If you’re a mom–or know someone who is–you’re likely aware of how challenging the journey of motherhood can be. And issues such as medical gaslighting can make matters worse. From fertility problems, miscarriages, and perinatal (prenatal and postpartum) depression to not having a solid support system, many women feel lost, hopeless, and abandoned during the often-challenging reproductive journey. In many cases, partners, friends, and family members don’t understand–or don’t know how to navigate–maternal mental health issues. Join Dr. Carla Marie Manly and a renowned Columbia-trained psychiatrist, Dr. Sarah Oreck–founder of Mavida Health–who offers a wealth of empathic, supportive information on women’s health and more!

Topics discussed include pregnancy, mental health, fertility issues, miscarriage, adoption, surrogacy, loss, grief, relationship issues, parenting, medical gaslighting, marijuana (cannabis), fertility testing, menopause, perimenopause, prenatal depression, postpartum depression, perinatal depression, and maternal mental health.

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Please note that this episode may contain sensitive material; listener discretion is advised.

Emergency Assistance Note: If you or someone you know needs immediate support, please call your emergency services. In the US, 24/7 help is available by calling “911” or “988” (Suicide and Crisis Hotline). Support/informational links are in the show notes.

IMPORTANT DISCLAIMER: No expert in this (or any episode) is offering medical or psychological direction; the content is purely informational in nature. Please consult your physician or healthcare provider before undertaking any new regimen or procedure.

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Connect with Dr. Carla Manly:

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Books by Dr. Carla Manly:

Joy From Fear: Create the Life of Your Dreams by Making Fear Your Friend

Date Smart: Transform Your Relationships and Love Fearlessly

Aging Joyfully: A Woman’s Guide to Optimal Health, Relationships, and Fulfillment for Her 50s and Beyond

The Joy of Imperfect Love: The Art of Creating Healthy, Securely Attached Relationships

Imperfect Love Relationship & Oracle Card Deck by Dr. Carla Manly:

Etsy

Amazon

Connect with Dr. Sarah Oreck:

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Threads: https://www.threads.com/@sarahoreckmd?xmt=AQF0w6kgOhAOPtLDQNOfwJbek_Rbo5Gea9rIosqF5GhTX_A

Mavida Health: https://www.mavidahealth.com/

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Medical Gaslighting and Women’s Mental Health with Expert Dr. Sarah Oreck

Key Tips for Improving Maternal Mental Health

If you’re a mom or know someone who is, you’re likely aware of how challenging the journey of motherhood can be. From the first hopes of having a baby to the early days of pregnancy and beyond, the path can be filled with hurdles ranging from fertility issues and miscarriages to perinatal, prenatal and postpartum depression.

As a clinical psychologist, I found that many women feel lost, hopeless and abandoned during the often-challenging reproductive journey. Partners, friends and family members often don’t understand or don’t know how to support maternal mental health issues. In this episode, I’m joined by a renowned Columbia trained psychiatrist who will offer us a wealth of empathic supportive information.

In this episode, we’ll focus on this reader’s real-life question. “My partner and I normally get along great but I’ve just had my fourth miscarriage. He can’t get why I’m depressed and just wants to keep trying. I bounced back after the first three but at my age nearly 37, this last miscarriage took it out of me. It feels like a sign that I should give up. My OB-GYN says to lower my stress and take it easy, but that’s no help. Can you offer me tips?” With that question as the focus of this episode. I’m Dr. Carla Marie Manly and this is Imperfect Love. Please note as this episode may contain sensitive information, reader’s discretion is advised.

I am joined by a delightful special guest, Dr. Sarah Oreck. Dr. Oreck is a Columbia trained Reproductive Psychiatrist and she’s also Founder of Mavida Health. Dr. Oreck will be sharing her expertise on maternal Mental Health. Welcome to the show, Dr. Sarah. It’s such a joy to have you with us.

Thank you so much for having me. I’m delighted to be here.

