PODCAST: Yes, Mom Brain Is Real — Here Are Tips for Improving It

ZACH MOORE: Welcome to On Health with Houston Methodist. I’m Zach Moore. I’m a photographer and editor here, and I’m also a longtime podcaster.

KATIE MCCALLUM: I’m Katie McCallum, former researcher, turned health writer, mostly writing for our blogs.

ZACH: And Katie, we have some guests today here with us.

KATIE: We do, we do. Are you going to introduce them?

ZACH: I will. I will. First, we have our returning guest, John. What's up, John?

JOHN DABKOWSKI: What's up, Zach, how are you?

ZACH: Good. Tell people who you are.

JOHN: I'm John Dabkowski. I am the Content and Creative Services manager at Houston Methodist.

ZACH: Good to have you back on the show.

JOHN: Thank you.

ZACH: And we have Melissa for the first time. Welcome, Melissa.

MELISSA SCHAFER: Thank you so much.

ZACH: Tell people who you are.

MELISSA: I'm Melissa Schafer. I'm Director of Marketing for Houston Methodist Hospital.

ZACH: And you're also a mom.

MELISSA: I'm also a mom.

ZACH: Yes, excellent, and that plays into our topic today. We're talking about mom brain, and some dad brain. That's why John's here.

JOHN: Potentially some dad brain. I think we're going to find out if that's a real thing or not, and if I can claim it.

[Laughing]

ZACH: Are you hoping to?

JOHN: Sometimes in a moment of need, you know, sure.

ZACH: So, Melissa, when did you first realize you had mom brain?

MELISSA: I don't know if there was a particular point, but before I had my kids, I have a 10-year-old son and a 6-year-old daughter. And in a previous life, I thought of myself as pretty sharp and reliable, and just could keep things to memory. And it's harder. It's much harder for me now. And for a long time I thought, well, maybe it's just sleep deprivation. And 10 years in, it really hasn't gone away. So, I was excited when Katie told me you guys were going to be doing an episode about this topic to maybe learn a little bit more about some of the science behind it.

KATIE: I'm glad you weren't offended I thought of you.

MELISSA: I was also offended.

KATIE: To be fair --

JOHN: I’m deeply concerned that with my 18-month-old, this is not going to improve like this, is it now?

MELISSA: Yeah.

JOHN: I'm looking forward to that.

MELISSA: Yeah, you live here now.

JOHN: Within 30 seconds we have a realization that I hate, which is great.

KATIE: Look, we're realists here, you know, I mean, not everything is the rosy, optimistic picture. But the whole point is, I think to address that it's something real.

ZACH: I'm not a dad. Katie's not a mom. We have no experience in this area, so we called in the experts here. Who called in their own experts, and who did you talk to?

MELISSA: I talked to Dr. Jessica Rohr. She is a Clinical Psychologist here at Houston Methodist and she's also a mom. And so, she has both personal and professional interest in the topic.

[Sound effect signaling beginning of interview]

MELISSA: I'm here today with Dr. Jessica Rohr, a Houston Methodist, Board Certified Clinical Psychologist and our Director in Women's Mental Health. She's an active researcher and advocate for excellent integrated care. And I am really excited today to talk to you about Mom Brain.

DR. ROHR: Me too, I'm excited to talk about it. I have it right now, so I'm excited to go over it with you.

MELISSA: So, I know you have some professional credentials that make you qualified to talk about this topic. Maybe, why don't you tell us a little bit about your personal credentials as well?

DR. ROHR: Yeah, so I am a mom. I have two beautiful, wacky daughters. I have a 2-year-old, and a 5-year-old. So really, in the thick of things. I was up at midnight last night rocking the baby because she has the cold that's going around.

MELISSA: Sorry.

DR. ROHR: Yeah, you know, it's just part of it.

MELISSA: Yeah. Well, I'm also a mom. I have two children, a 9-year-old and a 5-year-old. So, I'm farther removed from those baby stages, but still feel like I'm in the thick of it.

DR. ROHR: Absolutely.

MELISSA: So, I guess we'll start with some kind of basic questions. What is mom brain? Is there an agreed upon list of symptoms, mental or psychological, that new moms kind of, universally face?

DR. ROHR: So, mom brain is really an idea that came about more colloquially in the general population, and then has been followed up on by research rather than the other way around. And it looks like about 80% of new moms complain of some sort of changes in their cognition. Across pregnancy and in the postpartum period. And they're reporting things like short term memory loss, forgetfulness, just being disoriented, concentration difficulties, and difficulties with reading. And what that's looking like in their everyday life is they're having a hard time engaging in conversations, word-finding difficulties, just, you know, it'll just be right out of their grasp. And they're looking for it. Focusing on reading and comprehending it. So, reading the same page over and over again, using notes a lot more to organize tasks and commitments, forgetting simple commitments, forgetting appointments. Some people have it so bad that they even have trouble going back to work, because their work relied so heavily on their ability to kind of hold all that stuff in their mind.

MELISSA: These things all ring true for me.

DR. ROHR: Yes.

MELISSA: These really resonate. In particular, I'm sitting here with notes on my phone right now, things like, “Go pick up so and so, at 2:45.” And you say moms face this during pregnancy and then postpartum. In terms of the research that's been done, do we find that there's anything that connects women who experience this more or less acutely?

