Navigating Maternal Mental Health with Gabrielle Moskovitz LCSW, PMH-C

Julie Pernikoff: Hello and welcome to Gabrielle Moskowitz to Into Motherhood. We are so excited to have you here.

Gabrielle: Thank you so much, Julie. I'm so excited to be here.

Julie Pernikoff: Absolute pleasure. I'm so glad. I'm gonna read your bio. Gabrielle Moskowitz, LCSW, is the founder and practice owner of Mom Well Therapy, a boutique private practice specializing in maternal mental health. Gabrielle is currently pursuing a PMHC, which is a perinatal mental health certification from Postpartum Support International. Gabrielle is a boy mom of three and super passionate about helping women through the struggles of infertility. pregnancy loss, postpartum anxiety, and depression, and general motherhood stressors stressors. Gabrielle combines many modalities to help clients handle all that comes with motherhood, the ups and downs, and Gabrielle also offers couples therapy and believes strongly in the importance of actively working on your marriage throughout the motherhood phase. That was awesome. Thank you so much, Gabrielle. It's great to

Gabrielle: Hm, of course.

Julie Pernikoff: have you here. So should we just jump into it? Okay.

Gabrielle: Yeah, I was gonna say, let's dive right in. There's so much to talk about.

Julie Pernikoff: All right, let's dive right in. So tell us a little bit about who you are and what drives you to do the work that you do. Cause I think we got a nice taste of what you do from your bio. So just tell us about

Gabrielle: Sure.

Julie Pernikoff: yourself a little bit.

Gabrielle: Yeah, so I'm Gabrielle. I live in Bergen County. I am, as we said, a boy mom of three. and I was always interested in doing something in the psychology realm, but I wasn't sure what. And I I actually went into social work thinking, working with adolescents. and then I actually encountered my own maternal mental health struggles and I didn't feel like there was many resources during that time. And so I happened to be in school at the time. And so I sort of pivoted and and became really passionate about this topic, which I think deserves so much more space because moms are handling so much and we're really juggling things all the time. And it's like there's no real resources for this topic. Like maternal mental health is only just becoming a thing, right? And we've been moms for many, many years. Like, so yeah, I'm really passionate about it. And I think That passion and also like the some of the struggles that I went through helps me really connect with the people that I love to help as well.

Julie Pernikoff: Yeah, absolutely. And we'll get into the some of those struggles also tonight. so first of all,

Gabrielle: Yeah.

Julie Pernikoff: thank you for sharing that. what are some of the most common challenges that you're seeing postpartum mothers come in with?

Gabrielle: So for postpartum, a lot of it is the sleep deprivation, which like unfortunately is not so con like able to be controlled, right? Like you have a newborn and needs to eat every couple of hours. So I think one of the biggest indicators of postpartum anxiety and postpartum depression is lack of sleep, right? That's like the number one thing. So something that I work on with my moms is really to try to set up like sort of a support system so that they can get at least five consecutive hours of sleep. So I would say sleep deprivation is number one. especially for new moms if this is their first time becoming a mom, there's a lot of anxiety and like being overwhelmed with all of this information. You're kind of handed a baby at the hospital and like, okay, bye. You're expected to take care of it. Right.

Julie Pernikoff: Yeah,

Gabrielle: And

Julie Pernikoff: yeah.

Gabrielle: you know, now it's like all of the social media and the influencers and everyone posting like, get this stroller or that stroller and like Moms come to me and they're just so overwhelmed. They're like, There's 15 different strollers. What do I do? Right. And so it's like that spiral. So I would say sleep deprivation deprivation, anxiety. and a lot of times I do see postpartum depression and where like usually within the first two weeks, you know, what they call the baby blues. So a little bit of a lower mood and kind of like feeling down and depressed. But once it Surpasses those two weeks. We call it depression. You know, obviously there's other criteria, but sometimes I'll have moms come in and they're just like, I'm crying 24-7 and I I don't know why. Like I've wanted this baby for so long. And especially, I think it's hard when these moms with postpartum depression are ones that also struggled with infertility or pregnancy loss because then the guilt comes of like. I feel so guilty that something I've that I've wanted for so long, I finally have it and now I'm sad all the time. Like what's wrong with

Julie Pernikoff: Yeah.

Gabrielle: me? Right. So I see that also happen quite often. so I would say those are the main, you know, struggles that people come in with postpartum. And then actually one more thing is

Julie Pernikoff: Mm-hmm.

Gabrielle: the shift in like the identity and especially with your spouse or your partner. So people will come in and they'll say, All of a sudden, like I loved my husband and now I can't look at him. I can't stand him, like he's not doing the right thing, or I feel like I'm the one that's taking the brunt of taking care of this new baby. And so a lot of like those relationship challenges come up postpartum as well.

Julie Pernikoff: Wow. thank you so much for that. We are definitely gonna get into everything. I'm just like, my gosh. No, it's so good. It's so good.

Gabrielle: Too much, yeah. Yeah.

Julie Pernikoff: Moving back into the pregnancy phase, what would you want those mothers that are getting ready for this change to really plan for postpartum if that's possible? And is that possible?

Gabrielle: Absolutely. It is possible. And I I would recommend here, I'm gonna recommend a book that I think every postpartum mother should have. And it's called Rattled by Dr. Nikki Pensack. she's a psychologist, and she basically what she does is she comes up with an actual postpartum plan for pregnant moms. So we and I've been using her book and my own stuff, but we I'll literally sit with a client who's pregnant and we'll take a pen and paper and we'll fully make a map of the pre pregnancy of the postpartum plan, meaning, okay, who's sending who's where am I getting fed from? Are people sending me meals? Who am I calling for support when I feel overwhelmed? What am I stocking the fridge when I'm pregnant or freezer so that when I ha have the baby, I have extra things in the house? Who how many walks a day is attainable for me to get out of the house? How many once a week I'm gonna do a girl's thing? Like Every single thing can be mapped out where you're fully coming up with a postpartum plan. And I think the most imperative piece here is the sleep part. So that's when we talk a bit like about how real realistic is it if that your spouse will take some of the night shift? Are they on paternity leave? Are they going back to work? Maybe it's not possible. Like for me, for example, I'm married a doctor. So He it really wasn't, he really couldn't help me. Like he was in the hospital, he was on shift. And so in my postpartum plan that I had, we were privileged enough to say, we're gonna get a baby nurse. That is something that we, you know, budgeted for throughout the whole pregnancy. Every single paycheck, I remember putting like a couple hundred dollars on the side, just like for

Julie Pernikoff: Yeah.

Gabrielle: the baby nurse fund, knowing, knowing myself and knowing that I'm someone that needs a lot of sleep, and my husband does too, and he physically couldn't be able to help me in the night. So It's really coming up with these like literal schedules of like, okay, from this shift to this shift, I'm gonna do it. And then my husband will sleep and then we'll swap. So really, really mapping out. And we usually have the partner come in for that session, or

Julie Pernikoff: Yeah. Wow.

Gabrielle: join on Zoom just to like kind of get everyone on the same page of like, this is what's gonna happen when the baby's eating every three hours, this is what the schedule is gonna be. So it's really putting in like your support system, making sure also what's really important, I'll have all my clients kind of have a psychiatrist like on like backup, basically, right? Like finding a provider

Julie Pernikoff: Yeah. Yeah.