Dr. Sarah Oreck’s Personal & Professional Path to Maternal Mental Health

Before we launch into the question of the day and maternal mental health in general. Can you tell our readers just a little bit about what makes you, you?

I love that question. It’s so many things. The first thing is I’m a mother to three but had four pregnancies. I had a second trimester loss, which also makes me, me. I became a reproductive psychiatrist before even deciding that I was going to be a mother, which is interesting. It was always committed and thought about how the transitions in women’s lives are affected by reproductive hormones. Whether that’s the first period or perimenopause and the last period are so incredibly impactful.

Thinking about all of the deficits in medical school around women’s health and women’s health research was also a huge part of what makes me, me as a clinician and wanting to write those wrongs, wanting to wrong all the medical gaslighting that happens with women symptoms. I’m excited to have been able to gather all of that to create something called Mavida Health, which is a platform.

It is made to democratize very specialized mental health care that was only available in big cities or in big academic settings and not to everyone. We are rapidly expanding geographically as well as in access and availability in the network. That’s such a huge game-changer for mental health, which sometimes is hard to access.

I already have two questions. You chose the name Mavida.

That’s also a part of who I am. I am a Colombian-American. I’m the daughter of immigrants, which also makes me who I am. Mavida comes from maternal and life in Spanish. Mama and Vida together. That’s the origin story there.

I like that. I suspected with my little bit of Spanish. I thought that might be the case. Thank you. The other piece and it hit me as you said it, medical gaslighting. That resonates with me and I am sure with quite a few of our readers. Could you explain and expand on what you mean by that?

Confronting Medical Gaslighting: Advocating for Women’s Symptoms

Gaslighting is something that has started and we’re talking a lot about mansplaining and all of that. What I see is medical gaslighting, and I have an anecdote and why I became a doctor in part is because for a long time, if it wasn’t explained by something that someone learned in medical school or a textbook or something new. “That doesn’t correlate with anything that I’ve seen. This must be in your head or that doesn’t exist,” is often an answer people get.

Instead of, “I may not have studied that or we may not have the research on that but your symptoms are valid.” You are an expert in your body. Even as a physician, I’m not an expert in your body. You live your body every day. Who am I to say that those symptoms aren’t happening or they don’t correlate to something that I understand or know? They still exist. I can say, “I’m not sure what that is. I haven’t seen this. I’m not familiar with it.” It’s almost like this humility that sometimes our Western medical system doesn’t have.

If I haven’t seen it and I haven’t been tested on it, then it doesn’t exist and you don’t have it. It’s changing and flipping that script of like, you have something. I’m just not sure what it is yet. I’m here to explore that with you.” It relates to who I am and why I became a physician. My mother went through very early perimenopause when she was in her early 40s. I was a tween then. I was around 11 years old or 12 years old or 13 years old, which is this impressionable age.

I saw my mother falling apart in terms of the vasomotor symptoms, depression, brain fog and constantly being told, “You’re too young to have menopause. This can’t be it. People are menopausal in their 50s. You’re a decade early.” I saw firsthand her go to many positions. At that time, there had been a real pendulum swing in terms of hormone replacement. Nobody wanted to give her hormone replacement, which ultimately is what ended up helping her so much. Seeing that first hand was incredibly impactful and was one of the reasons I wanted to become a physician.

Thank you. Applause to you. I know on a personal level. I have experienced medical gaslighting and I know in working with many clients of any gender that it is such a common issue.

Sadly, in some ways, why experts have lost their way and to have been, in some ways, so planted by the wellness expert that’s selling you the vitamin and the thing that’s not evidence based. We see how that environment makes it easy for people to turn to alternatives to say, “If you can’t help me, can someone help me?” We’re in a place where the evidence base where experts are no longer trusted in the way that they should be. Again, that lack of humility has led a lot of people to run to the alternatives that aren’t necessarily safe or bring better outcomes but I do think it has a lot to do with where we are in trusting science.

