Ep 158: How to Prepare for Postpartum with Nicole Makowka of LOOM

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The earlier you can start thinking about the postpartum period, the better. Just like all other parts of birth, everyone’s postpartum experience will be different. There are both physical and mood disorders that can affect some people. Oftentimes even experienced care providers can overlook planning for this crucial period and that’s why Nicole Makowka is here today.

Nicole is a licensed marriage and family therapist and an expert in early childhood development. She is also the Head of Education & Wellbeing at LOOM - an online platform for sexual and reproductive wellbeing. She has developed postpartum curricula for LOOM and has a lot of wonderful insight into how to be better prepared for what comes after pregnancy and birth.

In this Episode, You’ll Learn About:

  • Why you should talk to your doctor about postpartum care beforehand
  • What are some common emotions people can feel postpartum
  • How common is postpartum ambivalence and why it’s completely ok
  • Where is the line between what is tolerable and what is something that needs clinical attention
  • What a “collective care map” is and why it’s a good idea to create one
  • Why you should feel empowered to ask those around you for help
  • What is LOOM and how is it helping birthing people

Links Mentioned in the Episode

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I want this podcast to be more than a one sided conversation. Join me on Instagram where we can connect outside of the show! Through my posts, videos, and stories, you'll get even more helpful tips to ensure you have a beautiful pregnancy and birth. You can find me on Instagram @drnicolerankins. I'll see you there!

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Ep 158: How to Prepare for Postpartum with Nicole Makowa of LOOM

Dr. Rankins: In today's episode, you are going to learn some great information about postpartum from Nicole Makowa, the head of education and wellbeing at Loom. Welcome to the All About Pregnancy & Birth podcast. I'm Dr. Nicole Calloway Rankins, a board certified OB GYN who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident, and empowered to have a beautiful pregnancy in birth. Quick note, this podcast is for educational purposes only, and is not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now let's get to it.

Dr. Rankins: Well, hello. Hello. Hello. Welcome to another episode of the podcast. This is episode number 158. Thank you for being here with me today. So this is a really great conversation that we have with Nicole Makowa. Nicole is the head of education and wellbeing at Loom and Loom is an online platform for sexual and reproductive wellbeing. She is also a licensed marriage and family therapist and an expert in early childhood development. In her role as head of education, Nicole leads Loom's curriculum development for its digital platform, helping to create cutting edge education across a spectrum of women's sexual and reproductive health experiences. She assumed this role after developing the original postpartum curriculum for Loom's brick and mortar space in Los Angeles, where she taught and supported thousands of new parents and their babies

Dr. Rankins: With over a decade of professional experience, Nicole is committed to serving women, children, and parents in an educational and therapeutic capacity. She has written for goop. She has created content and been featured on ergo baby. She served as a panelist for Bumble and well set. She has spoken at large corporations like sweet green, the wing, various academic institutions, and she lives in Los Angeles with her husband, son, and dog. So, as I said, in this episode, you're gonna learn a ton of great information. That's really going to be useful for you to help you navigate the postpartum period, including some postpartum issues that all women need to be aware of and what you can do about them. Some common postpartum emotions that parents experience and how to manage them. I was actually surprised at one of them and then things that women can do while pregnant to prepare for the postpartum period. I love the concept of what she talks about something called the collective care map, and then much, much more.

Dr. Rankins: All right, now, before we get into the episode, if you love my style here on the podcast, and you want a phenomenal go at your own pace childbirth education class that you can do from the comfort of your own home, and also comes with amazing support, then do check out my signature online childbirth education class, the Birth Preparation Course, it is the class to get you calm, confident, and empowered to have a beautiful birth. And the thing about the class that is different than the podcast is that everything is very organized to build upon itself and it really takes you through a specific order so that you come out on the other side of the material really ready and really prepared for your birth.

Dr. Rankins: You know, it's not, of course, just a bunch of like slapped together material. The order, the content, the slides, everything is very, very intentional to help. Uh, you get ready for your birth in a way that feels easy in a way that feels good in a way that really feels enjoyable. And it comes with the added benefit of a private Facebook community where I do Q and A's. Or you can ask me more questions or you can connect with other like-minded mamas. So do check out all the details of the Birth Preparation Course at drnicolerankins.com/enroll. Oh, and I forgot to add it also comes with lifetime access. So you take it once and you have it for all of your future pregnancies. So again, this drnicolerankins.com/enroll. All right, let's get into the conversation with Nicole Makowa. Nicole, I'm super excited to have you on the podcast today. We are talking about all things postpartum, something that is a really important topic, and I get a lot of questions about, so I'm excited to dive into the conversation. Welcome.

Nicole: Thank you. I'm excited to be here.

Dr. Rankins: Okay. So why don't you tell us a bit about yourself and your work and your family, if you'd like?

