kozēkozē Founder and Podcast Host, Garrett Kusmierz, sat down with the co-founders of Rise Wellness Collaborative—a comprehensive and collaborative mental health therapy practice in Ann Arbor, Michigan—to discuss perinatal and infant mental health.

Aimee Tuck is a perinatal mental health therapist and Jen Burke is an infant early childhood and perinatal therapist.

Together, they founded Rise Wellness Collaborative and, out of that practice, Bloom and Rise, a one-time or subscription box service for new moms, babies, and toddlers created for every stage of the journey to care for mom and foster creative development for baby. These boxes are not only packed with premium products, but also include a QR code to access insightful resources from subject matter experts directly related to the stage of the specific box received.

Let’s dive into the Q&A.

Q: What brought each of you into the perinatal space?

Aimee: After the birth of my first child, I was wrecked physically and emotionally—and it was really hard to find a therapist who specialized in that experience. So, once I healed from my own journey, I decided I wanted to specialize in it. I got perinatal mental health certified and met Jen at the practice I worked at then. Infant mental health is very closely linked to perinatal mental health, so we decided to brand out and create our own private practice that specialized in both mom and baby as well as young children.

Jen: I first got into infant mental health in a roundabout way. I was a recovering lawyer. I had worked in foster care for a long time, representing kids in DC. I had a background in seeing generational trauma. When I moved back to Michigan, I transferred back to doing more clinical work because I had a joint degree. I did a lot of work in bay court, which is foster care court for babies, and focused on reunification and helping foster parents build attachment.

A lot of infant mental health work is parenting work and secure attachment work and perinatal work. How people are experiencing their pregnancy, birth, and own attachment stuff is coming up all of a sudden when they have their attachment systems reactivated with their own baby.

It was a good overlap with what Aimee wanted to do. She pitched the idea during COVID in the backyard as we socially distanced from each other, and it kind of just happened from there. Why not start a business during COVID?!

Q: What is the most unknown aspect about mental health that most women aren’t as readily aware of when they get pregnant?

Jen: Most people know about postpartum anxiety and depression, but not postpartum rage. A lot of people have done work to deal with their own childhood stuff, or they think they had a good childhood and a good relationship with their parents. But then, they have their own baby and “sound like their own parents” or ask, “Why does it make me so angry when my baby cries?” The answer to that question is usually because their parents didn’t want them to cry.

Your only experience of being a parent before parenting is being parented, so your attachment system with your own parents is going to reactivate when you are trying to attach with your baby. So, it’s not always an amazing sudden bonding process for everyone.

Aimee: Having a baby really makes you reflect on the way you were parented. There is so much knowledge and information out there and people have to parse through different sources to figure out the best way of parenting. There are pressures of gentle parenting and feelings of shame and guilt if you are imperfect at it. We’re seeing a huge uptick in postpartum anxiety given all the information and resources available.

Or, if something comes back on a genetic scan and a doctor says everything is fine, people still dive into specifics and go down a rabbit hole because there is just so much information available. It’s a blessing and a curse.

The postpartum experience takes you through a wild ride. You go from having the most estrogen you’ve ever had in your life to zero. You’re weepy, and you experience hormonal shifts that impact people differently.

Q: How do people come to you, or how does someone know when they need support?

Aimee: People feel scared to say intrusive thoughts out loud because they’re afraid that the baby is going to be taken from them. They get wrapped up in postpartum anxiety. Sometimes people will tell their husband, and then the husband says, “Let’s go talk to someone about that.” A lot of times, we see people come in once they are out of the newborn/six weeks stage—like six months and on—or, they experienced postpartum anxiety or depression or rage during their first postpartum period, and now they’re expecting a second child and want a different story this time.

Jen: Some women come in when they even start to think about conceiving a second (or third) time. They don’t know if they want another one if that will be their experience again. It’s important to get to people sooner, so we do a lot of outreach to OB offices in our area and hone in on pediatrician offices since OBs discharge six weeks post-birth, and hormonal shifts don’t happen before that due to the adrenaline bubble. Three to six months out, women experience all of these things and no one is screening them. We want to normalize the experience, so we encourage other providers to really check in with mom (and dad) when new parents bring their babies in. Men can experience postpartum mood disorders as well—a lot of people don’t know that.

Q: How does postpartum anxiety or depression impact attachment?

Jen: It is so important to note that one of the things that feels so scary to people who have really thought about and prioritize and want to bond and have strong attachment with their baby is how scary it feels to not feel that or how postpartum anxiety or depression is impacting their ability to do it. There are resources and people who can help. You aren’t doing irrevocable damage in the first couple of months if it’s hard. You’re doing your best. There are people that can support you.