Gabrielle: that like if that something does happen and if there's a need for medication, they have somebody that they already vetted or know a friend that used, or I'll recommend some psychiatrist, just to have like everything literally set up so that when they get home from the hospital, they literally have a document that says postpartum plan and it has all of the information, all the resources and all of the numbers of everything that they might need.

Julie Pernikoff: Wow. Gabrielle, how do mothers how do they know to find you for this type of thing? How do they know to seek that out?

Gabrielle: I don't know if they know. That's that's what I'm trying to say here. I think like this is something that's so underspoken about, right? Like I feel like pregnancy in in our society is so glorified almost. Like you're pregnant, you're glowing, everything's amazing, look at you, right? And then you're kind of expected to again like go home with like a baby that you have no idea how to change a diaper, you have no idea how to feed the baby. And I think there's so many struggles that come after. leaving the hospital and the postpartum period. So that's why it's so important to like have a plan in place. and I think just like speaking about it, I don't think people necessarily know about maternal mental health. but I think we're moving in the right direction. Like there has been,

Julie Pernikoff: Okay, uh-huh.

Gabrielle: you know, Maternal Mental Health Month and there's definitely a lot of organizations. But I think it's just important for all women to kind of have providers that understand women's health because women's health is different than general.

Julie Pernikoff: When you say have providers that understand that type of thing, are you trying to say that like O Bs should maybe like flag that this type of service is necessary? Or like like who?

Gabrielle: Yeah, so so as something that I've yeah, so something I've been working on like personally is to kind of educate pediatricians' offices, right? That's a number one thing too. At like the let's say the newborn visit, you're going when the baby's a couple of days old, then you're going every like every two weeks for the first few months. We're trying to get, by we, I mean like me and s a few other colleagues are trying to kind of standardize that like when you go in for your newborn visit, there's a screener. That screens the mom for postpartum depression or anxiety. And there's there's what's called the Edinburgh scale. So it's like a it's like a one-page survey. and they do give it out usually at the six-week postpartum checkup at your OB. so most OBs that I've spoken to already do that. The problem is what happens next? What happens if somebody scores really high? Doctors are not so sure of like then what. So

Julie Pernikoff: Mm,

Gabrielle: We're trying to

Julie Pernikoff: okay.

Gabrielle: get more resources of like, okay, and then what? And then here's a list of all the therapists that are trained in maternal mental health. And here's a a list of reproductive psychiatrists. And here's a list of like postpartum support groups. And here's a list of, you know, X, Y, and Z. So so the pediatricians are important, I think, also.

Julie Pernikoff: Yeah.

Gabrielle: just because they see the moms often, right? You're going in in the

Julie Pernikoff: Right.

Gabrielle: beginning for many, many appointments. so we're trying to work with that in like the Brayden County area. Like it's something it's gonna take

Julie Pernikoff: Yeah.

Gabrielle: obviously time, but I think just like being able to screen for these things is is the first step, right? In getting the help that you need.

Julie Pernikoff: I'm smiling because I'm gonna give my pediatrician a shout out.

Gabrielle: Good.

Julie Pernikoff: I we go to pediatric health care of Long Island, and Dr. Halburn is awesome, but I'm laughing to myself because I say sometimes that the pediatrician is for the baby, but it's also for the mom. You really want someone that you get along with and that is looking out for you, also. And this is you're speaking, you're you're speaking the words that like obviously I was I was kind of alluding to that without realizing it. Like

Gabrielle: Yeah.

Julie Pernikoff: You need you need someone that's in tune with the whole family, not just the baby solely.

Gabrielle: Yeah, absolutely. And I think it's so important to like have that trust in the provider who's taking care of your kid. But like they're also in a way taking care of you, right? Especially as a first time mom. You don't know what to expect. So

Julie Pernikoff: Yeah.

Gabrielle: yeah, it's very, very important to have providers that you trust and like that are informed in women's health.

Julie Pernikoff: informed. That's a great, that's great.

Gabrielle: Yeah.

Julie Pernikoff: Wonderful. Wonderful. we touched on what the mom is going through. We touched on what happens before and then a little bit after and some of the proactive pieces, which is awesome. talk to me about the marriage. Talk to me about the relationship. What's happening there? Also,

Gabrielle: Hi, so

Julie Pernikoff: like, love that you bring in the spouse for a session beforehand. Quick question. Do you get any pushback for that?

Gabrielle: only once actually. So like not really. No. Cause we

Julie Pernikoff: Like are they ever like kind of offended? Like why do like why do why don't you think I can you know, I don't know.

Gabrielle: Yes. So so I also do couples therapy and I think this is similar, meaning

Julie Pernikoff: Right, okay.

Gabrielle: like, so when I do bring the partner in for the postpartum plan, it's there's no real pushback because it's kind of like we need you here to create a postpartum plan for your wife. It's more like putting it back on the wife, right? but when we do couples therapy, it's sometimes we get a little bit of like that pushback of like, Well, I don't need couples therapy. Like, why like does something wrong with the men? Like, there's a lot of stigma about couples therapy in general, but let's back up for a second. I think to note your relationship changes when you have kids. It's like very apparent, right? Because you're used to only being each other's priorities. And then you have this new baby in the mix who demands a lot of attention and a lot of resources, right? And so there's just less time for one another. And so there's so many things that you can do to kind of reconnect. But some of the things that I do personally and like I'll tell my clients to do so There's like maybe three or four things. So number one, regular routined date nights. When I say date nights, they could be date days, they could be date coffees. One time a week where you're sitting with your partner for minimum, I would say 45 minutes with no phone where you're connecting without your kids. So if it doesn't need to cost money, also I think there's like a misconception with that. Like you can sit on the couch with a glass of wine or a seltzer. Your phone's in a different room and you're playing a card game or you're just connecting. You're playing a board game, you're playing a card game, you're watching a TV show together and you're discussing it after, like just really connecting where there's no mention of like the daily duties and the tasks that need to be

Julie Pernikoff: Mm-hmm.

Gabrielle: done. Because I think a lot of that becomes the main focus of the conversation. Did you empty the dishwasher? Did you pack the kids' lunch? Did you

Julie Pernikoff: Mm-hmm.

Gabrielle: take out the trash? Like things like that. And so

Julie Pernikoff: Yeah.

Gabrielle: that's something that I basically like require. I mean, I can't actually enforce it, but like require for all my moms, like setting aside that time. And then something that I do

Julie Pernikoff: Yeah.

Gabrielle: personally and I found really helpful is once a year we go away for one night, even if it's just one night. and of course that requires logistics and planning and help and family help and all of that. But it's just so important to sometimes leave your environment and like environment with the chaos and the kids and the mess and sort of again reconnect as a couple. So that's another thing that I definitely recommend. and then lastly something that I also love to do is aside from the date night, doing weekly check-ins. So for me, I do it on Shabbat because we're not really on our phone. And so Shabbat afternoon or evening when the kids are sleeping, my husband and I will sit down and we'll kind of check in like what like How was this week? Was there something that I could have done that you was there something you needed from me this week? Or how can I feel how could you have felt more love this week? What how could you have felt more supported? And questions like that. and so I've personally found that really helpful because it's like a designated kind of check-in time as opposed to, you know, dropping something here and there, criticizing one another. Like it's easy to do that because your partner is your safe person. And I think that's At the end of the day, it's really important to like come back. So when you're criticizing your spouse, it's also coming from a place of like you can trust them and you can say anything you want. but you also need to prioritize the relationship because the best thing for your kids is a healthy marriage. So I think those three things are have been really, really helpful for myself and also for my clients.