Nicole: Sure. So I'm a licensed marriage and family therapist, and I'm the head of education and wellbeing at Loom. I'm also a parent to a seven year old and, um, I live with my husband and my kid and my dog in LA.

Dr. Rankins: All righty. So we are, we are on opposite coast. I am all the way in Virginia, so, oh, all right. And we'll talk a little bit about, um, Loom towards the end. Sure. But first I wanted to talk about, um, the postpartum things. And actually, even before we get into that, when I have guests come on, I like my listeners to know what education and training and background they've had to do, the work that they do. So tell us about what education and training you've had to do your work.

Nicole: Yeah, that's such a great question. Um, so I have my masters in psychology and I did all of my pre-licensure training, which is, you know, collecting clinical hours, working with a specific population for my marriage and family therapy license, working with children, young adults and families in something called therapeutic day schools. So they are schools that are, um, kids starting at age three and all the way through 22. And, um, the schools that I particularly worked in were with children and their families who have developmental disabilities. And so it was like from the moment of diagnoses and maybe the public school system couldn't support that particular child's needs, um, all the way through aging out of the program, which is when they were 22.

Dr. Rankins: Interesting. So then how did you make the switch to get into postpartum? Cause it's a bit different.

Nicole: Yeah, well, you know, like so many clinical careers, it's so nonlinear, like you think you're gonna do one thing and then you sort of get inspired. Um, what I realized was when I started my career, I did not have a child and I was working with children, but really I was working with the whole family system and I'm trained in sort of family systems theory. And so what I knew is that when one thing changes, everything changes. Mm. And, um, I did a sort of thing that not many therapists in the clinic that I was working at were doing, which is whether the families were funded for family therapy or not. I would've tried to loop them in as much as possible because, um, it's really important from my perspective. And I started really understanding how sort of parenting impacts your child and how your child impacts your parenting.

Nicole: And it's this very like closed loop system. And, um, I, I ended up getting pregnant and realizing that my passion was really working with parents even earlier than I was getting them at the school that I was working at. And so I didn't start working with those families until three, and I really wanted like the relationship to begin even earlier. Right. And so I started running groups as early as, you know, postpartum like two, three months postpartum. And, um, it, the shift, the, the focus shifted from, you know, the, topics being about sort of the developmental delays to just like generally what's happening in the emotional landscape and understanding that, um, we come into parenting with a lot of our own stuff and a lot of, um, our own sort of complex ideas of what becoming a parent feels like. And then there's just a slew of unpredictable events that follow and finding out that your child has a developmental disability is one of them. And so I just kind of widened my landscape and then started, um, more and more and more groups. And it just felt like such an untapped resource. Right. And I was getting requests to run groups like morning, noon night. Like I remember having a group that would meet at 8:30 PM because people were just like, I need the support, but I can't, I work full time and I can't do it during the day. Right. And so, um, yeah, so it just sort of evolved.

Dr. Rankins: Okay. Okay. I always love hearing people's origin stories of yeah. How we come to our work. It often evolves from personal experience and just, you could never predict the, the path and you just sort of follow the breadcrumbs that are left for you.

Nicole: Exactly. And it never looks how you think it's gonna look.

Dr. Rankins: Never, ever, ever, never, ever. So, all right. So let's hop into some things about postpartum. What are some of the issues? And I, I like to stick to around two or three that you really think women or families need to be aware of regarding the postpartum period, and then what are things they can do about them?

Nicole: Yeah. Well, I think to start, it's really important to have an understanding of, you know, some physiological postpartum complications and what to do about them. Um, and you know, I always suggest that when people are pregnant, that they start having conversations with their care provider or whoever that provider may be to say, um, I wanna practice getting more information about what's to come. And that is a skill that is, you know, highly utilized in parenting. And so I always recommend practicing that early on.

Dr. Rankins: That is such excellent advice because so much during pregnancy and it's, it's, it's great that you tell people to do it because the doctor may not necessarily do it, cuz that's not the way that we're trained. Um, so I think that that is fantastic to tell folks to start a asking like, Hey, what is coming next? Including postpartum.

Nicole: Yeah. And it I'm so happy to hear you say that because, and this is a little tangent, but I think it's important for your listeners to hear that from my perspective, the majority of my clients say, I don't wanna be a bother. Like I don't wanna take my doctors so busy. My midwife is so busy. I don't wanna take up more time. And I always say like the, the key to you having the kind of birth that feels safe for you is your relationship with your provider

Dr. Rankins: A hundred percent

Nicole: And so if you model like I am here and I'm being vulnerable and I'm showing you that I wanna know more, I'm not an expert in this, but you are, please give me the information that you have. So I can feel more prepared that is like laying the foundation for your relationship. And then birthing becomes a much safer place,

Dr. Rankins: A hundred percent. That is such a, an important point. And I think some of it goes back to even our society and, and women or birthing people have a hard time centering themselves and, and saying, like speaking up for the things that they, um, need. And there's like a hierarchy of relationship like, oh, this is the doctor. And you know, I don't wanna interrupt them. And, and things like that. I want everyone to practice like, this is, this is your body. This is your pregnancy take owner ownership of it. And it's not being selfish or, or, or, you know, you're not being demanding or anything like that. You you're just advocating for the best experience for you.

