know, we are trying to improve outcomes for all the family members. 

And I hate talking about this, but, you know, it’s just been in the news in the last few days that the government and the administration are trying to think of ways to get people to have more kids, but they’re not talking about giving them better parental leave, giving them more support, giving them, you know, more time with their doctor. It’s insane. It’s insane, insane, insane.

Ono: Yeah. It’s like adding pressure to an already pressured system. Like I literally have this vision of like a volcano erupting. So your healthcare system that again is doing pretty darn good. I’m not here to like hate on our current system and either, but it can be so much better and then suddenly you want to like over overly impact it. No, like don’t request or try to think of initiatives to increase birth weights in our country unless you’re going to improve prenatal care and expand the length of time of appointments. If you’re going to improve postpartum care and expand the length of time, the number of appointments. If you are going to improve access to mental health providers. It is so hard. 

There are many amazing mental health providers in my community who have to max out on how much insurance they can take, right? They can’t take enough, right? There’s not enough lactation consultants, not enough like lactation consultants of color, right? I have a list of problems I’ve amassed and to me, and until we can fix those problems or adequately address them, like we’re doing a disservice to our community otherwise.

Devon: Yeah. Well, you are out there. We’re all out there working to change it, trying, raising awareness. What would you say people can do now, either if they’re a pregnant person or a birthing person or postpartum person or they have people in their lives that are in that situation. You’re a partner, a spouse, a friend, a family member, until the systems change, what can we do to help people in this situation?

Ono: Such a good question. I mean, just talking about it, acknowledging it. I think something that you and I alluded to at the very beginning of this episode is the self-shame. And the second, I don’t know about you, once I feel shame about something, I go so inward and I stop communicating to the people that love me and need to support me. And so it’s really just being open about like about the identity shifts, about the guilt, about the ambivalence, about the morning, about the grief, like just acknowledging all those things. 

Finding your girlfriends or your you know, your spouse or your partner, the people that you really trust to just say like call out, hey, this is what I’m going through. I don’t know if it’s normal, but this is what I’m going through and just recognizing that Matrescence is normal, right? This epic shift is normal, but we haven’t yet normalized it because we’re not talking about it. 

To me like the biggest thing is just to be really open about what you’re experiencing and to call out your OB. I still remember and I can’t remember if I told you this anecdote, but I still remember I had this patient who I’d seen throughout her whole pregnancy. We had a great relationship and everything went well under pregnancy. And I think, you know, again, within the first six weeks postpartum, everything was fine. 

And then I saw her a year later for her pap smear annual exam appointment and she was the one who I still remember saying, hey, Dr. say like, thanks. You were a really great doctor when I was pregnant, but postpartum you dropped the ball. And that call out was one of the things that like it wasn’t just like the you like I personally did it. It was the system. It was the healthcare system. And that call out was one of the first things that resonated in my brain that eventually like became my postpartum podcast passion project because it was this reminder of like, oh shit, you’re right. 

Like I am a great doctor and I’m really am engaged and I support my patients best that I can, but like, yeah, our system failed her postpartum. We didn’t do enough. We stopped postpartum at six weeks when you and I just talked about how it’s months and years later. And so I give that anecdo to say, call out your OB, call out your midwife in whatever way is your loving language of letting them know when you need help, letting them know when something feels off or when you feel like you need a referral to a lactation consultant or pelvic PT or whatever it is, because I think just assuming that you need to figure it out on your own or suffer through it. How many clients probably have you had where like their first pregnancy, but they’re like, yeah, the first time around I just thought I had to just like grin and bear it?

Like, no, like tell someone what you’re experiencing and we can help you figure out that specialist you can get in with. But my biggest things are just being open, talking about what you’re experiencing, whether it’s to your immediate network of your friends and family members, but especially your obstetrics team. Let them know how they can lift up that burden from your shoulders and help in any way they can.

Devon: I think that’s huge and normalizing it and talking about it. And again, we’ve seen it. We’ve seen improvement. Like people are talking about things they didn’t used to talk about. But also too, talk to your friends who don’t have kids yet. Like when you come out of the fog, like here’s what it was like. Like I was not expecting this. I’ve had people say like, why did no one tell me it was going to be like this? I’m like, they probably did and you just weren’t like ready to hear it or you just didn’t absorb it because it wasn’t on your radar. But like put that on people’s radar. 