Julie Pernikoff: Mm. Wow. Say say a little bit more about the criticizing piece,

Gabrielle: I think like when you're so when you feel so safe with your partner, you can kind of say anything you ness you want, right? And I think when you first get into parenthood, again, there there's so much chaos. Like the house is a mess and there's bottles everywhere and somebody needs to wash them and somebody needs to put the pump away. And like there's so many things to get done. And so sometimes when we get overwhelmed, we take it out on the people that we love most. So like maybe we'll snap and we'll say like, Where's my bottle? Like, I don't know. Where's this? Where's that? Why didn't you wash the dishes? Why didn't you do this? Why didn't you do that? And like nobody responds well to like, why didn't you? Right. And so instead we we talk in therapy just about like reframing it to like, I really need you to wash, like, I really need help with the bottles. If you could please wash the bottles, it'd be so helpful to me, right? Kind of making a direct ask versus like, you never wash the bottle. that's not gonna land well with the person. I think what I was saying before is just like knowing that it's not intentional. It's more just like you feel safe with the person. So you're able to kind of open up and like be comfortable taking out that frustration and that like overwhelmingness onto them. Right. But

Julie Pernikoff: Mm-hmm.

Gabrielle: I it's obviously not great, right? Nobody wants to be criticized all the time. No one wants to feel overwhelmed. So I think using those like For something that we talk about a lot as a direct asking, right? Like nobody could read your mind, especially in a relationship. Like you might think your spouse could read your mind, they can't. So if you don't ask and then you get upset, right? And then it's like that resentment, that piece that kind of harbors and harbors and harbors, and then it's like an escalating thing as opposed to just saying, like, you know, I've really noticed that, you know, when I come home from work, all the bottles are left in the sink. It would be so helpful to me if when I come home, that's one of the tasks you do before I get back or whatever, you know, whatever you the task is. It's just asking because they don't they might not know. And like, yeah, they might see the bottles, but it might not register that like they have to wash them. So sometimes people need a little bit more direction and they you can't expect that your spouse is going to read your mind all the time.

Julie Pernikoff: Yeah. Thank you for that. Very helpful. It sounds like you have some proactive measures that moms can take in terms of communication with their spouses. Can you talk a little bit more? with us about the impact on marriage. I don't even know specifically like a question I want to ask. I just know that I want to hear you talk more about it

Gabrielle: Yeah, so I think it's a huge adjustment, right? Like you're used to being the two of you in the unit and now you have this third person. So just like without any other factors, it's an adjustment, right? And so something that comes up a lot with my moms in general is like that feeling, especially when your kids get older, like when your babies are crawling or you're walking or you have like, you know, toddler kids, like they're they always say this phrase of like they feel touched out, right? So what does that mean? It's like My kid is constantly grabbing me, mommy, mommy, mommy. This one's pulling me, that one's pulling me. And then my husband is like trying to give me a hug. And I'm like, okay, can you get off? Like I need a moment, right? Like I feel so over-stimulated and over-touched. That's how, that's what we kind of how we term it. And I think that is so relatable, right? Like you're as a mom, you're pulled in so many different directions, whether it's physically, emotionally, financially, any of those things. And so at the end of the day, like Your husband wants your attention, let's say, or you wants to connect, and you're so tired and exhausted and frustrated with your kids and the mess in the house that it's very hard to like go into that intimacy connection with your spouse. And I think that the topic of like, you know, sex definitely comes up with my clients in terms of like how also that changes postpartum as well. Just cause like, number one, your body changes, so there's physical changes, but also feeling that touched out, like, and then not wanting to have sex with your spouse as often or when they want to. So that's something that we talk about a lot in therapy. And I think, you know, all of the preemptive stuff of like a for women, a lot of the times emotional connection comes first, right? So that's where we work on like, how can you connect with your spouse emotionally? And then the physical part hopefully will come afterwards. And also of knowing that it's okay. if it's not as frequent or if you need a break from sex or like it's okay to have those but have that open conversation with your spouse. And so sometimes and I forgot to say before all of this, huge proponent of couples therapy. I've gone to the couples therapy therapy with my husband. We did it for two, two and a half years. It completely changed the way that we communicate and all of these things that I'm mentioning, I got from my experience with couples therapy, right? So really making that time for one another, but also having that open communication of like, what do I need from you right now to feel safe and to feel loved? Like what do I need to feel appreciated? Right. And so sometimes for me, like that looks like I need a night by myself. And that's okay. Right. Like I wanted to read my book. I want to take a bath. I want to light a candle. I want to listen to music and I kind of just want to like be. And sometimes I'll and I'll tell my husband that. Like, I want to connect with you, you know, today, but also tonight, I also might need an hour by myself after the kids, after I put all three kids to bed by myself. Right. And so it's okay to have these conversations and be honest with one another. I think that's the biggest piece of like there's a lot of things that people don't want to have these open conversations and then it leads to like even worsening stuff. So we'll have the partner sometimes come for a session here, session there. If like the if the wife is feeling kind of touched out or unappreciated, we'll talk about it together and we'll bring the spouse in and we'll have that conversation of like, what is he feeling? What does he need? Well, how is he interpreting that being cause sometimes the men will interpret it as like, my wife doesn't like me anymore, I feel rejected, I don't feel loved, like you know, I they they were used to being the priority. Now the baby's the priority, especially if you have like a nursing mom, right? So I think it's having those conversations and bringing the partner in and really discussing it and delving into it and seeing like how can we connect emotionally and which will in turn hopefully lead to like a that physical connection. but also knowing that like post everything is different when you have kids, everything, your marriage, your body, everything, right? and I think just knowing that is really helpful for some women and just having that knowledge, you know.

Julie Pernikoff: Yeah, absolutely. That's really interesting to hear from the men's perspective. Like what kind of things are they coming in with that they're, you know, feeling a certain way about and valid, valid.

Gabrielle: Yeah, valid.

Julie Pernikoff: talk to us about TIP T I P P.

Gabrielle: Sure. So that okay, so let's back up for a second. So I think it's important to kind of the tip skills are are skill that I teach my moms, but it really comes from that place of feeling overstimulated and overwhelmed. So the example I give is like, let's say, like for me, I have three kids, right? One is screaming for me, one is throwing his brother something. Like there's so much noise and like you're just feeling this like overwhelming need to almost like combust. Like, what's gonna happen? I'm gonna yell or I'm gonna scream or Gonna I I just gotta get out of here. Like it's very stimulating. So in order to kind of bring that energy down and like calm ourselves, one of my favorite skills is called the TIP skills. And those are from DBT, which is dialectical behavioral therapy. and so it's a skill that I teach all my moms, and I use it myself, and it's an acronym. So T-I-P-P. So T stands for change the temperature, T for Temperature. So I'll tell my moms, you can either Change the temperature to warm or cold. So how do we do that? Like this: a glass of ice water. I constantly walk around with a glass of ice water. I prefer to change my temperature to cold. I just them that type of person. But some clients will walk around with hot tea or they'll take a hot shower or they'll step outside if it's warm outside. I'll tell moms like they'll go in their freezer, they'll take an ice cube. When all of this is happening, you do it. You take an ice cube, you rub it on your neck, or your Farhead, whatever, just to kind of cool your body temperature. And cooling

Julie Pernikoff: Yeah.