Nicole: Yeah, absolutely. And, um, and then the other thing that I would say is really understanding sort of postpartum mood disorders and the emotional landscape that comes along with it. I, um, you know, as a therapist and as an educator, I have been floored by how much language impacts people's behavior. Mm. And the one thing that I have found, and I kind of like, this is my soapbox is that when we, as community members, as friends, as support people say to a birthing person or say to a postpartum person, oh, that's normal. That actually interrupts like the way that you're feeling that baby blues, you feel depressed, you feel anxious, that's totally normal that actually interrupts their ability to seek help.

Dr. Rankins: Interesting

Nicole: To seek support. And so I've been really encouraging people to say, it's common, that's a common experience, but that doesn't necessarily, I mean, it's normal.

Dr. Rankins: I like that. Yeah. Yeah.

Nicole: And, you know, and I think that just like making these little shifts internally and sort of saying, I shouldn't have to tolerate feeling like at a really low point and also having to take care of a child and then feeling like, oh, it's totally normal. So like, why, why am I gonna complain about it? Or why am I gonna go and seek out help is, um, such a detriment to your wellbeing, but also your experience.

Dr. Rankins: Absolutely. Absolutely. And that's something that I often say in the context of aches and pains during pregnancy, like when people say that they're hurting and they have back pain or pelvic pain and things like that, that we often say that it's normal. And I've, I've said that we, we need to shift that to say it's common, but we don't have to accept that as normal. There are things that we can do about it, like physical therapy or chiropractor or all of those things. And this is another great example. Like, although it is, is common, it doesn't, you don't have to accept that. That is how it's gonna be so that's a really important point. Any other issues or things before we move on to talk about some of those emotions and maybe the postpartum mood disorders in a little more detail.

Nicole: Yeah. I mean, there are so many, and I feel like, you know, we could probably have like an hour long conversation just about that, but, but in terms of kind of getting, getting into this, what I call like beginner's mind, state of being really gentle with yourself and understanding that even if this is your second, third child every pregnancy is different. Every birth is different. Every baby is different. And if you are in a partnered relationship, your relationship goes through different phases. And so being like coming from a place of curiosity really cuts through some of that shame that we have all internalized from, you know, the culture that we live in like, we, we have to know how to do this. And so just being aware of the fact that your friend might be telling you about, you know, the four births that they had and how, like they did it a certain way and, and just know that this there's no sort of guideline about how things are gonna turn out.

Nicole: I'm sure, even from your perspective, like every birth that you see has lots of its own nuances. And so just getting into a space of saying like, I don't know, I can't predict every single thing that's going to happen, but I can sort of be compassionate with myself and know that I I'm going to resource myself. I'm gonna advocate for myself and I'm going to come to this with a beginner's mind. So I don't put that sort of unnecessary pressure, like I'm gonna do it all the way that I have it planned out in my mind.

Dr. Rankins: Yeah, for sure. I, 100% something that I say over and over, anybody who's listened to the podcast or, um, and my chorus birth is an unpredictable process and we cannot predict exactly how things will go and you have to be open and prepared for all of the possibilities. And although sometimes that can feel overwhelming. It actually doesn't necessarily have to be. Um, and, and although you can't see everything that may come your way, definitely having an open mind to the possibilities that if something comes your way, that it's not like a complete surprise, for you. And you're like not, not blindsided about when things don't go, um, a certain way. So definitely, definitely another great point for sure.

Nicole: Yeah. I think that that's so great. And, and, you know, I think that going back to what we had talked about a little bit ago, like that's why the relationship is so important because when you're in it with someone else and, you know, listen, like my provider can't tell me every single thing that could possibly happen. And that might feel really flooding if I learned about every single thing that could possibly happen. Just the trust and knowing we've talked about, you know, enough of the possibilities where my provider, has an understanding of what my preferences are and is going to make the best decision for me uniquely for me. Yep. Yep. Um, and that's why it's so important.

Dr. Rankins: Absolutely. Absolutely. So let's shift gears then a bit and talk about some of the emotions that can come up postpartum. I know this is something I wasn't necessarily prepared for myself. Um, so what are some common emotions that folks experience postpartum?