I appreciate your perspective and I wholeheartedly agree because I come from a place where in all relationships, trust is earned. If you are experiencing something in your body, seek help and the person is telling you, “No, you are not experiencing that.” You’re going home or you’re in the office and you’re saying, “Yes, I am,” and you’re being told no, then you won’t trust that person.

yet, you often end up not trusting yourself, your own body and your lived experience. Thank you. I didn’t expect our conversation to take that turn but it’s beautiful and so appreciated. I am sure our readers are saying, “I or someone I know has experienced that or have experienced that.” It’s so wonderful. I imagine that in Madiva that people are getting a much different experience.

It’s incredibly holistic. It’s starting with the patient knowing themselves and how do we come with the humility of, “Tell me about your symptoms. Tell me what you think is going on.” It’s one of the first things clinicians will ask over, “Here’s what is happening with you. Let’s create this narrative together. Let’s try to figure out if there are biological reasons for you to have this.” Also, what are the psychological reasons? Again, we all come with symptoms for a variety of different reasons.

Perimenopausal symptoms are interesting because I have the hot flashes, the night sweats and all the list of symptoms but the context can make them worse. We know that people have the psychological issues around aging. You may have more issues with that. Our Western American culture doesn’t revere older women. Becoming older is also a sign of something dreaded versus other cultures where maybe the elderly are revered and become an even more important part of society.

It’s interesting and that’s where we come from, holistic. We’re going to try to figure out with you and we are fully evident in space. We are using all the cutting edge, science, and medications. We’re also thinking about mindfulness and who you are as a person and you’re surrounding are going to be so impactful to anything that you’re dealing with. Whether it’s postpartum or fertility struggles. That’s sometimes what’s been missing in medicine.

Having the context for the symptoms as you’re saying, if somebody is struggling, whether it’s with menopause or with fertility and having a sense of being supported by your partner, friends, family and your medical team. It’s a game-changer.

Weight loss is such an interesting one, where we’ve done so much gaslighting to people who are facing obesity. I think about this, with the documentary of the Biggest Loser and what that TV show was like. You just got to stop being lazy, just exercise and eat less now. That’s not the case at all. In some ways, GLP-1s and these new medications have unlocked something for people, but that’s just one example of where there’s so much gaslighting like, “My doctor just says I just need to eat less.” I was like, “I’m doing everything I can. I’ve tried every single diet. I’m doing exercise every day and I’m not losing a single pound.” I’m so happy that we’re starting to flip the script on so many of these issues, but we have a ways to go.

You’ve already given me other topics to interview you about, GLP-1s, weight and also menopause and perimenopause. Let’s set those wonderful topics aside for a minute for this episode and let’s talk about one of your favorite issues it seems. It’s the idea of maternal mental health. That journey from trying to conceive to conception to sometimes as you experience a miscarriage. How draining that journey can be?

I tell people it starts even with the people who are doing their egg retrievals and egg freezing. You already have that idea that you want to be a parent. To us, you’ve already started that fertility journey.

Fertility Struggles: Navigating the Invisible Load and High Expectations

I can think of a number of people I know who as they get a bit older, they have started saying, “I’m not sure I want to be a mom yet. Maybe I never want to be a mom, but I do want to have that egg waiting.” Can you tell us a little bit about some of the most common issues looking at this individual who wrote in almost 37 who’s had several miscarriages and feels exhausted. It sounds exhausted and hopeless. What would you say?

There’s like an invisible labor to fertility. There’s an invisible load to it, I should say and that’s the first thing. Sometimes, this is happening in the shadows and the background. Some people aren’t that vocal about, “I’m trying.” Some people like keeping it to themselves. What I find so much is that people who are going through fertility, even if you’re not using assisted reproductive technologies and by that, I mean IVF or those different interventions.

Even if you’re trying to conceive the old spontaneous way at home, it can be a lot on someone to try to figure out, “I never understood what my cycle is. Now I need to understand how many days my cycle is and when I ovulate.” It’s the first time many women even understand how their menstrual period and their menstrual cycle works, which is fascinating to me. Our education generally is pretty low. I have many patients that are highly educated like lawyers and if I didn’t go to medical school, I don’t think I would know the ins and outs.

