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220: Pregnancy, Parenthood, and Relationships with Hilary Waller

Welcome back to The Couples Therapist Couch! This podcast is about the practice of Couples Therapy. Each week, Shane Birkel interviews an expert in the field of Couples Therapy to explore all about the world of relationships and how to be an amazing therapist.

In this episode, we’re talking with Hilary Waller about pregnancy, parenthood, and relationships. Listen to the episode on Apple Podcasts, Spotify, and your other favorite podcast spots, and watch it on YouTube – follow and leave a 5-star review.

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The Couples Therapist Couch 220: Pregnancy, Parenthood, and Relationships with Hilary Waller

Learn more about the Couples Therapy 101 course: https://www.couplestherapistcouch.com/

Learn more about the Couples Therapist Inner Circle: https://www.couplestherapistcouch.com/inner-circle-new

In this episode, Shane talks with Hilary Waller about pregnancy, parenthood, and relationships. Hilary is a psychotherapist who supports new parents as they navigate pregnancy and parenthood. Hear the best way to support couples who are new parents, what to recommend for people who just found out they’re pregnant, why community plays such a big role, how often parents should check in with each other, and the most challenging cases she’s worked on.

This episode covers everything from pregnancy to parenting. Here’s a small sample of what you will hear in this episode:

    • Why is there a lack of support for new parents in their relationship?
    • What does Hilary recommend for new parents to maintain & improve their relationship?
    • How important is communication for new parents?
    • What types of support are available for new parents?
    • How can new parents set aside time for themselves?
    • What time period is the hardest for new parents?
    • How do you support couples who had a traumatic experience with their child?
    • What are some of the most challenging cases Hilary has worked with?

To learn more about Hilary and her books - Dropping the Baby and Other Scary Thoughts and The Perinatal Patient - visit:

https://www.psychologytoday.com/us/therapists/hilary-waller-fort-washington-pa/1251531

https://www.amazon.com/Dropping-Baby-Other-Scary-Thoughts/dp/0367223902

https://www.amazon.com/Perinatal-Patient-Compassionate-Postpartum-Depression/dp/1683736567

 

Check out the episode, show notes, and transcript below: 

 

 

 Show Notes

 

What is The Couples Therapist Couch?

This podcast is about the practice of Couples Therapy. Many of the episodes are interviews with leaders in the field of Relationships. The show is meant to help Therapists and Coaches learn how to help people to deepen their connection, but in the process it explores what is most needed for each of us to love, heal, and grow. Each week, Shane Birkel interviews an expert in the field of Couples Therapy to explore all about the world of relationships and how to be an amazing therapist.

Learn more about the Couples Therapy 101 course: https://www.couplestherapistcouch.com/

Find out more about the Couples Therapist Inner Circle: https://www.couplestherapistcouch.com/inner-circle-new

Transcript

Please note: this transcript is not 100% accurate.

Hilary Waller 0:00
It's sort of that, like, glance across the dinner table right when the kids are doing something cute, or even when the kids are doing something naughty, right? It's the ability to connect around the messiness of this period that helps us kind of wake up again one day and realize like, oh, like they're out of the house, or they're old enough to have sports and we can, like, do something together, and we want to,

Intro VO 0:23
Welcome to The Couples Therapist Couch, the podcast for couples therapists, marriage counselors and relationship coaches to explore the practice of couples therapy and now your host, Shane Birkel,

Shane Birkel 0:40
everyone, welcome back to The Couples Therapist Couch. This is Shane Birkel, and this is the podcast that's all about the practice of couples therapy. Thank you so much for tuning in. I'm a licensed therapist, and every week I try to teach on a topic related to working with couples or interview someone who's an expert in the field. And this week, I'm excited to share an interview with you that I did with Hilary Waller. She's an expert on working with people right after they have a baby or during pregnancy, during that time that can be really stressful for couples. And before I get to the interview, I wanted to share with you the couples therapists inner circle membership is open for people to sign up right now. I know many of you have been waiting for it to open up again, and I wanted to share with you an email that I received from one of the current members. They said, I have been a member of the inner circle since February, and I am delighted with the content. I'm never able to attend the live calls. But I love listening after the fact, the inner circle is the best couples therapy training resource I have found. You truly cover so many concrete nuts and bolts, types of things that come up in sessions. You're straightforward and clear in the way you present everything. I have listened to every single webinar you recorded in 2023 and I am a much better therapist for it. I love listening to your content while I'm out for walks, while I'm doing basic household chores, and while I'm driving. It fits into my life really easily, and I am usually riveted by the wisdom you are sharing. I look forward to continuing to take in your content. Thanks for the amazing work you do and for making this information accessible to me at a reasonable price. Yours truly, Adrian, well, I'm so grateful for Adrian, thank you so much for sending that email, and I just wanted to share that with you. You know coming from it means a lot more. I think, coming from someone else, if you're thinking about joining the inner circle, that you have that ability to hear someone else's perspective. And also, there's a free trial right now, you can join for seven days without paying anything, and check it out see if it's a good fit for you. But if you're interested, click on the link in the show notes and you can find out more information. So without further introduction, I want to get into the interview here. This is with Hilary Waller. Hey everyone, welcome back to The Couples Therapist Couch. This is Shane Birkel, and today I'm speaking with Hilary Waller, a psychotherapist who supports new parents as they navigate the challenges of pregnancy and parenthood. Hey, Hilary, welcome to the show.