Nicole: Well, this surprises a lot of people, but ambivalence is one that is probably the thing that I hear the most and one of the feelings that I felt very deeply, um,

Dr. Rankins: You know, I just wanna pop, like pause for a second with the ambivalence, because I think that's, I, I wanna make sure people understand what we're saying by that. Do you mean, is it like you're not necessarily happy or excited or thrilled that you have this new human being? It may be just like, I have this baby, what am I supposed to do? I don't necessarily feel connected to this new baby.

Nicole: Well, that, that is a feeling that people have, but I'm more talking about ambivalence in the sense of feeling sort of the duality of the experience that there are sometimes where you do feel really elated and sometimes you feel really lonely and sometimes you feel like you really miss that identity that you had before becoming a parent. And just that sort of complexity of holding both feelings at the same time and not feeling totally anchored on one side of the fence or the other sort of feeling that like ambivalent in between some days, I feel like this, some moments, I feel like this and some moments I feel totally counter to that.

Dr. Rankins: And then also that, and, and maybe we're gonna get into this, but, uh, understanding that that doesn't mean anything in terms of like your love for your child.

Nicole: Oh my goodness. Like, let's say that again. I, that is just, it is such an important, um, aspect of understanding the sort of like the complexities of what becoming a parent actually means that, you know, you can feel all of these things and you can love your child and do anything for your child. You can feel really resentful sometimes of being a parent and having to take on all of that responsibility. And you can also say, I would never make a different choice, or you can feel elated like much of the time and then have moments where you're just totally burnt out and feeling like I love you. And I need to hide in the bathroom for a minute. Um, that this, the two are not, um, tied together in a way that I think, you know, we have a, we have this sort of image of what it means to be a good mother or a good parent. And sometimes the, that means not being a whole person with a whole spectrum of feelings. Yes. And I think that that is like a really tricky place to have like hung our hat on because we really shame people. And we cut off a lot of conversation because people have received an, a message that like, if you, if you don't, if you're not happy all of the time, then there's something wrong.

Dr. Rankins: Yes, yes, yes, absolutely. And, and people just, yeah, people feel like they, they can't talk about it and I'm gonna tell y'all listen. It, I, from my own personal experience, I love my children. They are 12 and 14 now, but sometimes you probably won't like them because they, they do stuff that just they're human beings too. And their relationship, you know, they're not like perfect. So it is totally normal. And I think the earlier we can normalize that you can love your children with every fiber of your being, but it doesn't. But sometimes again, like you said, you wanna hide from them in the bathroom. That's okay. Like, there's nothing, there's nothing wrong with you because of that.

Nicole: And you know, this happened sort of developmentally, right? Like there's a, um, your, your children that are 12 and 14, my child who's seven. They need different things from us now than they did when they were infants. And so we go our own developmental process alongside our children. And there are moments where it is developmentally appropriate for us to not totally be in sync, like as a parent and as the child, their brain is developing at a different pace. We are have a fully developed brain. Like we have the ability to sort of plan and see, you know, on the other side of the elephant. And they're still exploring that. And I think for a lot of parents that becomes like a really tricky place, um, to be able to accept, like, I'm not gonna, like all of my kids' decisions, I'm not gonna like them all of the time.

Nicole: They're gonna talk to me, they're gonna try things out with me because of their secure attachment to me that they're not gonna try out with their teachers. And that makes my job a little harder. But I think it's also about like, reframing what loving your kids means that sometimes loving your kids means like having to make those hard decisions and like not always being in sync with what they want, but, you know, identifying that sometimes what they need is different than what they want. And that's, that's okay. Like they don't have to want the same things that you, you want all the time.

Dr. Rankins: Yeah, definitely, definitely. So what are another other couple common postpartum emotions that parents can experience?

Nicole: Well, I think overstimulated is one from a sort of mental and sensory, um, place. And I'd love to sort of chat with you more about that. Sure. But also, you know, feeling unsure, feeling lonely, like I mentioned, um, sometimes feeling like elation in a way that they hadn't felt before, like that sort of, um, chemical feeling between you and your child is sometimes surprising for people. Um, but the overstimulated piece is a big one.

Dr. Rankins: Yeah. I definitely wanna talk about that. What, what do you mean by overstimulation?

Nicole: So, you know, one thing that I have really noticed, and we've been talking a lot about at Loom is this sense of being overstimulated from a sort of sensory integration perspective? I, I don't know if you've, you know, had these conversations in the past, but a lot of postpartum people talk about how they feel so touched out, or they're like constantly in this caregiving mode, and their babies are on them all the time. And then they have nothing left at the end of the day. And if they're in partnered relationships, what I see in a lot couples is that, you know, one partner, if they're working outside of the home, they come home and they wanna reconnect. And some of that reconnection, they need that in a physical way. And then the caregiver who's been home with the child all day feels like I wanna lay in like a bathtub by my myself, and I don't want anyone to touch me.