DR. ROHR: So, the research is -- when I first started diving into the research was a little bit frustrating because the objective findings and research don't necessarily match the subjective experiences that women are having. And so, what that means is women are saying, “I can't think, I can't attend to things, I can't remember things.” And then when they're pulled into this nice, cool, dark, quiet laboratory setting where they're sitting at a table and there's nobody -- there's not tiny fingers on the under the door trying to, you know, pull your attention away. And -- their testing comes out and it says, “No, you're just fine, there's no deficits here, there's no changes.” So, a lot of the research suggests that there's actually not objective deficits in cognition in the postpartum period. There is some that suggests a little bit of changes in memory in the pregnancy period. Kind of peaks in the third trimester, but -- and then it goes back to normal postpartum. So, there has been this push and pull between moms saying, “No, this is real, and researchers saying, “No, it's not real.” And I think the answer is actually sort of a third answer. And I'll come back to your question about who experiences it more or less in a minute, ‘cause it relates to, I think, what we think is actually going on here with Mom Brain. Which is that it's not necessarily an organic issue, like our brains are degrading or we're losing our ability to think. But that there is, just as, in all of our lives, we have this resource demand balance that we have to keep in check. And what that means is we have to have a certain amount of resources to meet the needs of the demands that we have in our lives. And so, if the resource is, metaphor I like to use is money. We have to have enough money to buy the things that we want. The resources that we have cognitively are finite. We don't have infinite. Maybe over time, like the idea of anybody can learn anything throughout your life, sure. But in a given moment, we have a finite amount of resources because there's a finite amount of literally glucose available in our brains to do what we want them to do. So, the things that we do to increase our resources are really just sort of the basic building blocks of being alive. This is sleeping, eating well, exercising, taking care of yourself, drinking plenty of water, doing things that make you feel good about yourself, taking care of your mental health. Mental illnesses tend to really drain our resources. So, if we look at pregnancy, and postpartum, and you think about all those things I just listed, that -- we're not doing those things. Sleep is interrupted. It's hard to get a good meal in. It's hard to drink enough water. It's hard to get time, and energy, and focus. And for many people even like social support and resources to take care of the things we need to do, to build up our reserve of resources. So, if we think about sort of my money example, we just have less money to buy what we need to buy. And then the demand piece comes in, and the demand, I don't know that you can -- and tell me if you've had this experience. I don't know that you can adequately explain to someone who hasn't yet had a child, the demand that it places on you. Because it is an experience beyond just the task of holding, or feeding, or putting the baby to bed, right? And so, I think about it like, it's not like a hobby where, you know, when you have the baby, you’re with the baby, but then you can put the baby down like a book and go do something else. It's like owning your own business that you also do all the work for. It’s -- And when I say business, I mean like a Target that you also do almost all the work for. Some -- you know, sometimes there's a partner that's also helping. So, this means that the demand on your cognitive resources is huge, and this is on top of having another full-time job, in addition to having the baby, trying to take care of yourself, maintain a relationship, maintain friendships, keep the house. So, what we're looking at here is a really -- a shift in the balance between the resources you have available to meet the demands that you have. And there's the third piece -- am I talking too much?

MELISSA: No.

DR. ROHR: Okay.

MELISSA: I guess what you’re say -- It's a bit of a perfect storm. And I don't have the ability to maintain, even the supply of mental resources that I had prior to parenthood.

DR. ROHR: Yes.

MELISSA: And I now also have this entirely new dimension of need for my mental faculties.

DR. ROHR: Yes.

MELISSA: And so even at baseline, if I stopped doing all these things, if I stopped sleeping through the night, if I stopped exercising, if I stopped drinking water, I would probably find reduced cognitive function.

DR. ROHR: Absolutely.

MELISSA: And even if I maintained all of those things because I had a full-time nanny.

DR. ROHR: Yes.

MELISSA: I still have a lot more demand on myself.

DR. ROHR: Absolutely. And then the third piece that makes that all even more difficult is something that we are only just now learning about. So, in 2017, Hoekzema and colleagues came out with this just seminal paper, looking at women's brains across pregnancy. And they found that we have gray matter reductions. So, structural reductions in our brains from pre pregnancy to post pregnancy, which at first sounds scary like, oh, my brain is shrinking. But what they actually think is happening because of where the reduction is happening, is that it's what's called synaptic pruning. So, it means that it's reducing, it's getting rid of just stuff that doesn't need to be there so that we're more efficient at a certain task. And what that task is, is in the theory of mind network, it’s being attuned to our baby, being in touch with our baby, noticing it, figuring out what it wants, figuring out what it needs. So, the third piece of that demand resource puzzle is that we have less money. So, the first piece is we have less money. The second piece is the new thing we want is super expensive, but the third piece is and it's the most important thing that we've ever seen in our lives, it is more important to us than anything. And that is our, that's kind of our evolutionary way of protecting this child. So, we prioritize the baby. So, if we think about the fact that we have finite resources, and if a finite list of things that we literally can stretch our minds to attend to. We have this huge demand that gets bumped all the way to the front, stuff's gonna fall off the bottom.

MELISSA: Biologically, our bodies says, “I don't care what you used to be important to you, or what you may think is still important to you. Your baby is the most important task you have right now, right?”

DR. ROHR: Right. This is tough. And this is tough, I think for a lot of different reasons and putting a pin in the part of, you know, personal choice, and interest in things. This is tough because societally caregiving has been very undervalued, caregiving tasks, women's work has been very undervalued in society. So, there is this sort of there's this piece where we are saying, you know, I'm not -- I'm not producing the way I used to. I'm not -- productive is a big word in my office. People come in, “I'm not productive the way I used to be.” And I say, “Well, what does productive mean?” And what they mean is I'm, you know, I'm not responding to emails as quickly. I’m not writing my reports as quickly. It's this this really sort of work centered output focused, ideal of success that is that your body is kind of like, “I just don't really care.”

MELISSA: Did you see your baby smile the other day?

DR. ROHR: Did you see your baby smile. And I think generationally, we are starting to get to a place where women wanna be able to care for both. Where they don't want to have to say, “It's work over my baby or it's my baby over work.” They want to be able to have both.

MELISSA: So, I'm really interested in in this new study that's coming out, around this gray matter reduction and are they doing additional research associated with that, to see if this affects women consistently, or if it affects certain cohorts of women differently, or across different countries or societies. Because obviously this balance and this pressure on women to produce at work, is I think somewhat unique to the United States.

DR. ROHR: It’s a bit of the culture bound syndrome.

MELISSA: Right. So, do women globally experience this similarly, or do we just not know enough yet?

DR. ROHR: We really don't know enough yet. Unfortunately, and that's – You had asked earlier, do we know which women may or may not be more affected by mom brain, and it's sort of the same answer that we just don't know. I can guess that women -- like you said, women who have nannies, women who are more highly resourced, and thus have the ability to increase their resources, and that resource demand ratio, may find less of a drop off in what they can produce. But this research is so new.