Hilary Waller 3:21
Thank you so much for having me. I'm so excited to be here. Yeah,

Shane Birkel 3:24
I'm really excited to talk to you. Why don't you start by telling everyone a little bit more about yourself?

Hilary Waller 3:29
Yeah, so I am. I have been working in the field of perinatal mood and anxiety disorders for 12 years now, and the trajectory of kind of the work that I've done is, to me, interesting, so we'll start there, and then sort of branch off in different directions. My training in my background was in an MFT program, and because of licensing stuff, it was easier for me to get my LPC and so I went LPC path, but always really kind of saw the family system through a systems lens. So from a therapeutic perspective, that's kind of where my home is. And my original kind of academic interest was always in how parents affect their children. And so as I've sort of grown as a clinician and in academia, intergenerational trauma is a really poor interest of mine. And so really understanding how the family system, in the context of multiple generations impacts the babies that we raise, right? And at this point, even on, you know, it's literally a cellular level. I'm interested in continuing to learn about the impact as we actually develop in the womb. So when I was, you know, a young, bright eyed therapist, I called my first child my human development class extracurricular activity. She was born when I was just very early. Therapist, just finished grad school, and after she was born, my husband and I, because I'm a good couples therapist, right? We were. In therapy getting ready to welcome our first child, and so just doing, like the, you know, big life adjustment kinds of stuff. And I was six weeks postpartum, and I was nursing the baby, and I had a very, I had a very difficult time adjusting to breastfeeding, which is something we can definitely talk about, because all of these different changes, of course, impact who we are as a couple, right? How our family system functions, what's happening in those early days? So I'm in that session trying very hard to breastfeed this, like, six week old, really, like, beautiful baby, and my husband is sitting next to me, and he's, like, gazing at me, like, I'm like, you know, this is, like, the most beautiful thing he's ever seen, right? Really, really, really lovely, wonderful person, wonderful man. And when the therapist who we were seeing for the first time since she'd been born, we've seen her for a while before, said, How are things going? He talked about this being the most beautiful, transformative, wonderful time of his life. And I burst into tears and couldn't it took me a minute to really even get my grounding to articulate like this sucks. This is so hard and it is so painful. And in that moment, I could see so clearly how, on the one hand, we were so connected by this incredibly intimate experience of starting our family, and had this expectation that it would feel that way, and he was feeling one way, and I was feeling a different way. And we were both sort of functioning in life so quickly and at such a pace that we didn't even notice what was going on with the other so it was in that moment that I became, you know, really, really interested in the perinatal space. And so it, you know, or I guess, shortly after processing that moment, I started, I started working in training at the postpartum stress Center in Philadelphia with Karen Kleiman, who is a thought leader in in the field of perinatal mood and anxiety disorders. 40 years ago, she she really was one of the the individuals who led the charge toward noticing what's happening psychologically for individuals, for birthing women, and in particular in her practice and work, and also in couples. So I worked with her for a long time. I worked with her for over 10 years. Trained with her and clinicians at her center for a long time, and I'm now in private practice. As I've done more teaching and gone back a little bit into academia, made more space in my in my schedule for that and my current practice really consists of people. You know, as I've kind of moved along, I've seen tons of postpartum couples, and I'm finding myself in this niche of perinatal bereavement and medical complexity. So now I'm seeing couples whose lives have been really changed by unexpected circumstances around birth or early childhood. So the loss or death of a baby, loss of a late term pregnancy, maternal nearness, which is maternal near death. So I'm seeing a lot more of that sort of complexity in my clients, and also, of course, how that plays out in the couple. So that's my practice, my background, yeah, that's

Shane Birkel 8:12
great, yeah. And it's amazing to me how unique every situation is, right? I mean, it's hard to predict how the relationship is going to be impacted for each particular couple, depending on, you know, the perhaps, depending on the child, depending on the couple dynamics, all these different factors. And there's a lot of support for people about how to be parents and how to raise a baby and what to do for the child. But I think that, I mean, have you experienced that there's a lack of support for what's happening in our relationship? That that catches people by surprise, that all of a sudden we're we're putting all this attention on the baby, which is good, but we're sort of all of a sudden feeling really disconnected, totally, totally,