Nicole: Right. And so this sense of being overstimulated, because our senses are so highly activated during this postpartum period in a way that many of us have never experienced before. Um, and so that has been really surprising for folks. And we talk a lot in our program about, you know, what you can do from a sensory integration perspective during pregnancy and what you can try out postpartum. And when you think about your five senses, there's a lot that you can learn about your own sensory profile and what is regulating for your nervous system versus what's dysregulating for your nervous system and making those like little tweaks in your home, even have a big impact on just how you feel. And being able to sort of meet your own need from a sensory perspective helps kind of combat that overstimulated kind of chronic touched out feeling that so many people have postpartum.

Dr. Rankins: Gotcha. Do you think technology plays a role in that and the fact that we carry around computers in our pockets all the time?

Nicole: I do. And I think that, you know, this is always one of those moments where, uh, I, I, I completely get it. I'm a victim of it myself. It's so seductive to just kind of scroll through your phone and, you know, never tolerate that kind of moment of boredom, but I read an article and it's really like helped me, um, sort of find, find some balance, even though I don't love that term, but just like being a little bit more mindful and saying like, what am I picking this up for? What am I gonna do on it? And does it need to be right now, sometimes you're sort of like, I need to FaceTime a friend because I need that social interaction. And I, that's gonna fill me up in a way that's gonna fuel me for the next four hours that I am alone with this baby. And that's an amazing, but then, you know, when you find yourself, like every moment that you have, just because your phone is right there, feeling like I'm dissociating a little bit, and I just need to be like out of this environment because sometimes parenting can feel boring. Right. You know, sometimes it can feel really rote. And so, you know, just trying to understand like what that does to our nervous system to always be checking the phone or seeing what notification is coming in, um, can also feel really distracting and dysregulating.

Dr. Rankins: Definitely. Yeah. And I, I, I like to say instead of balance, I like to use the word, um, integrations, so how can we that yeah. How can we integrate technology in our lives in a way that serves us best? Because it's a great tool for, for, you know, for a lot of things, but it can definitely be used in a way that it's not healthy for you. So you definitely wanna integrate it into your life in a way that serves you best.

Nicole: Yeah. I love that. Yeah.

Dr. Rankins: And I also think we're, and this is sort of side note. Um, I think we're in a, a unique time where like my husband and I have talked about this, like where he and I, you know, we're raising we're in a sense, we are raising ourselves in the sense of learning how to use technology and we're responsible for teaching our children the same thing. So you knows. So it's, it's, we're all sort of learning that together in a way that serves everyone. I could, I have 100%, we've both been called out by our children. Like you tell us to get off of our devices. Look at you, you're on, you know, you're on yours. So it's just a unique time, I think, in history where we're all kind of figuring out how to make this work best for us.

Nicole: And it's changing so rapidly. Right. So there, there are ti and I, the pandemic has definitely accelerated this, but yeah. You know, there are days where I remember when my son was in Zoom school where it was like he was in, in front of a screen for eight hours and then I was still working and then my husband was still working and he then was on his iPad and it was like, so counter to everything that we had experienced before, around like limiting the screen time. But, you know, we've all had to kind of shift and evolve and we're learning in real time, like what the implications are.

Dr. Rankins: Yeah. Yeah. For sure. For sure. Now, one thing I do wanna talk about, and this is not necessarily emotion could also fall into the, um, realm of, uh, disorders, but I, I have, um, wanted to start talking more about postpartum anxiety. Because it's, so that I feel like I experienced, but even as an obstetrician, hadn't even really heard of so what are your, what are your thoughts about postpartum anxiety?

Nicole: Well, I think that we're in a really interesting time right now, because the level of anxiety across the board postpartum or not has never been higher. Um, and you know, this is, this is one of those moments where we're really dealing with collective trauma.

Dr. Rankins: Yeah.

Nicole: And we know that stress, chronic stress and trauma really, you know, increases levels of anxiety. Um, so I will say that I, I have not met a person in the last three years who, you know, wouldn't define themselves as anxious some of the time. Um, we, I think do a, not so great job of identifying for folks, like what does anxiety actually look like? And when to start seeking out some support for it. And I think that part of that is that we have this term that gets thrown around, which is baby blues. And I'm sure, you know, that has been like a part of the dialogue, even with your patients. And that there is a sense of like baby blues clinically happens, you know, for the first two weeks, and then anything beyond that is a disorder. And so there is that kind of normalizing of like, oh, your hormones are fluctuating.