You know, I always think of the cultures where you’re surrounded by your family members. You’re living in like multi-generational households. You have multiple siblings who are having kids before you, after you. You know, maybe you’re the oldest and all your younger siblings were born and you were part of that, you know, that sort of a thing. And you know, I think that exposure and just seeing what different people are going through, but we hide away. 

You’re not going to go back to work after maternity leave and be like, wow, my hemorrhoids are really bad. Like, but you can talk to your friends and other parents and even people who aren’t. Like one time I posted in a mom group that I was active in on Facebook, like what were the biggest surprises to you when you had your baby? Fully 50% of them said hemorrhoids. They had no idea.

Ono: No. Yeah. Totally. Totally. No, and like I mean, hemorrhoids are very normalized to me as an OB, right? So I’m so used to them and like and it’s so surprising every time. I’ve had people come to the emergency room of OB with a hemorrhoid thinking something really bad has happened. They thought it was like anal prolapse, which is incredibly rare. And like, can you imagine being that scared and unaware of that physical change that you come to the hospital in the middle of the night? Like I deeply empathize with that, right? 

And which again means that the more we talk, the more we share, the better. I had the sweet smile on my face because what you described with like this multi-generational family is the concept of the village. I love that concept. I think that is a former state that we existed in when we were kind of more simple versions of homo sapiens where we just were these nomadic communities that moved around together and you got to see so much. You got to learn so much from those the women and people birthing around you. 

And now we’re so much more isolated. But what I love is that there are people like you, Devon and people like me who are trying to help our patients and our clients recreate the village. We’re trying to I feel this like it’s wrap around, right? We’re trying to just bring all those resources together and hold our patients and their families in that space and lift them up back up again.

Devon: Yeah, well, it’s great and, you know, we both been doing this work for a while and have seen the shift beginning, which is huge, which is so huge. So I love that. I mean, in the beginning, I tell people all the time when I first started out, I was only getting hired by families with twins and triplets because they were the only ones who thought they needed support. 

And then over the last 10 years, it’s just been more and more and more families with one baby, their second baby, their first baby, like everything because they’re just realizing how much support is needed, which is so huge. But I love having a name for this concept. I think it’s so important. I’m doing an interview with the pediatrician in a couple of weeks and I’m curious to talk to her about what things look like on her end because when you have the baby, you go from being at the OB’s office all the time to being at the pediatrician’s office all the time. And I know they don’t have special training in like dealing with postpartum parents and stuff like that. But that’s an area where I think we could be making those connections and having more touch points and things like that.

Ono: I agree. I think I think in the best community practice setting is an OB who has a really good relationship with her pediatric team. And so I’m really lucky in that our clinic, we share the same space. They’re like kind of right around the corner from us. Sometimes they’ll come over and say like, hey, there’s a mom I’m really worried about. Like can you add her on to your clinic schedule? Or they’ll send us a message because, you’re right, they sometimes have more touch points than we do because we have the two six-week appointments. But that baby’s coming in sometimes weekly for those first couple weeks. 

Devon: They know run in. They’ll run in for anything with the baby. They won’t necessarily do it for themselves, but they are caring for that baby.

Ono: Yeah. I’m so glad that you have a pediatrician coming on because they themselves can be a really important advocate for those moms postpartum.

Devon: And then just quickly, I know we touched on some postpartum mood and anxiety disorder and stuff like that. That’s such a huge topic for me that I think is really important. What would you say to expecting parents as far as like what are some signs or some maybe things that they could or should be concerned about? I know that’s not the topic, but I feel like it’s important to mention whenever possible.

Ono: I totally agree. Yeah. We normally call like baby blues within the first like three or so weeks postpartum. So that’s the massive hormone fluctuation that you and I already alluded to. And so you’re just like suddenly feel really tearful. You know nothing is wrong, but you’re super duper tearful, easily agitated, etc. But for the most part, those parents who are going through or moms who are going through postpartum blues, by the time I see them for their two, three-week check in, they’ll say, hey, yeah, that first week or two, I was like really, really tearful, but like now I’m fine. Right? 

So it’s really short lived versus postpartum depression is a lot more serious than that. So things that we’re watching out for is extreme bouts of tearfulness that are going beyond the first three weeks. If you’re feeling like that lack of motivation, like you’re someone who going for walks is normally something that like made you feel happy, made you feel good, but like you don’t want to leave the house. Really severe anxiety. 

So you hear of moms talking about how like the baby’s asleep, but I can’t go to sleep. I just need to stare at them breathing because I’m really worried they’re going to stop breathing. Or like yeah, my partner’s offering to take the night shifts and I know rationally I should be able to let him take the night shifts, but I can’t because I’m afraid I’m going to miss something or even when, you know, someone is watching the baby, my brain won’t turn off and I can’t sleep. 