Hilary Waller 8:59
totally. And interestingly, one of the features of postpartum mood disorder specifically is that, on the surface, we can kind of function pretty well in many cases with the baby or with the children, and so we kind of channel all of our energy there, and one morning, wake up and realize, like, I'm not functioning in other areas of my life and clinically, when we look for signs and symptoms of postpartum depression anxiety, that's an important question to ask, like, what's happening in the other areas of your life, aside from functioning with the children or the baby? So yes, marriages, there's no it's so low on the hierarchy of needs in terms of support at this time that by the time we turn around and realize it's a problem, we're so disconnected and so busy and low resourced, because now we have like a toddler, right? So yes,

Shane Birkel 9:50
yeah. And so what is some of Obviously, every situation is different, but what are some of the things that you would recommend for people who just. Found out they're pregnant, going into this phase of life for them.

Hilary Waller 10:05
You know, I think the most common recommendation that that I hear and that we give is go on dates. And I find that very annoying advice, because it's not practical, right? So when parents are pregnant, and I start working with them during pregnancy, you know, we want to talk about things like shared values. We want to talk about things like, you know, what are your expectations for the first year of parenting? What would we like our life to look like, in terms of, you know, how we spend time with each other? What will childcare look like, who's responsible for what? So kind of brainstorming some of those things, and I can't encourage strongly enough, talking with other people in your circle, whether it's older generation peers who are transitioning to parenthood, really finding out what's been working for friends and family, and finding out what's not and figuring out what can we, you know, accept or for ourselves, and what will we do differently? But that is all fantasy, right? Because once the baby comes, then we transition to the state through the phase of like, well, what do we what do we do now? So number one is figure out how to protect each other's sleep. Very concrete. Yeah, that's good. Make the plan for worst-case scenario. So in my experience, every couple will benefit from imagining suppose the baby sleeps 90 minutes at a time for the first three months of life, right? It's unlikely that this will happen, but it could, right, set up for the worst case scenario, and that way we know, okay, here are the people we can call in the middle of the night for immediate help. Here are people who can come and spend a night with us. Here's how we both need to sleep so that we can function the next day, figuring out how to protect sleep. The other piece that I'll say is, and this is a really hard, I think, psychological adjustment for couples is that while we both are stressed, right, the stressors are enormous. It's such an understatement to use that word even, but we're both stressed, both partners, the partner who gave birth, is also recovering from giving birth, which means that not only hormonally, but every system in the body is changing very, very rapidly, and the way that that the birthing person's body responds to the stimulus of the baby is differently intense, right? So instead of couples right, like dad is exhausted, and I could talk all day about how undervalued the role of the non birthing partner is, right and how much we need to pay attention there. But a good rule of thumb, especially in the beginning, is to really help yourself prepare for really supporting the partner who gave birth. They really need it in a different way during that really vulnerable recovery period. Those are sort of the two points I would hit.

Shane Birkel 12:59
Yeah, I like the I like that the way you're saying that, right? It's not that the non birthing partner is unimportant and isn't going to have struggles, but it's sort of like that's a good idea to wrap your mind around, this idea that this person, the person who's birthing the child, is going through a lot of physical trauma. They're going to need, like physical recovery time, in addition to all of the other stuff that's going on. And let's make sure we're focusing on that for the first period after the baby's born,

Hilary Waller 13:32
exactly, exactly. Not to mention that again, aside from hormones, which is really only one part of this whole picture, just the mood lability that comes with having a dependent infant and whether you're breastfeeding or formula feeding, feeding takes up a ton of time. Whether you're breastfeeding or not breastfeeding, you're still dealing with lactation and hormones related lactation. So, like, there's a lot of there's a lot going on in the body that we, even when we've given birth, underestimate what's going on? Yeah, so mood, lability, bickering, couples picking on each other, that stuff is common and normal and requires a ton of self and other compassion. So that's another thing that I would recommend, is really, really working on the dynamics between each other, between with within your couple, that enable generosity, compassion, understanding, the assumption that we're that we're putting the other person, that we're able to put the other person first, is really important. We want to be generous with our faith during time.

Shane Birkel 14:39
Yeah, I remember, right before we had our second child, this guy I worked with, he said something to me like, Oh man, that when we had our second baby, that was like the hardest, most difficult, worst, like six months of my life. And there was something like. Really reassuring about that, strangely, like something like validating about that, like my wife and I were bickering a little bit more, or when we were struggling or or whatever, when, when we did have the baby, after we had the baby, it felt like, Okay, this is part, you know, this is this can help us stay in compassion and understanding, if we know that this is part of what happens, and this is a normal part of the experience for people.