Having to learn all of this about yourself, then start to track it. You can start to see how much effort this is. Most of the effort is targeted towards the female partner, especially in heterosexual relationships. You’ll find a real imbalance between who’s buying the ovulation test kits or whose figuring out, do I do an app? Is an app safe to do in different states? How should I figure out or how should I know when we should conceive? It all starts to build.

If we can start a conversation early with our partners of being held in that space like, “I need to get ovulation test kits or I’m looking for an app that might help us conceive. Do you want to help me do this?” Start to partner early. That can be so impactful but again, that’s flipping a lot of scripts and what we in some ways take on as women automatically. First of all, your education will tell you, “You can get pregnant like that.” That’s what sex Ed is. If a man looks at you, you’re going to get pregnant. It’s not the case at all, especially as we get into our 30s.

In the late 30s, the chance of conceiving in a cycle is like 10% to 15%. More likely, you’re not going to conceive that cycle and people often don’t think that. There’s these expectations, “If I stopped birth control. I should just get pregnant like that.” It’s almost like an achievement, a mentality, which I’ve seen a lot. People that are perfectionists think, “Why isn’t it just happening? I’m doing everything. I just tested that I’m ovulating. Why didn’t I get pregnant?”

It’s understanding that your odds are just not in that favor. Maybe if you were eighteen, the odds are slightly different but now you’re 37 or 38. That’s another thing of the expectations are high and you do hear of a friend that just got pregnant on their first try but that is an outlier, especially in your late 30s. Trying to get some understanding or science based on that can be helpful when you understand the statistics are 10% to 15% each cycle.

Now you have a better understanding of this isn’t a 90% chance. This is on the lower end. It might be a few cycles to do this and this is why that recommendation still stands. People should try to spontaneously conceive six months to a year. Six months is when you’re over 40 and then talk to a fertility specialist but there is a year of trial and error before you should be talking to a fertility specialist.

For some people that year can be excruciatingly long, especially if they’ve decided now, is the time.

I know and that’s where you have people going to fertility specialists earlier. Sometimes, that can help in terms of the education and just being told, “Everything is working. Everything’s in place. Let’s see what happens.” Certainly, knowledge can be helpful to understand what’s happening but to also give yourself grace. There’s nothing wrong with your body necessarily. It just takes time, but it is this interesting shift that we expect outcomes now.

We live in a world where you touch a button and it’s at your door the next day and it’s not how babies come.

In some ways, even practicing around some of those sources of immediate gratification can be helpful. What would it be like to just have to get in your car or take a walk down to Main Street and go to the bookstore? Look in a bookstore and find the book that you want to read. In some ways, practicing can be so helpful in all these other elements where we feel a loss of control or we can’t wait that beat or that month.

Grief After Loss: Supporting Partners Through Miscarriage

In general, it’s all good for stress reduction when we practice being patient, patient with ourselves, with life and also patient in this journey with a partner who is trying to get pregnant, who it sounds as if she’s experiencing some grief around this.

We just talked about what happens when nothing is happening and you’re just waiting and wanting. This example that you presented of this case is loss after loss. What’s difficult here is that when you are the one, even if it’s an early pregnancy and only you felt any symptoms. It often isn’t as real to others. Remember, I had a second trimester loss. It just was more real for me than it was for my partner, my mother, or my friends. My partner had been there with all the ultrasounds but they’re still something different about this experience.

I was the one that had all the nausea. I was the one that felt the pregnancy symptoms. That makes it sometimes an isolating grief. In that way, I have found that people are under-resourced. We find that the typical move is you go to your OB-GYN. Maybe they checked the ultrasound, “There’s no heartbeat. Here’s some options of what you can do, whether you can safely have the loss at home or you need a DNC.” After that, there isn’t much holding. There isn’t a postpartum. I tell my patients, “You’ve gone through the experience of being pregnant and then that’s a postpartum journey. You are now postpartum.” I think that’s shocking. It’s a revelation of how impactful it can be.