Gabrielle: the body temperature actually increases your oxygen flow and makes you calmer. Like it in it helps your nervous system. So that's the tea and tip. And then afterwards, sometimes it's not realistic to do all these steps. So the tea is like the most important one. I think if you're like in the midst of it, you can just grab something. You can always get a glass of water, you could always splash cold water on your face or warm water. and then I is for intense exercise. So that's where like you'll do, I don't know, 20 jumping jacks, or you'll run in place, or you'll do a push-up and to kind of get your heart rate up. And then you follow that by progressive muscle relaxation, which is kind of when you clench your body parts, like you clench it really tight for 10 to 15 seconds, and then you immediately let go for 10 to 15 seconds, and you can start with your forehead all the way down to your toes. and so I found that one really helpful also by itself. Like let's say you're on a work meeting or something and your boss says something and you're feeling triggered, like you can scrunch your toes in your shoe. Nobody will see that, right? Even if you're in person and you can scrunch, scrunch, scrunch for you know 15, 20 seconds and then let go. And so that that holding in and letting go is really helpful also for the nervous system. And then The last P is with paced breathing. So paced breathing is kind of like when it's a uniform breathing. So we'll talk about box breathing, which is like when you breathe in for four, you hold it, you breathe out for four, and then you hold it. So it looks like a box. Or you can do the, you know, two, four, six breathing or two, four, seven breathing. You can do just regular deep breaths. There's all these kinds of like pace breathing exercises you can find online. But each of these skills, the T I P P. They're all very effective, even doing one of those at a time. So again, recommend test starting with the temperature first. For me, that's the

Julie Pernikoff: Mm-hmm.

Gabrielle: most helpful. but they're all helpful. And so when you do it in order, it just shocks your nervous system and you just feel immediately calmer. So I think that's something that I usually teach it on like session two or session, like after the intake, because I'm like, this is something that we all need as moms.

Julie Pernikoff: Like as fast as possible. Let's just jump on the

Gabrielle: Yeah, yeah, yeah.

Julie Pernikoff: absolutely. Wow. I wanna do the breathing with you for a second. Can you show me the the four the box breathing? I literally have done it before, but I but I wanna do it again with you though. I just wanna remember. Okay.

Gabrielle: Sure. Okay. So it's like a box, right? So we'll like inhale for four. So Hold it for four. Did you see how I did the box? So okay. So but you repeated a few times and like it's just I

Julie Pernikoff: Yeah, so nice. Really nice.

Gabrielle: don't know, I think when you envision the box, like your mind is also kind of like focused on like the image and then you're forgetting about all the you know, it's it's a good

Julie Pernikoff: Yeah.

Gabrielle: distraction. Yeah.

Julie Pernikoff: Absolutely absolutely. It really resets. I also it's not the same, but I was a teacher for a long time and I just think about like different things that we would do. Like what did we used to call them? my god. Brain breaks. It's there everybody

Gabrielle: Yes.

Julie Pernikoff: needs help sometimes and and little physical things, like it just brings you down. It like slows things down. So moms

Gabrielle: Yeah, it does, it does.

Julie Pernikoff: need that too. Absolutely. That's so beautiful. Thank

Gabrielle: Yes.

Julie Pernikoff: you for that. Which interestingly brings us into another realm though. When things maybe are a little too big for us to handle, you talked before about having a psychiatrist on call, so to speak, on call or like someone back up. What are your thoughts on medication in general? You know, that where it plays into this into this overwhelm piece and more.

Gabrielle: Absolutely. So I'm gonna get vulnerable. So I am currently on medication. I take Zoloft and I usually does come up with clients because I think there's still such a stigma with medication, especially in like the Jewish community overall. And so it's something that I personally fought for so long. I'm like, I don't need medication. Like, I'm a therapist. I'm good. I'm good. and then you know, it took a certain breaking point for me to be like, Okay, let me try it, and it completely changed my life. So I'll tell people this just to kind of get that perspective as well. if you're struggling with anxiety, like what the medication does, and I I like to use this metaphor, it's like envision a radio, right? So all your thoughts are the radio, right? And it's the radio when you're anxious and you're feeling overwhelmed, like let's say it's on out of a hundred, the volume's like on a ninety, right? You're Constantly ruminating the thoughts, like it feels like there's a radio playing in your head over and over and over of all of these spiraling thoughts. When you take the medication, the radio is still playing, right? But it's like you don't realize it because it's maybe like a five or a 10 volume. So it comes and goes and it's like static y, right? Versus ha being constantly at a 90. So that's how I like to share medication. And I think it's the in my experience professionally. The clients that do the best are those who are take are in combination of medication plus therapy. So

Julie Pernikoff: Uh-huh.

Gabrielle: there's no like we're so quick to be like, okay, you have strep throat, take an antibiotic. Why are we so still so resistant about taking medication, right? It's something that there's a chemical imbalance in our brain, and we need that chemical. So we take it, right? If you had diabetes, you would take insulin, right? It's the same exact thing. And so I think. Kind of reframing it for people and and yes, talking about side effects and talking about why are they hesitant to do it. But I do really fully believe in medication, just like from my own experience, but also professionally seeing it in the clients that do the best, I would say, are those who are taking medication and coming to therapy consistently.

Julie Pernikoff: Like having their yeah. Yeah.

Gabrielle: and having a good provider, because there are some also not great psychiatrists, right? So I think I think it's also important if you're looking for a psychiatrist to kind of look for someone that does reproductive psychiatry, which is really cool, which I didn't know about until I was going through it. But like it's someone that's like specialized in taking medication when you're throughout pregnancy, breastfeeding or postpartum. So, you know, especially like I started medication right before I got pregnant with my third son. And so it was really helpful to kind of have that piece lined up and knowing that like it's safe to continue in pregnancy. And I knew that like the psychiatrist was on board and the OB was on board and everybody was like collaborating collaborating together. so yeah, I'm a huge believer in medication. I think it can really, really help somebody kind of calm those thoughts that are like constantly spiraling. And what I always say is like, why do we need to suffer all the time? Right. Like there's there's help, right? There's there's active help. And so Finding that right psychiatrist and like the therapist and getting on the right medication is so, so can be life

Julie Pernikoff: Yeah.

Gabrielle: changing for people. It really can.

Julie Pernikoff: Yeah, yeah. Absolutely. if you don't mind continuing with the vulnerability, if you could just tell us like one or two challenges that you're experiencing yourself, as a mom with your kids. If you have like a practical example even and people, you know, can relate to and and how you help yourself.