Hilary Waller 15:25
Totally, totally.

Shane Birkel 15:29
One common thread of everything you're saying is like the communication being so important, both beforehand, talking about the expectations, but also while it's going on. I think that becomes very important,

Hilary Waller 15:43
absolutely, absolutely. Because,

Shane Birkel 15:46
I mean, I imagine that, and again, it's going to be different for every couple because if some people might be good at saying what they need or saying like, I'm really struggling, here's what I need today, other people might have a hard time with that, and go into a place that feels a lot more lonely, or feel like, why isn't my partner helping out? Or, you know, and I feel like oftentimes there's a lack of communication happening when it's starting to feel more stressful, like that

Hilary Waller 16:14
part of that dynamic is informed by specifically what's going on when we adjust to parenthood, right and culturally, right? Within our American culture, we tend to do things in such a siloed, independent way. Nature of transition to parenthood is that we are we need community. We long for community. Mammals build community around welcoming a new member of the community, right? But in our culture, we really don't do that so much. So there's this really strong tension between wanting to do things ourselves, right, and desperately needing others to come and help us, support us, take care of us, right? So the dynamic between partners can look a lot like, you know, Mom feeling or dad feeling incredibly resentful of the other, right? Because they don't know how to intuit exactly what the other one needs, right? They don't share the same instincts around the baby, not because one is better or worse than the other, but because they're two different parents. They're two different people, and when everything is so brand new, we don't have a template for communication about it, right? So with the first baby, it's like we don't even know how to talk about a baby or need. We don't know what to ask of each other. And with a subsequent baby, it becomes harder and harder, because there's less and less time. There's less and less bandwidth. One partner's got the older kids, typically, and one partner's got the baby, right, right, swapping back and forth.

Shane Birkel 17:42
And so what advice would you give for people in this situation?

Hilary Waller 17:47
I think again, it's a combination of, like, prep work, right, and in the moment, having the generosity to be able to say, like, okay, like she snapped at me, I'm going to let that one go. Right? If there are patterns, right? If there are patterns of being snappish, if there's patterns of fighting going on, if there's stuff that's sort of negatively brewing and becoming uncomfortable, that's where we really, really want to take note when we like can't drop it and forgive easily anymore, or if we're noticing a pattern in our partner, because then what I become curious about is, is, is there a mood disorder ruling? Is there depression? Is there anxiety? Is there something else under the surface going on? Is it something that predated having children between the couple, right? Is there a couple's dynamic that that needs to be looked at? And also, you know, I'm a really big advocate, like mental health care should be part of our routine primary health so if we don't like how we feel in a relationship with someone like, let's talk about it and create. And this is the date piece, right? It's maybe impractical to go out to dinner every week, but creating space to go to couples therapy a couple times a month if you need it, right? Even when times are good, especially given telehealth, that might be date night for a little while when you have young children, and carving out that time is invaluable, right?

Shane Birkel 19:10
Yeah, and I think, I mean, you mentioned before, and you're sort of talking about it now, but like, just that seeking of external support. I mean, what other kinds of supports can people think about, obviously, there's like family and friends and things like that. But what you know are the are there things that people don't even realize are available out there?

Hilary Waller 19:33
That's a great question. The first resource that I'll give, very concretely, is Postpartum Support International. They the website is Postpartum.net Postpartum Support International, or PSI, is a fantastic clearinghouse for like every need that exists within the perinatal space, the reproductive mental health space. They offer online support, lots of great psycho educational information. Information. It's just it's a really great resource for people to check out before they have their children. Throughout that you know that first perinatal period, the other recommendation I have is for parents to sit down and think through different types of access to different types of resources they'll need. So I break that into four categories. Who do you go to for information? So when the baby has a rash, who can we call to get that information? Well, we think automatically, the pediatrician, but we might not think of such and such friend who has four kids and has seen a million rashes, right? So who do we call for information? Who? Who do we call when we need logistical support? So if we need someone to run and get diapers in the middle of the day, if the baby is napping and the toddler needs to be picked up at daycare, is there a neighbor who can run that errand and pick up the toddler from daycare? Right? So who can help us with kind of practical logistical things, who can help us feel distracted. So both individually or as a couple, who do we like to hang out with, if we don't want to be in sort of the heaviness of this stage, who do we just have fun with? Who do we laugh with? Who can we, you know, wear the baby and take a walk together, go out to dinner and sort of be in that messy space together and try to laugh and have fun? Maybe there's overlap here, right? Who's the couple that we like to hang out with? Who will hold the baby while we eat there, right? So who can we just enjoy our time with, and then, whose shoulder can we cry on? And again, while ideally, couples learn to rely on each other for a lot of their emotional support and a lot of their support in general, we have to recognize that we have to go outside our partnerships, because we can't be everything to each other at all times, right? It's too much to ask, and we also individually need space to be able to have our own social friendships. So not only do we ride each other's shoulders as a couple, who can we sit with, you know, in the backyard and talk about how hard this is. Who do we have individually to confide in and talk about how hard this is. So when we're hitting those four categories, we're pretty well resourced. And so if we have, you know, a couple of different resources in each category that we find in our lives, then integrating, you know, I give psi as an example because it's a really high quality, kind of safe place for people to scroll and get really good information, because, of course, they discourage sort of the broad, generally googling of all things related to baby and marriage, because we can find a lot online that could be triggering. So who do we have in our immediate community that we know, can we find some resources available to us online, and then beyond that, if you're not sure if there's still more, if there's still a gap, I really encourage reaching out to, you know, to a therapist or even to a pediatrician's office, someone in the local community who knows what resources are available. In my local community, for example, there are community centers that host new parents groups. There are breastfeeding groups that aren't just for breastfeeding moms. They're for people who are just feeding their babies, but they're antiquated and called breastfeeding groups. Sometimes you need to talk to someone, or find the person in the community that knows that information you know. So so really reaching out to people to find out, you know, what's out there.