Nicole: You're gonna feel really bad for a period of time. And then it's, and then it's like a light switch and it's just gonna click off. And so people start to feel like, well, when that doesn't happen, what's wrong with me. And I think that there's a lot of masking because when people feel like the anxiety is related to becoming a parent, they start to feel shame and guilt around that. And the truth of it is, is that if you are prone to anxiety prior to having a child, you will likely be anxious, postpartum the hormone fluctuation. And, you know, obviously does its own thing. Neurobiologically but then the responsibility shift, the lack of sleep. Just like all of the common, um, developmental shifts that happen in that first year of parenting can lead to a lot of anxiety. And then adding to that feeling responsible for keeping a child safe and healthy, keeping a child safe and healthy in a pandemic is its own anxiety point and not knowing sort of what to do when dilemmas come up.

Nicole: And this is why, you know, practicing during pregnancy saying, I need to understand this better. Or, you know, calling your practitioner in between appointments is so important because some of anxiety gets expressed with just feeling that like on edge that sort of keyed up kind of feeling, and sometimes, you know, narrowing down. Am I worried about something specific that if I just could get some peace of mind around it, I could really like relax my nervous system. Um, is like one form of anxiety. Another form of anxiety is just feeling chronic, really worried and stressed out and feeling, you know, keyed up. And so, you know, really being able to distinguish like, what support do I need right now? Is it a call to the pediatrician? Am I sort of finding myself ruminating a about, you know, a rash on my baby that everyone is telling me, oh yeah, that, no, that's just this or that, but it's keeping me awake at night and I'm not even getting enough sleep to begin with.

Nicole: Like, there are things that you could do to sort of help yourself. And that doesn't mean you have to, you know, know, go on medication, right. For some people they need to. But I think that just like broadening the conversation and saying there are gonna be moments where you feel incredibly anxious as a parent. And sometimes that means that, you know, building a relationship with a therapist could be really helpful to just kind of talk through what those anxieties are. Sometimes that means talking to your partner. Sometimes that means seeking a psychiatrist. I think that there's like, just like, there's a spectrum for everything. There's a spectrum for anxiety and sure. And really understanding that like it's important to recognize how it impacts your life and no one other than you, and maybe the person that you live with is going to have an accurate sense of what kind of an impact does this have on my life. So don't let someone else tell you, you know, friend, um, in-law a sister like, oh, you're just the, every parent's anxious. Well maybe every parent is anxious, but if they're able to kind of tolerate it and feel settled and not overstimulate it all the time, then that's one thing. But if you can't, then there are, are people and, you know, options out there.

Dr. Rankins: Got it, got it. Love it, love it, love it. So let's shift to some advice. What if you had three pieces of, or three things or that you think really help pregnant folks the most, um, for navigating the postpartum period, what, what would those things be? Or what would you want folks to know?

Nicole: So in our, um, program, we have something called a collective care map, and it's almost like a worksheet that you can print out and you can sit down either by yourself or if you're partnered with your partner and start to look at all of the things you can anticipate needing support around in postpartum. And I always recommend doing this prospectively. So doing it when you're pregnant is perfect because, um, you can actually like start thinking about who are the people that you would wanna pull in. And some of the sort of prompts are when you're eeding the baby, who's feeding you, right. And how can you plan for that? And some of them are, you know, let's say you are in postpartum and you start to, you have a history of your sciatica acting up. Who are you gonna call?

Nicole: You know, does your partner have the number for a physical therapist? Are you interested in building a relationship with an acupuncturist? Does your partner have that phone number? Um, sometimes what comes up for people is just the fact that they, they feel most regulated in a house that is neat. Who's gonna help with making sure that your house stays neat and, and kind of mapping that out feels like basic, but it's actually experience changing because then you get to really think, who am I gonna want in my space during a time where I'm feeling pretty vulnerable? Like let's actually talk about the people in our life that could support us, that we could count on and that we would actually want here. And then having an, having a really important conversation about visitors. This is like the one thing that people don't think about, but that is actually like a huge tension point.

Nicole: Postpartum. Some days you are gonna wanna see five people, some days you're gonna wanna see no people. And so what is gonna be the strategy around how you communicate to people? If I have to text you half an hour before you're supposed to come over and say, today is just not the day and not have to feel guilty or apologize for it. Is that gonna be your partner's job? Is that gonna be your mom's job? Like whose job is it gonna be to kind of help manage and protect your sacred space and then getting really, really, really rich around rest so, you know, planning for rest. And what does that look like? I do not subscribe to the advice of sleep when the baby sleeps, because I don't think that that's possible. I think that that is just like a pipe dream for a lot of people,

Dr. Rankins: For most people for, yeah.

Nicole: I do think that there is something and our co-founder Erica says this a lot, which is like actively rest. So what can you do to actively rest? And how can you do that in a way that feels restorative, but also planned, right? So maybe your rest and, and this is something that you could write down ahead of time. Like, I am someone who likes to rest in a dark room with light music on and journal. And to me that feels restorative and restful, but I also don't wanna be bothered. So I wanna do that with the door shut, um, and kind of start letting your community into your process and almost like sharing your preferences with them and saying, this is kind of what I've set up for myself. This is what my family needs. Are you on board for this and know that like it's gonna evolve, you know, those needs will evolve, but planning them ahead of time is really crucial.