Gabrielle: Yeah, sure. So I think for me, I am like very I like things neat. I like things a certain way in my house. So everything's like in order and I think having three boys, like seven and under, it's like very chaotic. Everyone's throwing things, everyone's like wrestling on each other, and I sometimes the noise feels very loud and it's like I don't want this one to get hurt and this one's throwing something and it's gonna knock down the light fixture and this one and that one. And I f feel myself like it's almost like I recall it like a bubbling anger. It's like bubble bubble, it's like a vision envision like the boiling pot, right? And like when you'll say you're making pasta, and then like you know how it like boils over sometimes if it's too high. So like you like, no, it's coming and coming and coming and coming. And so my first thing that I'll do is I'll run to the freezer and grab the ice cube to like calm myself down. But I would say like For me, it's like the the noise of like the yelling and the the wrestling and like that is very overstimulating for me. And so I know that. And so something that I'll do is like right before my kids get home from, you know, school or camp, I'll take five minutes where I'm not on my phone. Like I know they're coming home, let's say at four, let's make it up. At 350, I will sit for five minutes without a phone and I will do some sort of like breathing or I'll read my book. To kind of like mentally prepare my own self for like this chaotic time that there's coming in in 10 minutes. And so it's like me taking care of myself for even for five, 10 minutes before I know that the chaos is gonna start. So that's something that I find really helpful. and when I come, let's say I'm coming home from work and my kids are already home, sometimes I'll sit in the car for like one extra song before coming in, just to kind of like decompress from the day. And from like, you know, the heaviness of being a therapist and like just my own stuff. And I'll I'll I'll pull into my garage, I'll put on like my favorite song, you know, three, four minutes, breathe, like close my eyes a bit, and then kind of ground myself before walking into like what I know will be a chaotic evening. so those are two things that I find really helpful.

Julie Pernikoff: Yeah. Wow. Thank you so much. So can you tell us a couple hot takes? I know you have some.

Gabrielle: Sure. I have lots.

Julie Pernikoff: Tell us whatever you want. We're here for it.

Gabrielle: Sure. So I think number one is that like hot take, take care of yourself before anyone else. I think it's a hot take in terms of like we're taught, I feel like, from a young age, like mothers are supposed to be martyrs and you know, take care of everyone around them. And like, you know, we're supposed to work, but we're not supposed to work. We're supposed to be home, but we're not like you can't really win as a mom. And so my hot

Julie Pernikoff: So true. Yeah.

Gabrielle: take is like, take care of yourself before you take care of anyone else. And how I explain it to people is like on the airplane, what do they say? Put your own oxygen mask on before helping others. So if I have to decide between taking care of myself or like, you know, a child related task, I'm gonna prioritize myself. And it took me many, many, many years of being a mom to get here. So I don't want like it is a hot take, but it does take time to like fully get into that mindset. So that's number one. Yeah.

Julie Pernikoff: Yeah. Yeah, that sounds like that comes with experience. That sounds like that comes with some seasoning. Seasoned money. Yeah.

Gabrielle: A lot. Yeah. Absolutely. It's not easy. And it's not easy because you're we're driven as like women to like, you know, be maternal and you know care for everyone else and like especially like as a therapist, right? That's kind of my job. And so it's really like really took me until like men probably I was like 33 or something to kind of figure out that this is really, really important. And I know that if I take care of myself. I'm showing up better for my kids, my spouse, and my clients as well. so that's what I kind of come back to. So it's definitely hot take number one. hot take number two is like you can feel two things at the same time. And I think I don't know if it's a hot take, but I think it's a very hard concept, right? So I can feel immensely grateful for being a mom and I can feel immensely frustrated or immensely angry at my kids, right? And it's the same thing with your spouse. And I'll tell this to people, like I can love my spouse so much and also really dislike them and really get annoyed by certain things that they do. And I think it's like holding two feelings at the same time is like a very hard concept for people, but that's that's definitely like a hot take that I I know you can have both, right? You can have the guilt and the happiness and the sadness and the anger and the, you know, the pride all at the same time.

Julie Pernikoff: Yeah.

Gabrielle: And then hot take number three I would say is like take the medication. Like it it really can change your life. Like I I suffered for so long for no reason, right? And I feel like such a better version of myself because of the medication.

Julie Pernikoff: So you told you started taking it before your third kid and then you said it took till thirty three to get good at doing your own self care. Do you mind giving us a map? Timeline? 'Cause I'm trying to figure it out. I'm like, well, when was this?

Gabrielle: Yeah. So yeah. So I I actually started taking and this can probably lead into like other topics, but I've experienced like two pregnancy losses and it was after my second pregnancy loss that I kind of was in like a deep depressive state, which I had never experienced before. what was interesting was that it was postpartum depression, I just didn't have the baby, right? And nobody talks about that piece. So yeah, I I didn't it was an early loss. The baby was like nine weeks old, but I still had all those hormones, right? And so you can still experience postpartum depression or postpartum anxiety, even if you don't have a live baby. So I think that was something that I was I was already a social worker at the time and I had no idea about that. and so like that piece like really was like enabled me like to I'm like, I need to start taking the medicine. Like It was affecting me at work and at home and just like it wasn't I had two little kids, like it wasn't fair to them. And so that really drove me to to take the medication. But that was when I was thirty one, so or thirty almost thirty two. So it took me like

Julie Pernikoff: Well when did you when did you have your first baby?

Gabrielle: I was twenty-eight, twenty nineteen. Yeah. So, yeah, I took the medicine and like I it took me time to like that was I think when I start like maybe even taking the medication was the first step and like putting myself first. 'Cause I was like nervous of the side effects and all these things. But then I was kind of like, You have to do this. You have to do it for you and you have to do it for your family, and you have to do it for, you know, for for everything. And so, It takes time. Like these are all all the things that I'm sharing here are not easy. None of them are easy to do. And I think that's like important for everyone who's listening to understand. Like I might be saying, do this, do this, do this. It took me many, many years and I still am actively working on these things, right? It's not, it's not like a checklist. So you have to actively work on all of these things individually.

Julie Pernikoff: Yeah. I think your hot take in terms of like taking care of yourself, it actually is a very hot take. It it really is because I think I don't know if it's just in our community. Like I don't wanna be like, in the Jewish community this and like maybe other communities struggle with the same thing. I I don't wanna just say like put it on us, but it is really challenging. Like the the woman takes care of a lot. The mother takes care of

Gabrielle: Yeah.

Julie Pernikoff: there's like Shabbos, there's your job, there's the kids, there's the the home, like there's just so many things. and many of us are working.

Gabrielle: Yeah. I would say majority of us are working usually. so yeah, absolutely. Anything the mental load list.

Julie Pernikoff: And really not to say not to say if someone is not working that they're not like take you know, that they're not handling a lot either. I'm just speaking from my own experience, honestly. I can't speak to that. But it is it's a lot. So, I guess practically you give tips to cope as well as possible in all of these scenarios. It's really hard.

Gabrielle: Yeah. Also, this is something that I've done personally and I also found it really helpful. And this is based on like a book, another book that I read that's called Fair Play by Eve Eve Rodsky. So he she talks about dividing the household tasks, right? So with your spouse. So there as you said, there's so many things to do throughout the week. Like forget about Chavez, even just like who's gonna take out the garbage, who's running the dishwasher, who's gonna pay the bills, who's making the doctor's appointments, who's doing the camp forms, like there's a million things, right? So she actually has these cards where like she write, she wrote down all every single household duty on a card. And based on the week, based on each partner's like schedule of the week, let's say your husband has a harder week at work or you do or whatever it is, you kind of divvy up those tasks based on your schedule of the week. and so and the rule for this, which is really important, is like you give your spouse the task they're assigned to and they agree to, and you don't bring it up again. You let you fully relinquish control of like it might not happen today, it might not happen tomorrow, but they have seven days to complete the task. And like you're not gonna ask them about it, we're not gonna nag, we're just gonna trust that they're gonna get it done. So I did something similar with my husband actually with the help of Chat GBT, like Had chat write a whole list of like mental load things that I do or around that is needs to get done around the house. It was like about 53 items. and I printed it out. Yeah, I was like, there's so much more. But like it was like

Julie Pernikoff: Just fifty three, that is a huge I'm kidding. I'm like that's a lot, but it's probably yeah.