Shane Birkel 23:21
I feel like that's a great recommendation, especially if people you know aren't near family members or friends that are helpful. If you know there's always those new mom groups and community often, you know in communities that people can get some of that support from for sure.

Hilary Waller 23:40
And here's the other thing, it doesn't have to be your best friend, right? When you're a new parent, socialization, right? Peer support. I hear so often when my friends have kids, but they're back to work, right? My friends with kids, but they live far away, and I'm like, go, go find any group of parents that takes a walk in the park, right? Just be around other people who can talk to you about being up in the middle of the night changing diapers, because that's what we really need during that time. Maybe you'll find close, lifelong friends, maybe not, but really looking for anywhere that the new parents go to hang out? Yeah,

Shane Birkel 24:14
I'm wondering if you know people come to you for couples therapy and they're struggling, if there's like, a time frame that you ever sort of say, like, this is going to be hard for this period of time, or are there stages? Or how do you talk about that?

Hilary Waller 24:32
You know, as you're asking that question, I'm realizing I didn't define this word perinatal either, which I think is actually really important. The perinatal word specifically refers to the period of pregnancy up until one year postpartum. And we're using this term in in my field more and more and more because we really want to be looking at that whole kind of spectrum of experience through the pregnancy and through the first year postpartum. Many people think about postpartum depression for. Example, or being postpartum as like the first couple of weeks, or first maybe like, like until we go back to work is often the timeframe. And we also kind of reinforce that misunderstanding by discharging most of our birthing patients at six weeks postpartum. Medical doctors will will discharge them from their care at six weeks, eight weeks postpartum. And people, birthing people, parents, non birthing people, kind of assume like, Okay, well, I'm not postpartum anymore, right? But really, what we see is that Postpartum Mood disorders can develop any time during pregnancy or within the first year, sometimes two years postpartum. And as that applies to couples and relationships, it takes a while to kind of again, wake up to what's going on in your relationship. So it isn't unusual for me to see someone who will come in, you know, a year, three years, three years, two kids in, and say things haven't felt right since we were pregnant with the first right for those therapists who don't work in this sort of new parent phase, you know at all, and that's not the area of focus. Always ask, if your patient is a parent, always ask, what's the what was the experience of transitioning to parenthood like? Right? Because you don't know what symptoms or what communication breakdowns may have started then, and how that impacts the way we relate. And I should also mention that even when couples don't have children, gently exploring that decision, right? What is it like not to have children? Did you decide to did you decide not to have children purposefully? Or did that happen because of circumstance? Oftentimes we assume that people without children may not want or need to talk about the reproductive experience. But as human beings, we all have a reproductive experience, which means we've all decided to have kids, decided not to have kids, or experienced lots of different stuff in between, losses, fertility challenges, difficulties, finding the partner who we wanted to have children with missed opportunities. So really, really important to look at, you know, parenting issues rooted in reproduction, in addition to, like, what's happening right here in front of us. Does that make sense? Yeah,

Shane Birkel 27:11
for sure. Yeah, that's great. Those are great questions. And you know, I think you know if somebody, let's say, goes back to work after six weeks, and they had just had birth, and you know that they're still experiencing a lot of emotional struggles. You know, they might put the blame on themselves, like I'm supposed to be through this by now. What's wrong with me? Why can't I function? You know? And I so I love that idea of, like, sort of extending that and just sort of normalizing this experience that it's normal to have these kinds of struggles for a much longer period of time.