MELISSA: Tell me a little bit more about the nature of how women are studied, and -- for medical research.

DR. ROHR: I break it down into sort of three major reasons why women are understudied in medical research. So, the first one we can send it back to the Thalidomide trials. So, Thalidomide was a medication for morning sickness, and it was trialed on pregnant women. This is back in the 70’s and the very, I mean, the tragic, tragic side effects. Babies were born with horrific birth defects. So, the FDA said, “Look no more women of childbearing age in clinical trials.” So, from that time until the 90’s, was period of about 16 years, no women of childbearing age were in clinical trials.

MELISSA: Of any type.

DR. ROHR: Any type.

MELISSA: Not just those related to pregnancy.

DR. ROHR: Nope, any type. Excluded as a demographic. Only men, and when I say women of childbearing age that means age 18 until menopause. So, 50’s and 60’s, women who were not having sex, women who were on birth control, who had no chance of getting pregnant. All women were excluded. And the trickle down effect of that is that they were just sort of generally excluded from research. It was just easier. They're not in the trials, they're not in research. So that really set us back because during that time the internet was invented which completely changed what research looks like. One of the new types of insulin was first created, PTSD was named as a diagnosis in the DSM. So, it just -- it was a big time when women were virtually excluded from research. The second thing that's happened is that in pre-drug animal trials, researchers, up until about 2015, primarily tended to use male animals, rats, yeah, dogs, whatever. Usually rats, though. The reasoning is, you know, if you want to be sufficiently powered, you have to have -- if you introduce a new variable of gender male and female. You have to have so many more animals to be sufficiently powered to get the results that you want to get. The thing that comes up over and over again, is that their estrus, their menstrual cycle is confusing and kind of throws off the results, which to which I say…

MELISSA: Yeah.

DR. ROHR: We figured it out though. So, try.

MELISSA: It's very confusing so, we just won't deal with it.

DR. ROHR: Quite confusing. And then what ends up happening is -- The thing is people who are born biologically female or male are different all the way down to a molecular level. So, testing these medicines on male rats only, and then rolling them out into clinical trials, where if women were that included, they would experience these negative side effects. Up into medicines being pulled off market by the FDA because they differentially impacted women. Some were medicines -- There was a major heart medicine where women died more, when taking the heart medicine, than men do. One of my favorites is in the clinical trials, for Addyi, which is a female libido drug, one of the studies was looking at the interaction between Addyi and alcohol. They were if I'm remembering correctly, 14 people in the study, 12 men, 2 women.

MELISSA: In a drug targeting women.

DR. ROHR: Female libido, yes. The little pink pill. So, that's the second piece, but in 2015, then NIH said, “Y'all gotta stop doing this. You need to be including female rats or have a really good reason why you're not doing it. Like you're doing test --testicular cancer research or something like that.” Third is that, unfortunately women have been underrepresented in the work of science for decades.

MELISSA: This is where I thought you were going with this in the first place. I'm fascinated by it.

DR. ROHR: It's a whole story here. So, just the act of being a scientist, gaining tenure, maps on right on top of a woman's peak fertile years of reproduction. So, just the act of having children sets women back in terms of becoming a tenured scientist and then it's just -- it's only been recently that women have really been in the sciences. Had been able to break their way in, and unfortunately, people study what they care about, and are interested in. So, women are the ones who are studying women. And women are also the ones knowing that if you want to study women, you have to provide childcare in the study. You have to make sure the study times are during a time when the women can come, you have -- you can't -- there're so many reasons that women typically can't even participate in the research studies, because of their caregiver responsibilities. So, all that to say we are depending on the day, it depends on how I look at it. I either think, “Oh my God, we're so behind.” Or I think, “Wow, there's so much opportunity.”

MELISSA: I also like to say look how far we've come.

DR. ROHR: And look how far we come, and quite rapidly.

MELISSA: Right.

DR. ROHR: It's --- since these disparities have been really noted and called out. I think there's been a huge movement towards change. So, yeah, this the study on the gray matter reduction came out in 2017, six years ago now. So, we still don't even know yet about a follow up. Do these changes persist five years down the road, are they additive or cumulative with multiple children? Do you--

MELISSA: Oh, that was my next question.

DR. ROHR: Right, does your brain -- We don't know yet. Does your brain continue to prune and be more efficient? We don't know much about how dad’s brain changes as far as cognitive changes go, after pregnancy and postpartum, there's not a lot out there besides the mother who gave birth to the child. There was a little bit on foster moms, and how the more oxytocin they produce is real -- the more oxytocin that's released when they're with the children is related to their kind of caregiving network lighting up, but that's pretty much it. The same pattern is true for fathers, who are spouses of the birthing parent. So, the more time they spend with the child, the more their caregiver network is activated. And that's a network of both, kind of attuning to the child, and also sort of the amygdala, kind of fear response. So, noticing when things are wrong with the child. But again -- not doesn't quite get into the cognitive deficit piece, the same way that -- what we're talking about does.

MELISSA: That's really more about the brain responding to the child and adaptation.

DR. ROHR: Yes.

MELISSA: As opposed to this -- this real deficit that moms seem to collectively, pretty consistently feel or at least be able to describe, but it sounds like, it doesn't necessarily show up, in a research setting yet, right.

DR. ROHR: Right.

MELISSA: But lots of opportunity there. So, for those of us who may be experiencing mom brain, what can you tell us about how long it lasts? Does it go away?

DR. ROHR: So, if we go back to the kind of resource demand theory, then the idea would be that as we can increase our resources, and as the demand increases, hopefully, we are better able to meet the needs that we have decided are important to us. And so, I'm saying that really carefully because a big part of this again, is not just the fact that there is a deficit. It's more that we think there's a deficit. It feels wrong that we can't do all the things we used to be able to do. As opposed to, “Well, I've got two jobs now.” Yeah, it makes sense that I forgot to take the dog to get his nails cut. You take him. Somebody else take him. Some of these things are, potentially, not even things that were that important to me. But maybe tasks that I have picked up to try to prove my own value to myself, my own worth to myself, my own worth to a society that demands this kind of perfection out of mothers. So, there is sort of a balance there, of should we even call it a deficit when it is a change that feels uncomfortable. But how do we manage that discomfort? Is it by fixing it or is it by understanding that maybe it doesn't need to be fixed?