Gabrielle: things that like you do once a year, like even just like RSVPing to the birthday invites and like getting kids' birthday presents, like little things like you don't realize, right? And so

Julie Pernikoff: Yeah.

Gabrielle: I I printed it out and I I like we set aside a time. I said, I want to talk to you about something. And I had him go through each of the 53 tasks and rate each task from one to three. So one, it was like something easy he can do, he finds it easy to do. And three is like really difficult to do. And I had him rate all the things and every single thing that he put a one on, I said, Okay, now it's your responsibility. Like And he said, okay, and he he's been doing it. So this happened like a year ago. and so s I thought that was like really helpful because it's like almost empowering the other, like the spouse to like do something that's not so because what's what's a three to him is not always a three to me. And what's a three to you might be a one to him, right? So for an example is like I don't like dealing with like the garbage situation. So for me, that's a three. Like I don't want to take out the garbage, I don't want to roll it back and this and that. I don't know how to remember. So For him, he's like, that's an easy one. Like I'll just when I get my car in the morning, I'll take out the garbage. So since in the last year, I've haven't taken the garb like I haven't done any of that. So

Julie Pernikoff: That's great.

Gabrielle: it it's like little things like that that I found really helpful to kind of like give off tasks. But that to go back to like what you were saying in the terms of the Jewish community, I do think it is a hot take to say take care of yourself, but I think it's so, so important because you can't show up. Like as your best self, if you're not taking care of yourself. Like you're taking a care of everyone around you who's taking care of you.

Julie Pernikoff: Yeah. I you said that you were going into pediatricians' offices. I'm just wondering like if you've seen any movement or if you're considering any approach to like community leaders, like rabbis, college teachers,

Gabrielle: Yeah.

Julie Pernikoff: Robinsons, who else is

Gabrielle: doulas, mikvah ladies, yeah. Yeah, there is yeah.

Julie Pernikoff: Like all these checkpoints.

Gabrielle: Absolutely. So number one, I think rabbis are much more well informed about these issues. Like I personally I've seen it. I'm not going into different rabbis, like I'm just that's not where I'm at right now. But there is an organization called Tikva Sinu, which I just went to their conference about a few weeks ago, and they're a postpartum mental health. like crisis line where you can call them, they hook you up with therapists, psychiatrists, they give you a whole resource team and it's all free. and they kind of get you out of crisis mode and like set you up with the right resources. And so during this conference, this was a conference on maternal mental health and all of those providers were invited. not rabbis, rebitsins, because it was a women's only. So it was like Rebitzins, college teachers, doulas, Lactation consultants, therapists, and we were all, it was like 500 of us in a room learning about maternal mental health. And it was so powerful because especially like it was in Munsi, it was like the Yeshivish Khasidish community, and like this education is happening, it's taking place, like it's slowly getting more and more spoken about, and like everyone's getting more and more and more educated. So I do think we're going in the right direction. It was like really powerful to be in like a room. Full of women in all of those different professions, and kind of like everyone was there to learn more about maternal mental health and ways they can support women.

Julie Pernikoff: I have chells. That's so amazing. Was it did it also like span the gamut religiously?

Gabrielle: mostly like Hasidishish, like and then like me and some a few other modern

Julie Pernikoff: Okay. Okay.

Gabrielle: people, but but nobody like one person wearing pants basically. But yeah, it was mostly it was which I thought was even like more powerful in a way of like opening it up to communities that like don't even necessarily have social media or smartphones and like they're and I I was so impressed. I met like a bunch of therapists who are like practicing in Muncie and like really just wanted to learn more about this topic and like, you know, impressed also with like the college teachers that came and they're learning from a psychiatrist and a therapist. And like we we spoke about pars postpartum psychosis, like really, really heavy topics. And

Julie Pernikoff: Yeah.

Gabrielle: everyone chose to be there to learn how to like educate and be there for other women. And it was like so powerful that it was like women learning about women. How do we help other women?

Julie Pernikoff: So nice. that's amazing. It's like more than nice. That's that's powerful.

Gabrielle: Yeah. Yeah, it's my second year going, so yeah, so really

Julie Pernikoff: wow.

Gabrielle: recommend it.

Julie Pernikoff: Yeah, for sure. so I'll put I think I'll put like a trigger warning on the episode just because if you don't mind, I want to veer into a couple of topics that you know we spoke about beforehand,

Gabrielle: Sure.

Julie Pernikoff: and I hope you're doing okay. Like with time-wise, I really appreciate your time. Okay, thank you so much.

Gabrielle: Yeah, totally fine. Yeah.

Julie Pernikoff: I know you could talk about it a long time and I could ask you stuff for a long time. So, so let's keep going. so can you

Gabrielle: Let's do it.

Julie Pernikoff: Can you just give us a little bit more information, whatever's comfortable about secondary infertility and losses in general. wherever you're comfortable going in that direction.

Gabrielle: Yeah, I'm pretty open book. So so in twenty nineteen I had my son Noah, our first, and before I had him, like at my regular OBGYN appointment, I, you know, they they mentioned like, by the way, I think you have PCOS. So before you even try to get pregnant naturally, we're just gonna prescribe you clomid, like people with PCOS. which is now actually called PMOS, like they don't always ovulate. And so sometimes they have a harder time getting pregnant. And so instead of you waiting like six months to a year, like you'll take the oral clomin and and we'll see what happens. And you know, the first month

Julie Pernikoff: Wait,

Gabrielle: it works.

Julie Pernikoff: pause for a second. Just tell us

Gabrielle: Yeah.

Julie Pernikoff: PCOI. It's polycystic ovarian syndrome. But now it's what's the for?

Gabrielle: Pa so it they changed the name recently. Now it's polyndrocin endrocin metabolic syndrome.

Julie Pernikoff: okay.

Gabrielle: Yeah, they completely changed the name. Yeah.

Julie Pernikoff: Okay. And what happens?