Hilary Waller 27:52
Absolutely, the issue, actually, like, the way that I like to help people think about this, is that the struggles are normal, right? But just like with, with every relational, mood related issue, every issue, it's it's what's the duration, frequency and intensity of the struggle, how is it impacting us day to day? And so if, again, after three kids, back to back kids, we realize, like this doesn't feel good, right? Let's pay attention to that, right? If the struggles are still there, if the mood stuff is still happening between us, if we're feeling disconnected, it doesn't even it doesn't really matter whether it started with the first second or third kid, right? It's related to the transition of parenthood. And so there does come a point in all of our marriages we're kind of pausing to check in and like, ask ourselves, do we still love each other? Are we still connected to each other? Are we parenting well together? Are really, really important questions. I think all couples therapists would would share the opinion that that checking in at some point with each other is really, really important. And very often we see that these struggles happen around this transitional time.

Shane Birkel 28:59
It's interesting. You know, I meet with a lot of couples who are, you know, maybe their kids are teenagers or or even older. And there's this sort of a lot of times, there's this story or narrative, you know, about the relationship that, you know, we just sort of ended focused on the kids for so many years. We just put all of our attention into that, and we didn't really check in with each other. We didn't really, you know, maintain the communication or the healthy connection for our relationship, and it's good. What you're talking about is sort of, you know, obviously you're going to be putting a lot of time and energy into the kids, but we have to set aside time for our relationships or whatever other things we value in our life as well.

Hilary Waller 29:45
I love the there's an image that I show often when I give trainings of it really, really beautiful couple, beautifully dressed, laughing. Hair is done like it's just, it's just gorgeous, right? And then after I show that picture. Right? We talk a little bit about what this couple's life might be like. The next picture I show is a couple on it looks like the subway in New York City, where they're sort of like collapsed into each other sleeping, it appears, and I believe it's the dad is wearing, like a toddler aged child who's like, falling out like this, right? Everybody's asleep. And it's so interesting because it's what I love to discuss with groups. Is the the change in intimacy, right? There's the true, beautiful, wonderful intimacy of being carefree and dressed to go out to dinner and like that's wonderful. And I see how couples transition back to that right later in their marriages. It takes some effort sometimes, but there's incredible intimacy in leaning into each other on the subway exhausted with your baby, right? It's a completely different type of intimacy, but if we can teach couples to appreciate that and look for it, it's sort of that, like glance across the dinner table, right when the kids are doing something cute, or even when the kids are doing something naughty, right? It's the ability to connect around the messiness of this period that helps us kind of wake up again one day and realize, like, oh, like, they're out of the house, or they're old enough to have sports, and we can, like, do something together and we want to, you know,

Shane Birkel 31:15
yeah, that's great. I heard recently something like happiness is when the reality meets your expectations, you know. And I think what what you're saying is a good way to sort of reframe it, so that if we're not feeling like that glowing couple like the, you know, just started dating, like, that's okay, like, like, if that's our expectation, we're going to keep feeling disappointed once we have kids, but if we sort of look at it differently and define different ways of having that intimacy or connection, I think it's really helpful for couples to normalize what they're going through.

Hilary Waller 31:52
Totally Yes, I love that.

Shane Birkel 31:55
Do you want? Do you want to talk a little bit about some of the challenging cases that you're working with now,

Hilary Waller 32:01
I love to sort of work with, well, it's funny, because when we say we love to work with in, you know, our fields, often what comes next to something that people are like, I really enjoy work with the families who are grieving or who've experienced really significant medical reproductive trauma. By that, I mean I differentiate between the sort of psychologically traumatic birth and a medically traumatic birth. To speak to that just for a second, we hear this word birth trauma used and thrown around a lot, and even as really, really kind of well seasoned clinicians, we can see people who had a pretty uncomplicated birth with symptoms of PTSD, and sort of feel like, well, that wasn't a very traumatic birth experience, right? Why the PTSD? But we see, and I can validate in a million different ways and talk about it another time, why PTSD can emerge from kind of a medically normal birthing experience. On the flip side, we see medically complicated birthing experiences and a lot of PTSD around that. And so I see both kind of types of circumstances in my practice a lot, and really enjoy the work around reproductive trauma from a couple's perspective. I find it really fascinating to watch how this unfolds between partners. So that's been a really an interesting part of my work recently.

Shane Birkel 33:24
And can you say any more about that?