MELISSA: I like to talk to my husband about the mental load that I experience as the female head of our household. Because, you know, taking the -- getting your dog’s nails clipped, example. It's not even the “I need to be the one to take him to get his nails clipped.” It's there's this not insignificant part of my brain that is constantly running through my dog’s calendar, and when was the last time he got his nails clipped, and when is the next time he needs to, and, “Oh my god, we have to remember to schedule that.” And all of those pieces of mental requirement really add up.

DR. ROHR: Mm-hmm. And that's -- mental load is another -- or emotional labor. Is another topic that again, I've seen a lot in a sort of popular audience, but I haven't really seen reflected in the research yet. And I say yet because it's something that I would like to look at. Because it is very, very much something that falls on the woman of the household. And this idea of a task, not just being the task, but being the conception of the task, then the preparation for the task. And then the actual execution of the task is -- has been a really powerful concept to explain to, you know, couples were the man -- or the partner may want to be an equal partner, and it is saying, “What can I do to help? How do I do it? Why didn't you just ask me for help?” And the wife is standing there saying, “I don't know how to tell you, you should just know,” this kind of back and forth. “You should just know.” It reminds me of, do you remember that movie, “The Breakup”, with --

MELISSA: “Oh my God, Gary, I don't want you to do the dishes,”

DR. ROHR: I want you to want to do the dishes, why would I want to do the dishes?

MELISSA: Nobody wants to do this like a – perfect -- I said, I wish he had known the language of mental load because it's not that neither of them want to. She wants him to care enough about her that he's willing to see that something needs to be done and step in without being asked.

MELISSA: I use that example all the time, “I want you to want to do the dishes.” But it actually is very impactful in our house.

DR. ROHR: Yeah.

MELISSA: I hope Jennifer Aniston and Vince Vaughn know how important that line is.

DR. ROHR: It's really an important movie. And it's -- and I think there's -- I talk a lot with folks about how do I reduce my mental load, and unfortunately, one of the major answers of that is letting go of things from conception to task, which is tough for us.

MELISSA: That's very difficult.

DR. ROHR: Yeah.

MELISSA: As someone who has a right and wrong way to fold bath towels. These are difficult concepts.

DR. ROHR: Yes. And that's where we come back around to. Do I reassess myself in terms of, you know, how poorly I'm doing now, or do I reassess myself in terms of why were my expectations set where they were, and is that still reasonable for where I am right now? I talk with people a lot, not about lowering expectations, but changing them. I talk with people a lot about what does it mean to be productive? So, they'll come in and they'll say, “I took a day off, and I meant to be productive and I just I didn't do anything all day, it was such a waste.” “Well, what did you do?” “Well, I slept in and then I had coffee, and then I watched the Kardashians for three hours, and I looked at my phone, then I took a nap.” And I say, “Well, that sounds very productive, in terms of self-care, and your mental health, and giving yourself a break, and enjoyment, and leisure, and joy. Maybe not in the ways that we have sort of been trained, women have to be productive to be of value.” And that -- and not just women people, but they're definitely, is something to think about, in terms of women entering the workforce, and having to say, “See, I'm just as good as a man. I can show up the same way a man can.” While still holding all of the emotional labor that you talked about at home. And then saying, “Why can't I remember to get my dogs nails trimmed?” Because you can't, because you just can't. So, something has to be changed.

MELISSA: That's not really the answer I wanted.

DR. ROHR: I know. I was gonna put that on my notes. “She's not gonna like this.”

MELISSA: I wanted to hear you say, when you do Wordle every day, that's going to really help improve that size of the brain box that you have.

DR. ROHR: Sure.

MELISSA: And then you're going to remember these things, and you're not going to want to lie on your bed all day, and watch the Kardashians on repeat.

DR. ROHR: I think -- I think, again, that really -- and I know you're being funny, but I have to as a psychologist, I have to stop you when you're being funny, and tell you about what your jokes mean. But this again, this insistence that the leisure that women choose is silly or unproductive or unnecessary. I find, really interesting that that we can't just have a nice day, where our mind is turned off, where we're not making decisions for everybody, where we're not holding the calendar for the dog, and the partner, and the children, and ourselves, and we can just watch the Kardashians fight about a salad. And it's really -- it's really soothing and lovely until we start to feel the shame about not having been productive that day.

MELISSA: Right. And then we enter into the cycle of shame, and we go into overdrive, into all of the things that we didn't do on the day that we gave ourselves a mental break.

DR. ROHR: Right, right.

MELISSA: And we feel guilty for not doing those established self-care activities. “Well, I didn't spend that time meal prepping. I didn't spend that time exercising. I was not hydrating, and meditating. I was literally filling my brain with junk reality television.” And so, there's a lot of that, at least, personally.

DR. ROHR: Absolutely, absolutely self-care –

MELISSA: Very therapeutic conversation for me.

DR. ROHR: I'm so glad. No, self-care becomes another chore that we feel like we're failing at. And especially when self-care is relegated to think -- you know, self-care used to be, you know, you have a hobby that you have time to devote to every single day and now it's like do good self-care, take a shower. That's not self-care, that's hygiene, that's personal hygiene. Or leisure used to be, I don't know, going –Well, for some men going golfing, eight hours every weekend. And for a lot of women leisure is taking a shower, going to the bathroom with the door closed.

MELISSA: For some dads, they still are golfing for eight hours, every weekend.