Yes, babies rely entirely on adults and caregivers for regulation. It’s the only way they can learn about who they are in the world and how they will be responded to and how to manage emotions. They have no system for that until we help them develop one.

Thi is why I went into infant mental health. It can help with attachment. Aimee and I have co-treated patients. There is support available. Having moments of anxiety or depression or rage is not the same as being that way all the time, either. If you can “turn it on” for a bit of the day, sometimes that is enough of a buffer for the baby to feel attachment and get what they need from you.

Aimee: People are afraid they won’t be attached to their child or effectively form a secure attachment, but the five minutes or short periods of time you are engaging with your baby are important. We need to normalize the fact that for people who give birth, you’re expected to feel bonded to your large baby that just came out of your vagina, or you had major surgery and was ripped from you, and all of a sudden you’re supposed to be sunshine and rainbows. You birthed a whole human. You’re not going to be like, “I feel perfectly fine.” They scream in your face at 3am. It’s okay to not be like, “My sweet baby” and instead feel frustrated. It’s a human experience. Even with friends, we want space or we have feelings of annoyance or frustration. It’s a normal experience.

Jen: Clients are worried about whether they will feel bonded right away. The joke is that the baby is largely a stranger to you—and that goes for the first couple of months when you’re learning each other. So, it’s normal not to feel an immediate overwhelming bond like you know and understand them. You don’t have to get it right all of the time. Parents of babies who are securely attached nail it 30% of the time .The other 70% of the time, they reflect and repair. You don’t have to be attuned 100% of the time. I’m not even attuned to myself 100% of the time. Secure attachment is not the result of perfect parenting.

Q: Do you prescribe medication, or is it part of what you work on with clients? Do you believe there is a time and a place for it?

Jen: We do a lot of psychoeducation and collaboration with client OBs or psychiatrists who provide the medication, but we don’t prescribe it ourselves because we are not medical doctors. Medication is an individual decision. It’s not an immediate solution to go in tandem with therapy, but it can be a vital tool, especially in the postpartum period. There is not great medical advice around taking medication during pregnancy and breastfeeding because it’s hard to study. We talk with our clients about the risk of medication versus the risk of depression or rage. Therapy is trying to keep head above water; medication is the life vest that helps you float. Then. therapy helps you swim.

Aimee: There is a mind-body connection. The stigma around medication, impacted me personally and I didn’t take it when I should have. I finally did.

Postpartum anxiety or depression, if left untreated, can still be present two years postpartum. Getting medication at any point could be really good, especially when paired with therapy. Medication helps get chemicals back into balance, but it doesn’t change your thoughts. Therapy helps you get on a better track of thinking.

Q: Do moms have similar or different experiences pregnancy to pregnancy?

Aimee: It depends. We’ve seen people with perinatal anxiety or postpartum depression with a second pregnancy. It seems to be a 50/50 mix. Subsequent pregnancies, you are chasing around a toddler or other child, so there is no time to rest or nap. You can’t sleep when the baby sleeps, and so the sleep deprivation hits differently. But also, people have learned a lot after giving birth and being pregnant the first time, so sometimes it feels easier because you know what to expect.

Jen: There are definitely predispositions. If you experience it in your first pregnancy, you are more likely to experience perinatal mood disorder again. It doesn’t mean it will look exactly the same in terms of intensity or symptoms. It could be a different experience every time. You do know more, and so you know to get help sooner. Especially for those who have experienced birth trauma, how people navigate that impacts how mental health feels after and during subsequent pregnancies and prep for birth.

Q: How did you come up with Bloom and Rise and the boxes?

A: It started out of recognizing the clinical need. There are lots of pregnancy boxes that are amazing, but they focus less on postpartum care for moms in particular. Bloom and Rise boxes offer products that both support moms and relationship-building between mom and baby. The boxes speak to specific phases of where people are—birth, nursing, mom, mom/baby, mom/toddler. You’re still doing something really hard no matter what stage you are in, so we include helpful and uplifting things and items for self-care that make you feel good. We also have sibling boxes. All of the boxes come with a QR code for exclusive access to resources.

People love pregnant people. But as soon as you give birth, everyone is just like, “Nope, give me that baby,” while the mom sits there with leaking boobs. We wanted to make sure that moms also felt taken care of.

This blog post was written based on kozēkozē Podcast Episode 345: Perinatal Mental Health with Rise Wellness Collaborative.

If you’d like to listen to the conversation first-hand, tune in here.

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