Dr. Rankins: Yeah. I think this is really good because we often tell folks, you know, accept, help and ask for help, but it sounds like it, this provides kind of a map. So you can ask for exactly the help that you need. Like like, can you bring, can you bring me a couple of measl? So cuz I don't wanna have to worry about cooking or would you mind coming over and just folding some laundry because, you know, that's right. I can't do this right now. So it just helps you to focus on the things that you really need really need help with. And then as far as a care team, like I always say to folks have the number for a lactation consultant on like standby and ready. Maybe you wanna postpartum doula. Maybe that might be something that you'd be interested in and wanna look into. Um, so it sounds like you're just helping folks to have a structured approach that they can use during pregnancy to get ready for those things afterwards.

Nicole: Absolutely. And like letting people into your unique experience. So to say to them, I am someone who's really, um, stressed out when I see my house a mess. I, I know that I'm not gonna be able to tidy up as much as I want. So when you come over, would you spend the first 10 minutes kind of getting the house in order before we visit? And that's like a huge disclosure. I mean, it's so basic, right. But we don't often know that about our friends and unless someone tells you explicitly, then people will come over and just kind of plop down next to you and act like, yes. And so, you know, I always say like, think about postpartum visitors as part of your support team. Do you need your support team to just like come over and be a guest or do you need your support team to chip in and then be able to emotionally connect with you and people want to help like the, the majority of the time when given a task and being really explicit people are totally on board.

Dr. Rankins: Absolutely. And I'll also say, uh, don't feel, uh, guilty, I guess I would say in the sense that you know that people, yes, people want to come see the baby, but really this time, especially in those first few weeks, postpartum is about you forming your relationship with your new child and that needs to be the focus. So it's okay if you tell your visitors to come over and quick peek at the baby, but can you please go wash the bottles or can you please go, you know, do other things don't you're not being selfish if you're saying like, I, I, I need you to help me so I can spend time with the baby. Not that you spend time with the baby and it's fine if you want other people to spend time, I'm not saying don't let people do that, but you don't, it's, it's totally fine to, to give other people things to do other than like holding the baby or changing the baby, you can stay with your baby and let them do other things.

Nicole: Yes. I mean, that's such a good thing to remember. And also, you know, I, it, for some reason it made me think of, we were just running a postpartum group and one of the people on the call were saying that she, this is her second, babe. And with her first baby, the only thing that she remembers, like the kindest visitor that she had was a friend who, every time she came over, she walked the dog for this postpartum mom. And she was like, I, I don't remember what it felt like with a lot of other people, but that was like such a little thing that went such a long way. Like she walked in the door, leashed the dog and took the dog out on a walk every single time she came over. And it was like one less thing for me to do a dog that wasn't running around in between my legs. Like just no, those little tiny nuances make such a big difference for people.

Dr. Rankins: Absolutely. Absolutely. So I wanna, um, talk a little bit, tell us about what is Loom and what are the resources that Loom has to offer.

Nicole: Sure. So we're a digital platform that, um, provides on demand education for all things related to sexual reproductive wellbeing. Um, the first two programs we launched with are pregnancy and postpartum. Um, but we are developing education beyond that. And, um, you know, right now we have an online program, uh, pregnancy and postpartum that has on demand. So, you know, watch whenever you want video classes, as well as audio conversations and written text guides. And then, um, anyone who purchases a class also gets access to gather, which is our educational support group for folks who are pregnant or postpartum. And the, the groups are topic based and happen every month throughout the month.

Dr. Rankins: Nice, nice, nice. And, um, uh, we can say at the end, what all of those links are. Sure. Uh, and as we wrap up, I have just a couple last sort of rapid fire ish question. Okay. So what is the most, what is the most frustrating part of your work?

Nicole: Uh, I mean right now, just how much misinformation there is out there and, um, just how much shame and stigma there is about what the emotional experience looks like postpartum and and, um, having to kind of help people unlearn some of that when they get to us.

Dr. Rankins: Yeah. Yeah. I mean, everybody with a internet connection now is on can be online and saying stuff. And so, yeah, there's definitely a lot of misinformation. So then on the flip side, what's the most rewarding part of your work?

Nicole: Um, really building education that's accessible and evidence based as well as practice informed. I think that that's like so key for us that, you know, we know that women have been understudied and so research is not always going to be caught up with what people's needs are and really having, um, practitioners that we consult with, um, and being practitioners, creating the content to be really practice informed.

Dr. Rankins: Got it. Got it. And then what is your favorite piece of advice that you would give to expectant families?