DR. ROHR: And that also -- I mean, and to bring that back around to the mom brain versus dad brain -- And that's kind of, when we see men feeling less of the dad brain. A lot of it is because there are less demands placed on them, and they're using less resources. In addition to the part where they didn't have that nice, little restructuring, that the birthing mother, the birthing parent had. I do think, and wonder if that's gonna change because I have seen a pretty major shift in men wanting to be more involved in their families, and in their relationships, and with their children, wanting to do it different. Unfortunately, we're sort of in this interesting, kind of, change point lynch pin. I don't really know what to call it. Where men want to do it, but they don't really have a model for how to do it. And also, they were socialized by the mothers and fathers who did it the other way. Mom was in charge of everything, dad hung around and made the money. And so, I do have women coming in and saying, “I have a lovely partner, he wants to be a partner, he's trying, but he is not a partner because I'm still holding all of the mental load, the emotional labor, and I'm exhausted. And I'm dropping things, and I don't know how to -- I wanna be grateful that he's not like, you know, his dad was. But I'm also angry that he's not stepping up the way that he promised, when I met him, this you know, feminist progressive guy.”

MELISSA: Or I'm not letting him step up.

DR. ROHR: Or I'm not letting him, because he's not doing it the way that I want him to. So, again, there's the two, you either do it all yourself or we think about your expectations. Where did they come from? What are they driven by? Are they driven by the need to be this perfect model person that doesn't exist, or are driven by some actual internal values that mean a lot to you. You know, why do the towels to look a certain way? Is that because it just makes you feel at peace when it's there, and you don't mind doing that task because you know it's for you? Or is it because it's -- you're worried your mom will come over and make fun of you for the towels being a mess. And which of those is more important?

[Music plays to signal a brief interjection in the interview]

ZACH: Okay, checking in. Melissa, do you feel vindicated, so far?

MELISSA: I mean, a little bit. It's reassuring to know that I'm one of 80% of women.

ZACH: Yeah, that was a high number.

MELISSA: Yeah surprising, especially when -- then she comes back and says that, despite the fact that women are organically claiming to experience this, the research isn't necessarily there to back it up yet.

KATIE: Yeah, I did -- I think it's a cool example though of how, you know, 80% of women are experiencing this and so it's kind of led the research that way. You know, a lot of times you have a known medical condition and people are researching it to solve it, or is this like women saying like, “Hey, I'm feeling these symptoms, I'm noticing these things.” And now, the research is slowly catching up to them. But I think that's, you know, that’s a cool example of that. But it also just shows how powerful of a phenomenon this is, I think.

MELISSA: Yeah, absolutely.

JOHN: I totally buy the 80% just based on experience -- recent experiences with my wife, who once a day says under her breath, “Mom brain”, about something she's done. Two recent examples that I got permission to share with the group, and with everybody listening. About a week ago, she got out of the shower, and just like, “Today, I put conditioner in my hair first, before I put shampoo in my hair.” That was the example of the day that she kind of, was like, That's my mom brain moment of the day.” The second one was more my favorite, we were in my car doing something, driving somewhere. Her phone was dead, so she plugged it in, and then she jumped out to pick up food or something, I can't remember what, and put her phone in her purse to get out with it still plugged in in my car. And then, trying to get out the door with an attached phone and  purse, in the end. So those were my two favorite recent examples, but I don't think I'm speaking out of turn by saying, every day, if not multiple times a day, she has a mom brain thought to herself. This is something new, this is something different, in the last 18 months.

KATIE: Yeah.

MELISSA: It’s hard, it's hard particularly for women like your wife, who again, are -- she's used to having it together. And it can be a little bit intimidating, and overwhelming, and scary to suddenly feel like, “I cannot do this anymore. I can't keep all these things straight.” And you know, when you were telling your stories, I was thinking about the first time we took Nathaniel on a trip. And he was about three months old and, you know, I booked the flights, I booked the parking, I booked everything. I had all the times in my calendar, and we show up at the airport parking lot. And the guy says, “What airline?” And I said, Southwest, and he said, “Ma’am, you’re at IAH.”

ZACH: Oh no, which is about what, like an hour away?

JOHN: Yeah.

KATIE: Without traffic.

ZACH: Without traffic.

[LAUGHING]

KATIE: Oh boy.

MELISSA: And it was just this wave of, “I am not the same person that I used to be.”

KATIE: So, you didn't just say the wrong airline you were at the wrong airport, completely.

MELISSA: We were at wrong airport.

KATIE: Okay, I was thinking maybe just like, oh, said the wrong airline, don't worry, quick recovery.

MELISSA: That would have been easy.

KATIE: Yeah.

MELISSA: No.

JOHN: Increasingly -- And again, this is where maybe there's a dad brain part of this and it's just a lack of downtime, and an increase in stress, and trying to remember way too many things, but increasingly, I personally cannot rely on my memory for just about anything anymore. Whether it be professional or personal, and I think that's probably got something to do with it.

KATIE: Any good examples, any good stories, you just gonna throw Jennifer under the bus?

JOHN: No, I’ll throw myself under the bus. Took me a good 35 minutes to find my car keys today. And, you know, and I can kind of trace that back to a change in my life because it all comes back to how I got home yesterday. And it was 5:29, and I try to be respectful of our childcare, who leaves at 5:30. And -- but I had to go to the bathroom, and I ran to the bathroom and still tried to get her out on time. And, yeah, so I'm running around like a crazy person, just getting home from a full day of work to then, you know, a few hours of parenting before bed. And yeah, I put my keys in a place I had never ever put my keys before in my life. So, yeah, for 35 minutes today, I was looking for my keys. At one point, I literally had my head in the trash can looking for them because he also is now at the age where everything goes in the trash and it’s very funny to him.

ZACH: Where were your keys?

JOHN: My keys were in a section of my bag that I've never even used before. So, again, like -- I think that probably gets back to, I got home in a stressful state yesterday and was wound up, and now, have no memory of what I did with it. Whereas in the pre-times, when I did not have much of a worry in the world, once I got home from work, that probably wouldn’t have happened.

KATIE: Yeah, that kind of sums up her sort of like, trifecta of the perfect storm, of you already don't have much mental bandwidth, now you have something that takes a ton more, and oh yeah, it's like the most important thing that's ever been in your life. Like getting to your kid, and so yeah, I mean that's a good example of just how something as simple as keys just becomes this like monster of a storm, of emotions, and trouble, and struggles.