Your hormones have started to rise and then they plummet again. You are having that same echoes of the experience that people have in post-partum, yet it’s something we downplay. It’s not something that people are immediately referred to care for. I can say, grief looks very different for people that have losses. For some, it can be this deep loss like you lost a living member of your family. For other people, t’s like, “No big deal. I’m going to try next month.” It’s important to respect that entire range. It doesn’t mean one is more valid than the other.

Thank you for that. I’m so glad that you emphasize that if you are grieving and you’re feeling a deep loss, no matter how many weeks or months you are alone. That is a real and valid sense of loss. Your grief is real for someone who does not experience that. They’re just like, “Whatever. Not meant to be.” That doesn’t make them cold or non-maternal. It simply means their relationship with that issue is different.

That’s so important to validate. You also have this incongruence sometimes between partners and that can be hard. “Let’s just move on. Let’s try again.” This was significant for me and I need to take a beat in the reader’s question and that can be very hard. This is where at Mavida Health, we do individual therapy and group therapy, but couples therapy is part of what we do because the path to parenthood very much changes the romantic dynamic.

It changes a relationship entirely and that starts even in trying to conceive. Certainly, when you’ve experienced loss and loss that’s being processed differently by two partners. It can be so helpful to just get in there and talk about what these differences are. I always want to go out and say a couple therapy is not just for people who are about to split up.

I agree, wholeheartedly. I wish that couples therapy was as important to people as it is to have the oil changed on their car or get their teeth cleaned every six months. When we engage in mental health care as individuals or when we engage in our couples, and you mentioned this early on in our discussion. When you have a couple and they come together, whether it’s looking at apps together or figuring out what the journey looks like together.

That togetherness, that sense of being connected on the same page, being partners, and I emphasize that piece, which you’re emphasizing as well in every book that I have to do with relationships. Particularly in my fourth book, The Joy of Imperfect Love. I talked about how important that partnership is. If you have this healthy strong partnership or at least are nurturing it and actively growing it.

As you go through these fluctuations, as you’re wanting to conceive, it doesn’t make them less likely to arise. It does mean that when the challenge arises, you’re going through them together. You have the skills to talk. You have the skills to cope. You know how to attune to your partner. If you don’t know what they need, you know how to ask.

Partnership in Parenthood: Navigating Fertility, Loss, and Male Factor Infertility

It’s also, I know my husband did not feel the grief of our losses in the way that I did but that it was okay eventually for us to hold those two truths and be able to love and respect each other. Even though we had a different experience of this traumatic event that we have as a couple. That’s absolutely the case. What I’m hearing in this patient question is that there’s a drift even in their wants and needs.

After three losses, it is important to start to get an evaluation to see if there are any genetic risk factors that are making this more challenging. I’m going to put that in after three losses, but people sometimes preemptively do it after one. When we think of the number, after three, we want to evaluate. Is there anything else going on here that’s making this pregnancy difficult?

Thank you for that and you pointing out that after three and nothing against her OB-GYN, but maybe if she’s not been sent in for that evaluation or it is time to request it to be an advocate. It’s so hard to be your own advocate if you’re suffering from a sense of hopelessness or depression. Having your partner there or having a friend be able to go with you to advocate, that’s what you need.

Again, this is a woman’s issue. Is it her uterus? Is it her lining? Yet we are seeing more and more that sperm is a huge part of the equation. We’re also seeing a lot of issues with motility and sperm morphology that affect fertility rates.

Thank you, because many people aren’t aware. We’ve been fed a diet of believing that the sperm does the job. In some circles, people still believe that no matter how old a man is, his sperm at twenty are as healthy as they are at 70 or 60 or 50, and that’s not the case. Please tell us about this.