Hilary Waller 33:27
Yeah, I find it really fascinating how, when at baseline, this is a couple whose life has just sort of like exploded into parenthood, which the metaphor that I use for parenthood is like, if you take, you know, like, a beautiful glass, blown item, and then you throw it onto concrete, and have to, like, put the pieces back together, right? That's a little bit what parenthood can feel like, especially within the context of a couple. And so you've got that going on, right? And in addition to that, or as part of that, you have a partner who has given birth and is dealing with all the complexity of that. But when there is on top of that, an emergency hysterectomy, a traumatic set of birth circumstances that maybe impacts the health of the baby, the baby ends up in the NICU, there's perhaps a death late in the pregnancy or early in infancy, unexpected outcomes for mom or baby, then we're dealing with, in addition to, kind of the baseline mess, we're also dealing with the potential for a lot of trauma and a lot of grief at a time when, you know, our nervous systems don't have a ton of bandwidth for any more than what nature automatically gave us, you know, so, um, so the puzzle of helping couples kind of pick those pieces back up and differentiate between like, Okay, this is what it might have been like before this happened. And here's the trauma, and here's the grief. And you know, as the clinician who can sort of help support processing all those things at the same time, I find that work really fascinating. And. And very rewarding, yeah,

Shane Birkel 35:01
and I'm sure it's very different, you know, if, if some, if a couple, goes through an experience where it's a very physical, physical trauma of having the child and it but they have the child, versus other situations where they lose the child, obviously, that's a very different sort of process for them to go through.

Hilary Waller 35:24
Yeah, and it's a very, very disorienting when I'm kind of fortunate enough to see a couple right after the traumatic experience, you know, or make contact with them within a couple of hours or a couple of days, referral from the hospital, for example, what they tell me is we don't even know how to, like, stand up like we literally can't put one foot in front of the other. We just came home without our baby. I gave birth, and my baby has died. I We don't We literally don't know what to do next. So much of that work is really grounding the couple together. Very often I'll see couples after a trauma together, and then after a couple of sessions, we sort out kind of who's going. Where are we doing couples work? Is one of you going to stay in individual work with me? Is one of you going to be referred out to someone else for individual work? You know? What is this? What is it going to look like? Because in those first moments, just like in the first moments following any trauma, we really just need to be able to sit, breathe, get some good psycho education. Kind of figure out, what do we do, first, second and third, so that we can begin the process even of, you know, any form of therapy, those moments are incredibly vulnerable and truly I, you know, I tell my clients this, I feel unbelievably privileged to get to hold that space for them during that time in their lives.

Shane Birkel 36:44
Yeah, absolutely, yeah, that's so hard. What other considerations I know we're getting to the end of the conversation here, but just in general, you know, if, if people, let's say it's been six months since they had, you know, had their birthing experience, and they're still really struggling in their relationship and feeling a lot of stress. I mean, do you have any any more? Obviously, you've already given a lot of wisdom about that, but any other thoughts about what people can do, or even as therapists, like anything we can consider to help people in that situation.

Hilary Waller 37:22
Yeah, you know, if we can, sort of, I think that that work with perinatal patients, right? Perinatal couples individuals, the more we can sort of step back and be curious about their context, the better. I think we can work with them. What I mean by that is, if we can step back and really see here are, and to some extent we do this in all coupled work, here are two individuals, right? How are they functioning individually? How are they functioning together? What was intimacy like before, right? But now that intimacy has been shattered, and emotional and physical intimacy, which I should touch on in a second, now that that's been shattered on the concrete, right, how can we as therapists witness the experience of them sort of finding those pieces and putting themselves back together while holding and normalizing it isn't going to look The way that it looked before this beautiful sculpture, all the pieces will find them over time, but we're going to reassemble them, and it's going to look a little bit different. It might look a little bit broken, right, but we can bring it all back together. The process of doing that is painstaking, takes a long time, requires a lot of patience. Is it going to happen in one course of treatment, right? It doesn't require a mood or anxiety disorder or crisis to reach out for help to put those pieces together, right? So as a therapist, I really I consider my role as kind of gently witnessing and guiding the experience of, how do we rebuild this relationship, building relying on building a ton of patience and compassion for each other. As I said in the beginning,

Shane Birkel 39:05
I love that framework, and it allows for, allows space for whatever the dynamics in the couple are, whatever the unique specifics of what they're going through. You know, can fit into that? Yes,