JOHN: I heard this thing, to give another podcast a shoutout, on Plain English with Derek Thompson, which has become one of my favorites, and he, I think recorded this podcast when his kid was like four weeks old. They’re like in it and in the trenches, and he was talking about like, trying to compartmentalize your life more. And have like different rooms in your mind through where certain things live. So, like being a dad is in one of ‘em, working is in another one, working out is in another one, having relationships is in another one.

KATIE: That’s a big house you're building here.

JOHN: Big house with a lot of rooms, but like trying not -- and trying not to put too much pressure on one of those rooms.

KATIE: Yeah.

JOHN: To like give you your happiness or what have you.

MELISSA: I think that’s close to something that Dr. Rohr was talking about too, was really just revaluating the organization of your house, and it's you’re adding an addition to your house. And suddenly, it becomes the entire house.

JOHN: That is definitely what happened.

MELISSA: And what do you do, and how does your brain respond to this sudden influx of responsibility? And you just can't – you don't have bandwidth to do all of the things that we used to do.

JOHN: And you increasingly, I'm trying -- we're trying to tell ourselves, like we also kind of, you don't have the bandwidth, or even the realistic scenario to push back on any of it. Like this is life now, it's totally changed, got to roll with those punches.

[Sound effect signals return to interview]

DR. ROHR: I have 2- and 5-year-old, like I said, and I just recently realized I gotta write stuff down. I gotta write stuff down, I held it for a while and was able to still hold things in mind and function, but with a lot of anxiety. And then recently, I had about two weeks where I dropped, three or four things, pretty significantly, in a way that felt pretty shameful to me. And I looked at it, and I thought why in the world did I think I could keep these things in my head, anyway? This is nuts. I have so many things I'm trying to do. I have a fairly good self-care routine worked out, I've -- my resources are high, but the demands are higher. And I just have to come to terms with that. So, I've got an Excel sheet now, and I write things down that I never thought I would have written down -- I was not a write down person, and that was -- that's another piece of it is that was part of my identity before. I'm sharp –

MELISSA: You didn't have to write things down.

DR. ROHR: I'm sharp, I got stuff, I'm quick, I can manipulate information. So that I think is another pain point for folks when this is shifting is thinking well, “Who am I, if I'm not that.” We're so much more, so much more.

MELISSA: So actually, let's talk a little bit more about this adaptation as a biological advantage. And what are these advantages that we should celebrate as moms whose brains are changing?

DR. ROHR: So, a really important thing to know about this developmental place and what our brains are doing is that, with these changes and hormones, it is a new period of brain plasticity. So, that's why we see kind of the structural change. Plasticity means a time when your brain can change a lot, and when we're little, there's a lot of plasticity, and when we are going through puberty, there's quite a bit of plasticity. And, you know, we call that adolescence. And what you care about changes, what you think about changes, what you look like, what you smell like, all of these things change. And that's actually quite the same in motherhood. Some people, some researchers even call it matrescence, so there's adolescence and you have matrescence. But because we are so highly plastic during this period, because of the hormonal changes. So, we've got this nice amount of plasticity, and flexibility, and then you also have this, what researchers call an enriching environment. And so, like for rats, it would be like going from the kind of sad little cage to like a tiny little living room with music, and lots of different types of food, and lots of different textures except that's you with your baby. So, there's new social changes, there's new emotional changes, there's cognitive complexity, you're trying to figure out problems, you're learning somebody else. There's novel situations, you're doing things you've never done before. So, there is this period of kind of massive expansion, and change, where your brain is quite plastic, and you're encountering all of this new stimuli and information. And learning about kind of, who you are in the process, and what to do with it. And so, at the same time, that a lot of women are finding themselves, not really, loving the mom brain part, they're also finding themselves, some of them healing from kind of past hurts from their own childhood. Giving their child the care and love that they wish they had gotten, doing things a little bit differently, learning things about themselves, taking the opportunity to go places and do things they've never done, learning new languages, like in time with their children. There's all sorts of new opportunities that can come with this sort of enriching environment of a baby.

MELISSA: Is there anything we can do to maintain that brain plasticity that we pick up?

DR. ROHR: There is not a ton of information on that right now. So, I was just -- I was just reading a review this morning about the changes across motherhood. And we know that in the pregnancy and postpartum period, we see some of that sort of subjective decrement in working memory, and along with these increases in being able to -- The kind of caregiving be able to, almost read your baby's mind. And then we know that in menopause, there's going to be another sort of plasticity and that comes along with, actually, some positive things, which can be tamped down by our society's terror about aging. But there's like quite a lot of positivity associated with menopause with, a lot of people feel more secure, and at peace and more -- there can be more time, and space, and you're sleeping again, and maybe the kids are out of the house, and there's just more energy. And the in between the motherhood part is not -- There's -- it's like a wasteland. There's like nothing there, so we don't really know, it's just hard, it's just hard. And the plasticity seems to really be associated with hormonal changes. So, my guess is that, when the hormones are back to kind of being as stable as they will be, that we're not going to see as much of it. But we also know that the more that you're learning and thriving, the more your brain is going to respond to that. So, it's a sort of a mixed bag.

MELISSA: Some of our listeners may be moms themselves, and I imagine they're going to find a lot of really helpful and personal information out of this conversation. Every single one of our listeners is going to know somebody who's a mom, many of whom are personally experiencing this. And they may be experiencing it, very privately. What is something that somebody who knows a mom should be doing to help better put some supports around for that mom?