We’ve seen an increase in marijuana use in our country and we know that that affects more motility directly. Sadly, we also may have more toxin exposure and plastic exposure, which may also be impacting it. We’re seeing the use of IVF sometimes because of male factor infertility, and that’s important to note. When you come and start having a conversation about what’s going on, sperm checks are one of the first things that you’re going to do with the fertility doctor, which is interesting.

Again, it’s just not what we’re fed. It’s like, “After 35, your egg quality goes down.” No, it’s a two-way street. Additionally, we know that men, the age is a little bit higher, like over 60 are going to have some issues with sperm quality that may lead to increase in autism spectrum disorders, for example. Which has long been blamed on women over 40, but that’s not the case. There’s more to the story.

Overcoming Fear: Embracing the Maternal Journey With or Without Children

There’s a lot more to the story. It’s so complex and so nuanced. I have another question for you. When we’re looking at this reader’s question it sounds almost hopeless in a sense. It’s like, “It’s not meant to be. Maybe there’s a message here.” Do you have any tips on that sense of, “It’s not right for me?” As well as how a partner, friends or family if they don’t have the resources that are available in a clinic like yours like Mavida. What are some things that they can do to notice when somebody’s struggling and some basic tactics that they can employ to help the individual feel, seen, safe and supported?

I think so much of this can start with just telling your story. What was it like to have that loss? For friends just be there to hear and listen versus, “When I had my loss, this is what I experienced.” Too quickly, we want to interject. We get nervous around these topics of grief as a society. We may want to say, “I’ve experienced this too.” What we forget is when we interject our own experience, we’re not giving space for that person to tell us about their experience and their experience may be very different from ours. That’s something I learned because I hadn’t been a mother before I was in space.

People were always, “How could you do this if you’re not a mother?” I was like, “It’s a huge advantage because I don’t have anything to project on my patients’ experiences.” It’s allowed me to hang back, listen and hear, “This is what’s occurring.” Friends, sure join in like, “I hear you. I’ve been there,” but give that person space to air out what’s going on and even just be able to talk about it. For a lot of people, admitting they’ve had a loss is the first time that people are like, “I had one. Grandma had three. Your aunt had two.” People come out of the woodworks.

It’s like, “Why didn’t we talk about this before? Why aren’t more open that this happens?” With very high frequency that you didn’t do anything wrong or you didn’t drink too many margaritas at that bachelorette party two weeks before you got pregnant or you’re not too old. As people, we want to feel like we have so much more control than we do. We blame ourselves like, “There’s something wrong with my body. This must not be meant to be.” As you start to hear, “You’re not alone in this.” It just feels more grounding and less isolating.

Thank you for using both of those words so that you feel more grounded and less isolated. Both of those are so key. I’m going back to the reader’s question where it said, “The doctor said just to have less stress and take care of yourself.” They’re great words, be less stressed and take better care of yourself.

I just want to do that.

I feel pretty empty. Whereas if you have a partner who shows up and says, “I don’t understand. Please tell me more. Please tell me what that felt like or how your heart is doing.” When a friend or a family member shows up, no judgment and just says, “What’s happening? Can I make you a cup of tea? Let’s go ahead and talk. Please share.” It’s in that space of non-judgmental empathy where that’s where the grounding and the healing comes from. Not the, “Let’s get over it and try again.” I get it. I get excited.

Reorienting Values: Navigating Fear and Desire in the Parenthood Journey

Maybe, “At least you know you can get pregnant.” That’s a very common one. I would hold back on those. Let people tell you. Let the person who’s experiencing the grief tell you what their experience of it or what they’re feeling. Even if it’s different from what you may experience, that non-judgmental holding is very hard. Also, with this, something that’s coming up is something I tell my patients. For this reader, there’s going to be a rearrangement of her values, her desires and her goals. One of the things I ask people is not to base their values on fear and not to change what they want for themselves or a family structure that they may want because of fear of loss.