Hilary Waller 39:17
great. Yeah, I'm going to mention, I'll go back to physical intimacy for a second. Because, you know, again, this postpartum period, we know that in kind of the first six, eight weeks, we do receive clearance, often from medical professionals like resume normal activity, unless, in the case of a more medically complex birth, most women, most birthing people, will receive the guidance like, go exercise. You can have sex again. You can kind of behave normally in the world as you were before. So what that actually means is your body has recovered enough that you can resume normal activity. But what we think it means is and it should look the way that it did before, right? So after we give birth and we've. In, you know, lightly stretching and walking, let's say right. In those first couple of weeks afterwards, we don't go out the next day and run a marathon, right? And most of us know that we can't right. We need to train for that. Similarly, when we are cleared to have sex, when we're clear to experience physical intimacy with our partners. Again, we don't go out and run a marathon. So again, really, really good communication about what feels okay, right, what feels safe, what feels painless. It's very hard for birthing people, for women in particular, to talk about their to talk about what's happening in their bodies after they've given birth. We as peers, don't talk about it nearly enough. And because the challenges are so kind of routine, a lot of OBS and midwives, they don't tell you, like, yeah, your vagina might hurt for months and months and months. It's so normal for that to happen that we almost it's almost unremarkable, but the way that that translates to sex is really, really complicated, obviously. And if we're not communicating with our partners, what's going on for us, they can't know. They can't be respectful, right? They feel rejected. We feel ashamed. And so this dynamic really can become very, very challenging and very toxic. So again, Opening communication is one piece, but also respecting the communicating about the body in these really intimate, private ways can be very hard and unfamiliar for people who've given birth. So psycho ed for both partners. I really, really, really encourage non birthing people to understand what's going on in the birthing body. Look it up the same way that you might look up how to swaddle a baby. Find out what's going on in your partner's body. How does it feel to give birth, right? How long does it take for a C section scar to feel normal again? Women can experience numbness in their C section scar areas for months and months and months and months afterwards. It doesn't have to inhibit sex, but it might feel like, Please don't touch my belly. That's uncomfortable, right? But as partners, we can be uncomfortable communicating that in intimate spaces. So again, really, really opening up to the possibility of lots of compassion for each other, and again, really sort of circling back to deferring to the person who's given birth sort of really give space for them to experience their bodies. Things can hurt unexpectedly. Things can be uncomfortable unexpectedly. Things can feel violating or vulnerable unexpectedly. So really good communication about physical intimacy is very important, and if one or both partners again isn't feeling comfortable or safe or having their needs met, emotional needs met by the physical intimacy piece. That is a definite sign that we want to have someone who can facilitate that conversation, a therapist, someone else you know,

Shane Birkel 42:54
yeah, that's great. That's so important for couples to hear. Thank you so much, you know. And it's, it's like giving people permission to value their experience and their you know, have a voice about what's going on for them and the compassion piece for each other. I i really that. I'm really grateful that you mentioned that. Thank you. Yeah, yeah, that's great. Well, how can people find you? Do you have a website or someplace people can find you more information about you right now, the

Hilary Waller 43:22
best place to find me is in psychology. Today, I do have, I have two books that I co authored. I mentioned my work with Karen Kleiman at the beginning of at the beginning of our time together, so they can find information about specifically intrusive thoughts in postpartum, dropping the baby and other scary thoughts, I co authored with a group of amazing co authors, Karen and I also co authored the perinatal patient, which is the book that I wish I had when I started working with new parents. I wrote it because I wanted to sort of like a, almost like a how to work with perinatal patients for Dummies style book, right? Like, here's what it all is. Here's any worksheet you might need. Here's all the information. And quite honestly, it's written in a voice that speaks to patients also. So if you're a person who wants to really understand, kind of the inside perspective of, like, what does it feel like to be postpartum? Like, partners can read it, parents can read it. It's self promotional, and so I get a little bit shy about that, but I think it's a really great book. So I really recommend, if you kind of want the broad strokes of what this period is like my that's my academic Navy right

Shane Birkel 44:33
now. Yeah, that's great. So that's called The Perinatal Patient.

Hilary Waller 44:37
Yep, it's published by PESI Publishing. It's available on Amazon and through PESI.

Shane Birkel 44:42
Okay, great. And the other one is dropping the baby, and other intrusive dropping

Hilary Waller 44:46
Dropping the Baby and Other Scary Thoughts, yeah, other

Shane Birkel 44:49
scary thoughts. Okay, yeah, great. Thank you so much. I really appreciate you coming on. This is a great conversation, and hopefully we can catch up again at some point in the future. Yeah. Wonderful.

Hilary Waller 45:00
Thank you so much for having me. All right,

Shane Birkel 45:02
thank you so much, Hilary. I'm so grateful for you. This is such an important topic. I know a lot of people really struggle during pregnancy and right after having a baby, and struggle in their relationship, that is and so I'm so grateful to have you come on and talk about this. Also, if you've been thinking about joining the Couples Therapists Inner Circle. This is a really good time to join. Be letting members in for the next week or so, actually, only maybe a couple more days. And I really hope everybody checks it out. I mean, you can click on the link in the show note, show notes, and there's seven days for free to take a look see if it's a good fit for you. Thank you so much, everybody. This is Shane Birkel, and this is The Couples Therapist Couch. Bye, everybody!

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