Gabrielle: So it's a syndrome of your body. And like there's many different things that can happen. but one of the main things is infertility. Also insulin resistance. People gain weight, they have acne, they have facial hair. Like there's a bunch of different, very unpleasant symptoms. none of which I really like it was a kind of a surprise to me when I got diagnosed with it. but it was helpful because it was he was like, Why would you you don't need to wait? Like we'll just give you this oral pill, you take it on day five of your period, and you hopefully it works. And it worked on the first month. So great. I had my son, Noah, and then when Noah was about one year old, we decided like we were ready to try for another one. We went back, we took the Clobin medication again, the same dose, same doctor. and it wasn't working. So we upped the dose, wasn't working, up the dose wasn't working. and then the doctor said we can try letrozole, which is another oral pill to help ovulation. so I took that for a few months, it wasn't working. And then they basically said, like, you should go see a reproductive endocrinologist, which is a fertility doctor, because we don't really have much more we can do for you. So that was like a very scary moment. just because it's like it's scary to like see what, you know, and I I thought I knew what like I knew the diagnosis, I wasn't sure why. Something that had worked like a year or and a half prior wasn't working now. so we did go to RMA in New Jersey and we we did a whole infertility workup, which was like I think just like very physically and emotionally taxing. you know, we had to go in for like early morning monitoring and blood work and it was just it was a lot, and especially with like the one year old at home. and so we were going to be doing a medicated cycle, which meant that like I would be doing a trigger shot of Clomid and then timed intercourse and like with blood like monitoring. And right before we started that, I got pregnant. So we were like, great, we don't have to do the treatment. and unfortunately, when I was nine weeks pregnant, I had been discharged from RMA, went to my regular OB just for like a routine checkup. And there was no heartbeat. But I had already seen the heartbeat a few times. So it was like very, very shocking. And like there was no physical symptoms of a miscarriage. So it happened to be alone in the appointment. So I called my husband and he was like, Are you joking? Like he really didn't believe me. It was a very, very hard time 'cause like we were trying to get pregnant for at least nine months at that point. We finally got pregnant and now all of a sudden, like, we weren't pregnant anymore. and so I had a DNC, which was fine. It was like Just surgery. and I it was very, very hard to like recover after that, I think emotionally, not physically. but thankfully we got pregnant a few months later and we had our second son, Caleb. So it was very, very hard to experience that loss. And I think with loss, like nobody really knows what to say, right? So some of the lines that I got that I would recommend for our listeners to not say was like, this is just a blip in the road. Or, your baby must have been really sick. So like it's better now than later. Or how many, you were only nine weeks pregnant? Like my friend was 28 weeks pregnant when she lost her baby. So it's a lot of like justification, right? And like it felt very invalidating. Like all I wanted anyone to say was, I'm so sorry. That's it. There's nothing else to say. I had some really good friends who like sent us dinner or like some of my friends sent me a candle or cookies, like little just things like saying thinking of you. but it was a very d difficult time. And then we had Caleb and it was a very complicated pregnancy, which we may or may not get into, but it ended up with like an unexpected C-section, which was very, very hard to recover from physically and emotionally. and after I had Caleb, I said, like, I'm never going on birth control again because it took me so long to have him. and my OB actually said at the time, he's like, I'll see you in a few months. and he was right. So we got pregnant naturally. Like Caleb was, I think, three or four months old. Like it was very, very, very unexpected. and

Julie Pernikoff: That was after C section.

Gabrielle: after a C section, it was like very unexpected. And when I I went to the doctor, And he's like, you're gonna if you're for sure need another C-section. It's like you're they're gonna like 13 months apart. You can't it it's too close together. And he was actually even worried that like it was so close together that like the C-section scar, like it was a little like anxiety provoking, but it was gonna be okay, hopefully. and I remember being so shocked at first, but also like just like grateful because I knew I wanted three kids and I'm like, it took so long, like maybe this is like just like a gift. I should just be happy. and then You know, went to the doctor, saw the heartbeat multiple times, and then ended up having like a natural miscarriage where like I saw it in the toilet type thing, which was like very traumatic. especially because I didn't want to be pregnant. So I think that was the harder piece. It was like I didn't ask for this, and now I'm having a second loss on top of it. And I remember actually when I went to the doctor before I miscarried, I wasn't nervous about this pregnancy. 'Cause I was like, I already like had a pregnancy loss. Like it doesn't happen twice, it happens once. Like everybody has like a miscarriage. Like, I don't know, that was like my justification. So it was very, very shocking. and you know, I ended up in the ER by myself on Shabbos. It was like a whole thing. and so it was very, very hard to recover from. And that's the point when I started the medication piece. But I think again, people don't know what to say or do when someone experiences a pregnancy loss. And I think Something so powerful that somebody said to me was a friend actually said, she said, nobody could be there for you if they don't know what you're going through. So nobody usually really knows when you're early pregnant, but so they don't know that you miscarried unless you tell them, right? So I ended up telling my friends because I knew I needed the support. And I think that was like really, really helpful for me to kind of put it out there and be like, I just experienced a miscarriage. like I don't really want to talk about it right now, but like I just wanted you to know, like in case I'm not present or I need a few like some space or whatever it is. and everyone was really, really receptive to like receiving a text like that. and again, checked in, sent dinner to us, like really, really nice things. but I think it's just important for people to understand, like, you can't, there's nothing really to say except for like that sucks, and I'm sorry. Like, don't try to like fix it or don't try to say like But your body got you at least you got pregnant or there's like a lot of this like trying to make it not so bad. Like it's better now than later, like type thing. And I think like people say these things with good intentions, but it's very, very hurtful to the person like experiencing the loss.

Julie Pernikoff: Yeah. Thank you for sharing that. That's also and it's also practically

Gabrielle: Yeah.

Julie Pernikoff: very helpful

Gabrielle: Yeah.

Julie Pernikoff: to hear like what to say. So wow.

Gabrielle: Yeah, yeah.

Julie Pernikoff: Okay, we'll just take a second before transitioning into talking

Gabrielle: Mm-hmm.

Julie Pernikoff: about birth and delivery. We're really, we're really covering a lot of ground here. So thank you so much for everything you're sharing. Talk to us a little bit about deliveries for you. What were those like? C section and thereafter

Gabrielle: Sure. So the first my first son, Noah, was like very easy, vaginal delivery, totally normal, recovery, everything was fine. and then with Caleb, it was like a complicated pregnancy. And then at 36 weeks, I woke up in the middle of the night, like heavily bleeding, which was very scary after had I had already experienced one loss. and so like rushed to the hospital, like wasn't really feeling him moving, like very, very, very scary. situation. And when we got to the hospital, thankfully, like they hooked me up to the monitors. Everything was okay. But they were just concerned that it was like a placental abruption. And so they said like we can't discharge you at 36 weeks. Like it's too dangerous for the baby. We have to induce you. And so they broke my water. They induced me at 36 weeks. Like it was one of those like in the middle of the night, like we were at my in-laws on pace after like ran to the car, didn't wake anyone up. My Two-year-old was sleeping, like it was just one of those like chaotic times. and I ended up having him the following day. And in terms of like the C-section, there's a lot more to the story, but like the it the doctors sort of mismanaged me. And like when they induced me, they didn't necessarily do like all the things for induction. And so I wasn't dilating very much. and then the doctor said to me, he said, I'm going home in like 20 minutes, so like you can wait it out and labor overnight, but like some other doctor will be into the morning. I know you don't like her so much. So, like, you might want to do a c-section. it was more like coercive than that, but I'll say it like that. And

Julie Pernikoff: my gosh.

Gabrielle: and also, like, I don't know, I was like hooked up on medication. I didn't know what I was doing. So we did do the C-section.

Julie Pernikoff: Okay.

Gabrielle: and I think for someone that had already had a vaginal delivery. In general, C-sections are traumatic, right? You're kind of on the table. You can't see what's happening in front of you. You're it's an operation. Like it's legitimately an operation. And it's so fast, right? Like with like the vaginal delivery, the first one, like it's like 45 minutes of pushing, and then things slowly, slowly happen. But like with the C section C section, I remember it was like 8 15 at night that like the doctor was like, I think you should have a C-section. And like Caleb was born at like 8 48. And that was like From the time they like decided, consented, got me to the OR, like it was like a you know, it's very, very fast. and I just remember like lying on the table and like shaking. and I think it was very I think C sections are very traumatic in terms of like it it's it's out of your control, right? Like you're not pushing. The doctor is opening you up and like cutting you open. And I think when you have a vision of how you want to give birth and it doesn't necessarily go according to plan, like that's Grief for someone. And so for me, it felt like this like grief of like I knew what it was like to have a regular vaginal delivery. And now I remember post C section, like I couldn't get out of the bed. I couldn't stand up. Like it was so, so physically painful. and it was also just really hard because I had a two-year-old at home. And so I couldn't lift him and I couldn't, you know, I'm a doer, so like I couldn't dry for six weeks. I couldn't bake things. And I like to like cook and bake. Like I couldn't take things down from my counter. Like I had to be very, very I was physically limited. and I think emotionally it was very hard because it was my recovery was slower. And so like emotionally I felt slower.