DR. ROHR: When people are trying to find ways to help their loved ones, who are struggling, regardless of what it's with. But let's say, you know, for this is -- these cognitive changes in the wake of motherhood. I always ask people to first, try to be validating. Validating -- to validate means, to express that, you can understand why somebody would feel a certain way, given their situation. So, “I am just -- I cannot believe I dropped the ball on this nail appointment for my dog, I feel so stupid. This is really embarrassing.” You don’t have to tell them, “Yeah, you should feel stupid.” That’s not validating, but you can say, “I know that’s really hard. I totally understand how hard it is to drop those things.” I would also really stay away what I’ve seen called toxic positivity. Because some of this, if it’s framed correctly, when we’re not so much trying to fix a problem, but more grieving that change -- because that’s sort of what I’ve come to with the mom brain issue, is – Yeah, and it should, like I said, it should reduce as we get more sleep and our resources improve, but there is a brain-based change that happened through pregnancy. And we can grieve some of those changes, that saying things from a toxic positivity point of view, like, “Well, at least you did.” Any time a sentence starts with, “at least,” just shut your mouth and start over. We're not starting sentences with at least. “Well, at least he is healthy,” I don't know, it doesn't help, and it doesn't nod to what's going on. So, trying to validate, support, give permission. It's okay, it's okay, we've all done it. Doing some self-disclosure about times that you've also struggled. The amount of times that I've had people come to my office and say that they've experienced something, and that is an extremely common shared experience, but they feel like they're the only one. I was -- it happens almost every day. And so, a major part of my job is just normalizing it, and saying, “You're actually not the only one, it's quite normal.” The second thing I would do, if we're thinking about this demand resource theory, again, is trying to either reduce the demands, help reduce demands on mom, or inc -- help her increase her resources. So, can you step in and help her get a nap? Can you come over so she can work out? Can you bring over food? Can you take the dog to the nail appointment? Can you say, “Tell me what's on your plate for this next week, and I will just do it. You don't have to think about it anymore and I'll get it done.” And then actually don't mess it up, and not do it.

MELISSA: But not that. I didn't actually know this is not the best week.

DR. ROHR: That's more than I anticipated.

MELISSA: I was thinking something's small.

DR. ROHR: And trying to is even a resource ask, to ask mom, what can I do for you?

MELISSA: That's what I was going to say, is if you say, “How can I help?”

DR. ROHR: It is -- which is so confusing, a lot of times for the male partners because they want to be helpful. And the explosion that happens when they say, “How can I help, or what can I do?” Or the one, I go back and forth in my husband on, is, “Do you want me to?”

MELISSA: Oh, my God!

DR. ROHR: Do you want me to just do it?

MELISSA: Just do it.

DR. ROHR: Just do it, and that's what –

MELISSA: Please don't –

DR. ROHR: We've had that conversation –

MELISSA: Answer that question.

DR. ROHR: Please don't make me turn you down, because women are socialized to make things easier on other people. So, if you give her the opportunity to make things easier on you, she will. So, don't give her the opportunity. And if she really doesn't want you to, she'll step in and say, “No, no, I've got it.” She'll tell you, yes.

MELISSA: I will tell you that I didn't need you to do this.

DR. ROHR: Yes.

MELISSA: But otherwise, take a shot.

DR. ROHR: Absolutely. So, coming in, saying, “What's on the agenda this week?” And that's more of an in the moment, what I would really recommend especially for partners and caregivers is having constant regular conversations about the shared tasks as though they are shared family tasks and divvying them up, along the way. And not relying on the woman to hold all of them. Because that is absolutely a burden that she doesn't necessarily need to hold.

MELISSA: These things are all really helpful. Thank you.

[Laughter]

Hopefully other people also found them to be helpful.

DR. ROHR: I hope so, too. It's tough because I always say when -- if you ask a psychologist a straightforward question, and they say anything other than “it depends”, or don't give you a super long answer, then don't listen to them because they're wrong. Because nothing is ever straightforward. But mom brain is -- and I've even come along way with -- I gave a presentation on this a year ago, and I was very angry. This is a real thing, this is happening, it's a problem. We need to address it. We need to figure out how to do these research studies, that can adequately capture what's happening. And then, as time has gone on, and I've learned more about the context that, while trying to do it all, we're trying to do it all alone. And that's never the way it was meant to be done. So, being able to pull in people to help scaffold each other, and build our village, I think is one of the ways that we can help to reduce, not necessarily the experience of mom brain, but the distress it causes.

MELISSA: That's an interesting perspective in that, the solutions may not be the ones we thought we were looking for.

DR. ROHR: Exactly.

MELISSA: But there may be solutions to these problems.

DR. ROHR: Yeah, we're not -- may not need to fix yourself because it may not be that you're broken. It's just, we need to figure out how to fix everything else. We'll just fix the world not ourselves. So, maybe it is easier just to do Wordle. I don’t know.

MELISSA: In the meantime, I will continue doing Wordle, and watching reality television.

DR. ROHR: Good. That's what's good for you. I think that's a good idea.

MELISSA: I'm curious if you've identified anything related to moms, experiencing mom brain, and people experiencing some of this covid brain fog? And if there's any link or connection or similarity between the two, and if there's learnings to be had for treating one or both?

DR. ROHR: So, I do hear about it quite a bit. We have -- we're looking at writing some papers about how to manage what's called long covid, with the brain fog, and the different neurological changes. I worked with moms all through covid. And that's actually, when I started, one of my first mom's programs, was in the midst of covid, because as many people know, covid was extremely damaging for moms, for everybody, but moms specifically. And one of the metaphors that I used is that after a while, even after sort of the acute, kind of phases of covid passed, it was still there. There was still the, you know, if your phone rings and it's the school saying something -- you know, always worrying in the back of your mind. But it was like, you were trying to go about your normal day with a backpack full of bricks on. So, you're just supposed to do the same stuff, but you're just weighed down. And really, now that I've kind of thought through more of the mom brain, it's another bit of the fewer resources, higher demand theory. We do know that long covid is marked for both men and women, mothers, father, whoever by these neurological symptoms. What we're not sure about yet is why. And some of the theories are that it is that excess stress, that it's sort of a post trauma response, that -- and maybe that there is actually some physiological organic change, but it's -- the research is still coming out about that and we're just not, we're not really quite sure. And I think that the way to address it is the same, which is sort of a radical acceptance about where you are, at least for right now, and how do we work within that. Manage our expectations, change them, don't lower them. And try to find a balance between what you can give, and what you're asked to give.

MELISSA: Right. No, that's good, that's helpful. Thank you. The comment about the mental load, feeling very similar, conversations about planning something, and then having to have ten alternate plans associated with it, and not really knowing if we were going to be able to do it until the last possible minute. It’s just fatiguing.