And so those are some classic signs of postpartum anxiety. And so sometimes patients see it in themselves. And so sometimes, you know, again, by the time they see me for their six appointment, they’re really open about that. We also automatically have them fill out a survey, mood survey anyway. Sometimes it’s their partner that says something, right?

Devon: Yeah, that’s a big part of it too. Like they’re not themselves.

Ono: Yeah. And so sometimes it’s the partner that is saying, hey, like this isn’t you. I’m really worried like should we mention something to your OB? And I think there’s the more extreme ones that are scarier, but, you know, these are the ones that to me are like 911, you should go to the emergency room is kind of the more extreme like signs of like psychosis where, you know, you’re either you’re hearing things or seeing things that are not there. You’re suddenly having thoughts of harming yourself. 

So, you know, suicidal ideation is something that can happen with extreme postpartum depression. And if that’s ever the case where you’re having persistent thoughts of harming yourself, even with a plan, like that is an emergency. You go and you get emergent psychiatric care or thoughts of harming others. We hear it as rare as it is, infanticide is something that can happen when moms have severe postpartum psychosis. 

And so really, you know, if those are something that you recognize, if you’re in that mental state, we can recognize I’ve had those thoughts. I know I’m not going to act on it, but like I don’t know where these are coming from and those are scary to me. Again, start with saying it out loud to someone and having someone else hear you and say, yep, that is scary and, you know, those are sometimes situations where the partner will call our office and say like, this is what she shared with me. Like, what do I do? 

And depending on the scenario, we’re telling them go to the emergency room or we have some outpatient maternal health clinics too. But yeah, really knowing the signs from like the more mild like postpartum blues up to the extreme of like is this a potential symptom of psychosis. And I say those things not to scare anyone, but some of those again, really rare times of postpartum psychosis when it’s been undiagnosed and missed, really scary things can happen. And so if this is a platform which is acknowledge to just be aware of those things and knowing those red flags to keep you and your family safe.

Devon: And even I think anywhere along the spectrum, if you’re a friend or a family member and you feel like the person is not themselves, is, you know, some amount of anxiety is normal. I’m worried I’m going to drop the baby when I’m walking up the stairs. That’s normal, but like I’m worried the baby’s going to explode or something. Like that, you know, that’s less so. And so looking out for that in your loved ones as well, I think. 

And it’s never wrong to just check, right? It’s never wrong to call the doctor and just check. I’m sure you get people calling and saying I think I have anxiety because I’m worried that the baby’s going to cry while I’m in the shower and you’re like, that’s fine, it’s not big deal.

Ono: Yeah. It’s never – exactly, that’s if anything to take away from this conversation, it’s never wrong to just share what’s happening to you, to be open, just check in. I think that’s why I feel really fortunate in the system I work in that we have like an active my health online option where patients can message us. If it’s urgent, you can call us. Like I think care ideally should be available 24/7. It might not be me because I do I need boundaries. So I’m not I personally not available 24/7, but we have amazing nurses who are able to triage concerns 24/7 because I really truly think that if anything feels off, you should always feel like you have the ability to let your healthcare team know.

Devon: That’s great. And that’s what we were talking about too with being proactive about seeing a pelvic floor therapist or a mental health therapist or lactation consultant. I mean, best case scenario, they tell you’re fine and you’re happy about it for the rest of the day and then in every other situation, they’re going to give you the support you need and the help that you need. Well, Dr. I’m sorry, I’m going to say it wrong again.

Ono: No. 

Devon: Nseyo? 

Ono: Yes, you did great.

Devon: Okay. Nseyo, thank you so much for talking with us and I’m sure we will speak again. Your podcast is called The Golden Hour.

Ono: Yes, podcast is called The Golden Hour. You can find it on Apple, Spotify, YouTube. You also can find me on Instagram. The Instagram handle is GoldenHour.fm. And yeah, it’s like having conversations like with amazing people like Devon and just trying to the goal is to make sure that pregnant persons and their families can feel empowered through this epic journey that is preconception through postpartum.

Devon: I love that and I love that it’s out there for people because I realize not everyone was like me and was obsessed with finding out everything there was to find out about birth and babies and everything from a young age. So this is, you know, this is news to a lot of people. So thank you so much again and have a great rest of your week.

Ono: Thank you.

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