Julie Pernikoff: Yeah. Yeah.

Gabrielle: and so yeah, I think it's so interesting because I I've done research on this and like there's a much higher incidence rate of postpartum depression and anxiety in people who get C-sections. and I can kind of see why, right? Like it's sort of it didn't necessarily unless you like plan a C section, it didn't go according to plan.

Julie Pernikoff: So right there's collective which is

Gabrielle: There's elective, which is like fine, it's a different conversation. But like I think for majority of C sections, it's nobody necessarily unless you're, you know, it's your baby's breach, like most people envision going to give birth and like having a vaginal delivery, especially if you had already had one, right? So you know what that's like. So I think that was the harder piece. Yeah. Yeah.

Julie Pernikoff: It's a whole other category. That's very interesting. Sorry, go ahead. yeah.

Gabrielle: So yeah. So that was my C-section. It was very, very hard. That

Julie Pernikoff: Wow. So that one's second. Yeah.

Gabrielle: was my second son, Caleb. And then for Avery, the last, I was very adamant about having a V back just because I again I knew what vaginal delivery was like, and I knew what C-section was like, and I wanted the vaginal. And so I ended up switching practices and going to the city to shout out Dr. Fox. He's the best. and that practice, and he I had The easiest, like chillest three-minute pushing delivery, eight pounds, 11 ounces, like two

Julie Pernikoff: No way. No.

Gabrielle: seconds, like he flew out. So it was great. It was like a great ending. And then my husband always jokes, he's like, let's end on a bang. Like, no more kids. Like we we got the V back. We're good. but yeah, so so that's our family. Yeah, sure. So

Julie Pernikoff: Wow. Can you tell us what happened if you feel comfortable? And and if you don't mind like a little bit about preparing for the V back, like, you know, all of that. 'Cause that's

Gabrielle: Yeah.

Julie Pernikoff: that's a little taboo too still, unfortunately.

Gabrielle: Yeah, I think unfortunately, like I think also like a lot of doctors won't do it. So I think you if you it's very important to you need to agogate for yourself and like go to a practice that will do it. So for me it was so important. I remember when I got pregnant with Avery, I called Dr. Fox is he's like a family friend, and I said, like, can I stay in New Jersey? Like I was living in New Jersey at the time, like, can I do a V VAC in New Jersey? And he was kind of like You're a very complicated case because like you had the placenta eruption and the miscarriage. You gotta come to like you gotta go to a Newark hospital. Like you you have to. and so I said, okay, so I schlepped to the city every couple weeks. I ended up having like gestational diabetes with Avery as well, which was not fun. and because I had PCOS, they test you at 14 weeks for diabetes. So I was doing insulin shots daily and take checking my blood sugars from 14 weeks until 37 when I was induced, which is a many, many weeks. so that was really, really hard. But it actually worked in my favor. We always joke like with the practice because because I had the placental abruption and because I had the gestational diabetes, they were worried that. A that the placenta would abrupt again and B that the baby was gonna be on the larger side. Usually when you have diabetes, the baby's is on the larger side. So because of both of both of those things, they were able to induce me at 37 weeks. like they that's the recommendation if you have those two things. And so that and they think like that's why the B back was so successful, is because he was 811 at 37 weeks. So like he

Julie Pernikoff: Wow.

Gabrielle: would have been like, yeah,

Julie Pernikoff: So and you did well with induction.

Gabrielle: So

Julie Pernikoff: One second though, they confirmed that the before the C section that the bleeding was due to placental abruption.

Gabrielle: So they didn't confirm the the practice I went to was horrible. And like they actually told me it wasn't a placental abruption at the time, but Dr. Fox has privileges at Ingwood Hospital, which is where I delivered the C-section. And he read my chart and he was basically like, You're not heavily bleeding after like 32 weeks. It's it's considered a placental abruption. so so it kind of like reframed things. So it ended up working in my favor, meaning like they induced me on the earlier side at 37. And this induction was a world's difference from the other induction. Like they did so

Julie Pernikoff: I know. So what did they do differently?

Gabrielle: they so for the for the last child Avery, they did like protocol induction, which is like inserting a balloon and to like dilate your cervix. They didn't do that at the Englewood hospital. They literally just broke my water and gave me pitocin. But like the balloon opens up your cervix. And like there was just like very methodical steps that they did with the induction.

Julie Pernikoff: Yeah. But they can't do side attack for V back. And you still did well. That's amazing.

Gabrielle: Yeah, right. So yeah, yeah. And so I don't know. I I think it was also just like I my body knew what to do, like I had done it before. but I think in terms of just like in general with VVAC, I think it's it can be you can choose not to, right? Like I totally understand why you somebody would choose not to, but if you choose to do VVAC, I think it's really important to like know that ho like it might work, right? So I kept like telling myself the whole pregnancy, like, I'm shopping into the city, I'm paying for parking, I'm like taking days out of my like work to like go do all these things because I'm gonna have a V back. And then I remember one appointment, they were like, Your baby looks really big, like it's not looking good. Like you probably will need a C-section. And I was distraught. I'm like, this is terrible, it's hysterical. And then I kind of was just like I kind of like zoomed out for a second and I said to myself, like, you are doing every possible thing you can for this V back, but you can't control if it's gonna happen or not gonna happen. You can just do your best and whatever's gonna happen is gonna happen. and so I think it's really important if you're having a V back to kind of set those expectations of like, Yes, you want this, but sometimes we don't always get the thing that we want. But knowing that we tried, I think is really. can be really powerful for some people of like I tried at least. and so for me it was like a really, really good experience, thankfully.

Julie Pernikoff: Yeah, wow, it worked out. Thank God. That's a great

Gabrielle: Yeah.

Julie Pernikoff: point though. I think that that'll be very valuable for a lot of people. I it's some people would just say like also giving it up to God. Like it's kind of

Gabrielle: Right.

Julie Pernikoff: like it's fine line in between there. I don't know. It's very similar

Gabrielle: Yeah.

Julie Pernikoff: things. yeah, wow. Thank you so much for all of this. And we discussed so much. Is there anything you wanna add in or anything we missed?

Gabrielle: I just think like to end on the note of like what I like to always say, like women are superheroes, we're amazing. I think we need to give ourselves so much credit, especially as moms. Like we're constantly juggling a hundred million things at once. And like take a second, like if you're listening to this episode or whatever you're doing, like take a second and just kind of acknowledge yourself and like what how proud you are of like all the things that you can do, right? As a mom. You can work, you can be a spouse, you can be a daughter, a sister, a partner, like a friend, you know, a million things. And like I think women are just incredible. And we ha we go through so much with our bodies and our mental health and everything. And like at the end of the day, we are amazing. So I think just ending on that note of like, I always say women are warriors. We we've gone through it all.

Julie Pernikoff: Absolutely. Thank you so much, Gabrielle. This was wonderful.

Gabrielle: Thank you for having me, Julie.

Julie Pernikoff: Absolutely.