Nicole: Um, I mean, I would sort of echo what you were saying. I, I say, ask for help early and often that's like my mantra ask for help early and often, if you haven't asked for help every single day, you should, there's always someone that can support you. We've gotta like turn this individualistic mentality around and start letting people into our experience. Yes. Um, and that just kind of models for other people in our community that we are not doing this alone. And then that models for our children, they don't, they have a community. They don't have to do this alone.

Dr. Rankins: Absolutely. Yep, yep, yep. Yep. So where can people find you? I know that, you know, guys listening, like I obviously I provide online resources, but I'm not the only one there's there's. And I say that to say that, you know, this should be a collaborative effort. We all have different ways that we approach some things may resonate with one person over another we're all in this space because we want to serve pregnant people. And so I am happy to, to, um, for you to share any other resources or things that you have, you know, with more collaboration and not competition. There's like millions of people who have a baby every year. I think there's space for lots of different folks.

Nicole: Absolutely.

Dr. Rankins: Yeah. So where can people find you?

Nicole: They can find us on Instagram and our handle is loom HQ. So L O O M HQ, and then our site is loomhq.com.

Dr. Rankins: And, uh, thank you for that. And we'll link that in the show notes and got as the founder, uh, of Loom Erica, uh, please pronounce, is it cheaty? Is that how you say her last name? Cheaty. Yes. She's um, quite an inspiration in terms of the things that she's done with this, this company and, um, getting funding and, um, really, uh, uh, a inspirational story. So I'm, um, um, wanna say that I really enjoy enjoy her and her, uh, her work as well.

Nicole: Yeah. She's honestly an inspiration to all of us too. And every single person working at Loom is there because of her.

Dr. Rankins: Yeah. Yeah. All right. Well, thank you so much, Nicole, for agreeing to come onto the podcast. This was a great conversation and I know folks will find it helpful.

Nicole: Thank you so much for having me

Dr. Rankins: All right. Wasn't that a great episode. I really enjoyed chatting with her. That was some really, really great and useful information. There's so much of these things that I wish I personally would've known when I was having children back in the day. All right. Now, you know, after every episode where I have a guest on I'll do something called Dr. Nicole's Notes, where I talk about my top three or four takeaways from the conversation. Here are my Dr. Nicole's notes with my conversation with Nicole Makowa. Number one, I really loved what she said. I wanna reiterate the part about practice, getting information about what's to come. I mentioned when I said the doctors are not always great about giving you some of that anticipatory information and guidance, as far as what to come, especially about the postpartum period. Unfortunately, there's a lot of emphasis on the pregnancy, the labor and the birth, and not nearly enough emphasis on the postpartum period. So definitely practice asking like I'd love to get prepared for some things that are to come. Now inside the Birth Preparation Course, I do have a whole section on getting ready for the postpartum period, what to expect with physical recovery, emotional changes, things to help you be prepared, especially for those first six weeks. So do check out all the details in the Birth Preparation Course, drnicolerankins.com/enroll.

Dr. Rankins: All right, number two, I loved how she talked about building trust. And one of the pieces of that is talking about your preferences ahead of time. And this is where a well thought out birth plan can go a long way. One of the big mistakes that I see people make about a birth plan is that it's about downloading a template, a form that they found online, and then presenting that when they go to the hospital, just handing folks this piece of paper, if that is what you do, then you are entirely too late in behind the game in terms of actually having wishes what's in the birth plan. Uh, making sure that that's gonna be respected and listened to making a birth plan should really be a process that happens in the prenatal period. Not just when you get to the hospital where you understand that the doctor, the nurses, the hospital are going to support what is in your actual birth plan, that they're actually gonna support your wishes, your wishes. And that's a process it's way more than a piece of paper. And that's what I teach in my class, Make A Birth Plan The Right Way. So you can check out that class also at drnicolerankins.com/register.

Dr. Rankins: All right. And the last thing I wanna say is reiterate that sometimes you just may not like being a mother. Okay. Sometimes you also may get really frustrated with your children and that is okay. It doesn't mean that you love them any less. Uh, another thing I'll add, sometimes you may not like being pregnant. I never particularly enjoyed being pregnant. All of that is okay. It doesn't mean you love your children any less, that you're not any less, you know, happy or thrilled or sta ecstatic. That is just a normal part of being a human being. All right. So there you have it. Do me a favor, share the podcast with a friend, also subscribe to the podcast, wherever you are listening to me right now. And I love it. If you leave a review, in Apple Podcast and let me know what you think. Do, just head to my website, check out all of the resources that I have for you about pregnancy and birth. I have free guides and things you can download guide to pain management in labor, um, meditation guide the birth plan class, the Birth Preparation Course, tons of resources there. My website is drnicolerankins.com. All right. So that's it for this episode do come on back next week and remember you deserve a beautiful pregnancy and birth.