DR. ROHR: Oh yes, fatiguing is -- fatigue is the -- has been quite a universal, shared experience with covid, and even now trying to get back into things, watching children, who started school during covid and how are we managing their transitions. It's not over in the way that many people feel that it's over, and I think that can also feel quite isolating for people. Friendships that were lost because of it. It's still tough.

MELISSA: Thank you for acknowledging that. Dr. Rohr, this was a pleasure for me and really, as I said, very therapeutic.

DR. ROHR: Oh good.

MELISSA: So, I wanna thank you so much for giving us your time today.

DR. ROHR: Well, thank you for the opportunity. I love talking about this, and I'm happy for people to have a language to help explain what they’re experiencing.

[Sound effect signals the end of the interview]

ZACH: Okay so, I'm kind of intimidated about being a parent now, after hearing all this. What -- do you guys still recommend it, or?

JOHN: The short answer is yes. I would say, for me, the pros outweigh the cons. Jennifer and I have dreaded taking trips with an infant toddler. We've dreaded trying to do things we used to do with him. And every single time we've gone back from whatever it is saying, “Alright, we’re glad we did that. Like, we didn't regret doing this.” It was harder than it used to be, it was different than it used to be, but we are glad we did it. So, maybe that helps you.

ZACH: Yeah.

MELISSA: Life is different with kids.

ZACH: Yeah.

MELISSA: And everybody hears this, you don't take vacations, you take trips.

ZACH: Okay.

KATIE: Whoa, I've actually like not really heard it that way.

ZACH: That sounds pretty profound.

KATIE: I’ve heard it. I've just not really like, “Okay, trip, vacation, whatever.”

MELISSA: It's distinctly different.

KATIE: I hear you, I hear you now. In gonna context, I hear you.

MELISSA: But they're so rewarding, and like John said, the pros, at least for us really out way the cons. That’s why we have a second one.

ZACH: Yeah, I was being somewhat facetious there, but like I think of this, important, here like -- I think people might be a little intimidated when they hear all this stuff. ‘Cause, you know, people especially when you don’t have kids yet, you’re kind of used to being control of your own life, your own schedule, your own mindset. You map out your day, and it goes a certain way, then, you know, get a new human being in your life, who needs your attention 24/7, sometimes. Then all the regular responsibilities of parenthood, and that's an intimidating thing. But ultimately, it's worth it.

MELISSA: Absolutely.

JOHN: We've heard a lot of advice today. I am focusing on controlling what you are able to control. Get the moments where you’re able to take care of yourself, when you're able to get the moments or take care of yourself. But also don't put yourself under too much pressure, if one of those moments doesn't happen today, or the next day. I think that's something, I'm newly trying to focus on here after, kind of, hearing all of the advice.

ZACH: Yeah, is this something that, you know, the whole mom brain and by proxy dad brain mentality. This is something that is relatively recent, right? It's not something a lot of people, when you talk about the challenges of parenthood, I don't think people think, “Oh, forget isn't -- forgetfulness and absentmindedness is not -- probably not even the top 10 of things, when you're preparing to be a parent, right?

MELISSA: Yeah, that's a really good point, Zach. I don't know because the research is relatively new as far as scientifically what women are experiencing. But I also think that perhaps, there's something unique to American moms. And we've only recently been as heavily represented in the workplace as we are, and that adds an entirely new dimension to what we expect of women, and what women expect of ourselves. And so, it's hard to say whether this is new, or whether we're just looking at ourselves differently.

KATIE: Yeah, I thought it was interesting when she mentioned, it's also, you know, in your list of to dos, like taking the dog to get their nails trimmed. Like, it's not even really an important priority, but that's not the point, the point is you used to be able to remember those things. And so like, I love that you asked about how someone like me, I'm not a mom, but how can I support the moms around me. ‘Cause there are tons of moms around me, and it's, you know, it's -- I can help them do those sorts of things. Like yeah, they don't really need much for you, anyways, and things really people to chip in and help do. And I thought that part was really interesting, ‘cause I think it's easy for someone to just say, “Oh, why does it matter you forgot to get the dog’s nails trimmed?” It's like no, that's not the point, the point is I used to never forget this so –

MELISSA: Right. And there's so many steps to getting the dog’s nails trimmed, and that used to just be second nature. To keep all of those different pieces in mind. And I did, I really appreciated the tips that she was giving because there are few things more frustrating than when my husband says, “How can I help?”

KATIE: Yeah.

MELISSA: Oh my -- Just do anything.

KATIE: Yeah, I also love that you guys brought up the classic Breakup line of, “I want you to want to do the dishes.” Classic, and it was awesome. And, you know, like you mentioned, just do something without asking. Anything. Like just pick something. And like you said, you even said it. “I'll tell you if it's something that either didn't matter, or didn't mean anything to me, or I don't want you to do it, but just like, do it.”

MELISSA: Just try.

KATIE: Because I think as women, we typically do just handle stuff, just, like naturally. And so, just getting some help on that, taking some of the pressure off.

MELISSA: One of the things that she really keyed in on that was kind of disappointing to me was, this is life now.

KATIE: Yeah.

MELISSA: There is no magic solution to what I consider to be a persistent state of brain fog.

KATIE: Yeah, your brain’s been pruned.

MELISSA: Yes, I've been pruned for new priorities, and I didn't take advantage of the neural elasticity to do anything useful.

KATIE: It was interesting that you kind of -- you keyed in on that. I didn't even think about it, when you're like, “How can I hold on to this like thing that I've gained?” And I was like, “Oh wow.” Yeah, of course, you would kind of like -- you're just -- I do feel like you're very on top of things, so I'm like, “Man, yeah, that's true.” Like, you would try to, like, get something out of it too, at least.

MELISSA: I got nothing out of it. I wish I had this conversation 10 years ago. And now will learn new languages.

ZACH: That was some great lessons for existing parents, future parents, potential parents. John, Melissa, thanks so much for joining us this time.

JOHN: Yeah.

MELISSA: Thank you so much.

ZACH: That’s gonna do it for us on On health with Houston Methodist, this time. You can share, like, and subscribe wherever you get your podcasts, and we drop new episodes every Tuesday morning. But until then stay tuned, and stay healthy. 

[Music ends signaling end of episode]