Often, when we have those breathing experiences, the fear starts to drive us. I don’t want to feel that again. I don’t want to go there again. You may need time but to reorient yourself to like, “This is what I want and here’s how I’m going to make these values aligned decisions,” is hard when fear is knocking at your door. It’s very important and that’s something that can be so helped by just talking about those things out loud. Even writing down, what are my values? What are my values in my relationship? Those things can be helpful and you can do that right at home.

I want to emphasize the piece that you just talked about because it’s so critical when you think about a woman who’s had a miscarriage or several miscarriages. The idea or the desire is there for a child, but also as you’re very clearly saying and I want to illuminate it. That possibly has another loss. As much as you want a baby, you also have the ghost of, “If I get pregnant then I might lose it again. I might lose it.”

That is the anxiety and the fear coming in and it’s understandable. That fear is understandable because then if you do have another miscarriage. That bubble of Hope is punctured again and then there’s more grief and loss. What would you say, Dr. Oreck, for someone who is looking at that specter of loss and as much as they want a baby but there is just that wall or that fear of losing again?

Sometimes it just takes time and you may not be ready now. Also, people change their minds and they might think, “Maybe I’m okay. My life has a great deal of meaning without children,” which I also think is important. I’m in space and obviously, I love this transformation to motherhood. I also think it is a perfectly valid decision to say, “I have a lot of stuff going on or I can make meaning in these other ways.”

I always love to say you don’t have to have a child to be a maternal. There are so many ways to be maternal in the world. Whether it’s birthing books or an idea or being a wonderful aunt or friend. I also think family structure can be all sorts of different ways. You can be a stepmother. You can have adoptive children. You can have children via surrogacy. The idea of being a mother can look all sorts of different ways and maybe it’s different from what you initially thought. In terms of when that specter is there, I say, take a beat and take some time.

Ultimately, even having a child in this biological way or not is opening yourself up to this grief. I talked about how there’s so much loss of control that in some ways this fertility process, this pregnancy is only practice for the next entire adulthood. Patients feel the same way. You give a key to a car to an adolescent. It’s the same, “Are they going to be responsible? Are they going to get in a car accident?”

In some ways, it’s only practice for this loss of control that comes with having a child that you do not control who is a separate person, who makes their own decisions. In some ways, it reverberates to our loss of control even with bigger things in the political landscape. It’s an exercise and how all of our lives we think we exercise so much more control than we probably do.

That is such a wonderful point to highlight, that idea of looking at it in so many ways, a loss of control and not needing control everywhere and giving up our belief that we do have so much control when we have far less control than we often want to believe. Thank you for highlighting that piece. I also appreciate the part where you brought up how having a child does not make you maternal.

There are many people who have children who don’t have a strong maternal instinct at all. They have very low maternal instinct. In the absence of a child, you can also do or if you do have a child presence, it means you can’t give that maternal instinct more energy and into so many areas as you said into creativity and children who need to foster.

Think of any of your preschool teachers or any kindergarten teacher. You are already seeing that and how much of that we truly need in the world? It’s also important to think about.

Not to minimize any woman who’s wanting to be a mom, that pain, that heartache and the importance of continuing to try as long as it’s meaningful. Dr. Oreck, you are filled with so much kindness, empathy and wisdom. Any other tips for our readers? I know there’s so much more to cover.

Grounding yourself now, in your present, in your surroundings and the little joys. I think we forget how powerful nature is in helping our mental health and how powerful just getting good nutrition and enough water during the day. Enough sleep can be revolutionary in how you’re feeling.

Marijuana Use in Pregnancy: What the Research Says About Maternal Health

You make me just think of a question. Thank you for that, and I don’t want to sign off before asking you this question because you had talked about the use of marijuana and the impact on sperm. I’m not aware. What is the research on maternal use of marijuana, especially with gummies being so popular?

This is a big issue that we’re contending with, even how gummy it looks. They appear to be very benign. It’s like a little gummy bear that I’m taking. The research so far and what’s hard about this is, it’s mostly animal models. We don’t have that much research on things like, “Here’s patient A who used marijuana during pregnancy versus patient B who did it.” What we see is a little bit of what we see echoed in adolescent studies where the brain of adolescents and children is growing at such rapid rates, and marijuana is not helpful for that cognitive process.

The animal models have shown us and I can’t say there’s any amount of marijuana that I feel comfortable or safe with patients using during their pregnancy. It’s so hard because people easily are like, “It helps nausea for oncology patients. Why can it help my nausea?” We’re just at a place where we don’t know enough. The data so far that’s based on animals and adolescents is we know it’s not good for adolescents.

We know the use of marijuana and often I say, until you’re 21 or older, your brain is growing and changing. We see, and they have done studies that test scores on kids who are using marijuana are just significantly lower than those that aren’t using it. There’s other factors. There are those that aren’t perfect studies, but what we have doesn’t make me feel comfortable with marijuana during pregnancy.

I appreciate your non-judgmental and very clear evaluation. It’s important to highlight and I don’t steer away from controversial issues like that so there’s the research. I know we have to go, but the other piece I wanted to mention because it just popped into my mind is that I just became aware of research on maternal health and neonatal health during times of extreme heat.

I saw that, too. This is a whole other topic. Climate change is a mental health issue. It is a health issue. This is one example where we’re going to start to see that.

I was stunned. It makes perfect sense and they were talking about it’s not the temperature itself. It’s the fact that if you’re in an area, for example, that’s used to 80s and they’re high heat. It’s going to affect the individual’s health, particularly mom and baby. If you’re in an area that’s routinely 100 and it’s 105. That’s not going to be bothersome because the person is accustomed to that. All of these little things that we want our readers, if they’re struggling with fertility and issues, to be aware. A doc like you is going to be so helpful because you look at the whole individual as well as current research and I’m so grateful. Thank you for that. Where can readers find you Dr. Oreck?

I know how important the care I give is and so basically, I’ve multiplied myself and I’ve created Mavida Health and you can find us there, at MavidaHealth.com. We are live with clinical services in California, New York, New Jersey, and Texas with most major commercial insurance. We have an app which is available for free for everyone in the US.

You just have to sign up at MavidaHealth.com and you can have access to all of our meditations, teachings, all on the path to parenthood, and perimenopause. You have access to all of that information for free. We’re also on Instagram @MavidaHealth and my personal Instagram is @SarahOreckMD with a lot of tips and tricks on your mental health.

You’re wonderful and I thank you so much for all of that information. I appreciate your time, information and your energy.

Thank you so much. I appreciate it.

To our readers, I thank you for going on this journey with us. It’s always a joy to share time and wonderful information with you, and this is Imperfect Love.

Important Links

• Sarah Oreck’s Website
• Sarah Oreck on Facebook
• Sarah Oreck on Instagram
• Sarah Oreck on Threads
• Mavida Health
• The Joy of Imperfect Love
• NAMI HelpLine
• Dr. Carla Manly’s Website
• Dr. Carla Manly on Instagram
• Dr. Carla Manly on Twitter
• Dr. Carla Manly on Facebook
• Dr. Carla Manly on LinkedIn
• Dr. Carla Manly on YouTube
• Dr. Carla Manly on TikTok

About Dr. Sarah Oreck

Dr. Sarah Oreck – A Columbia-trained reproductive psychiatrist and founder of Mavida Health, a virtual mental health platform supporting people across the reproductive journey. As a mom of three and one of the few psychiatrists focused entirely on fertility, pregnancy, and postpartum, Dr. Oreck has spent over a decade helping patients navigate the emotional toll of trying to conceive, loss, rage, isolation, and identity shifts. She’s also one of the only experts speaking out about ZURZUVAE, the first oral FDA-approved medication for postpartum depression—and the larger conversation around why maternal mental health still doesn’t get the attention it deserves. Her clinical perspective is matched by a disarming honesty and empathy.