E16: 7 Domains of Motherhood

Welcome. This is the "7 Domains of Women's Health," the show. I'm Dr. Kirtly Jones from Obstetrics and Gynecology at the University of Utah Health. And I am a reproductive endocrinologist. I spent a lot of my time as a clinician helping women become mothers, because infertility was a big part of what we did. And I asked women, a lot of women, why they wanted to be a mother.

Of course, the flip side is I also was very active in helping women not become mothers through contraception. Some women choose to be a mom, and some women become mothers not by choice but by chance, and some women are choosing not to be mothers. I actually chose to be a mother down to the minute of the making that choice. I had the kid that I wanted, that we wanted, but I had absolutely no clue what was coming down the pike for me.

So today we're going to talk about the seven domains of being a mother. And I'm going to back out a little bit and talk about what I heard about octopuses. It's not octopi. It's octopuses. Octopuses live their lives. They do their octopus thing. There are male and female octopuses, and eventually they get to be grown-up big and it's time for them to make babies.

And they have sex with sperm and eggs, and they lay their eggs. The female lays their eggs, and then the female protects those eggs until they're ready to hatch. She doesn't move very much. She blows water that has nutrients and oxygen over her eggs. She does not eat for as long as it takes for those eggs to hatch. And then she dies. It's as if her whole life was waiting and learning to be big enough so that she could do this pretty long activity.

And in some octopuses that live deep in the ocean, deep deep, that may be four years of sitting on your eggs keeping them safe so that they can hatch and you can say, "I'm done."

It turns out that males also die after they add their sperm to the egg, so it's not just the girls.

So, for some octopuses, and for creatures all over the planet, being a mother is hard. Some mothers carry their babies for a long period of time. Some mothers stay with their babies for a long period of time. Orangutans stay with their babies for about seven to eight years. The baby has to be completely independent before she will become pregnant again. And this is probably the longest inter-birth interval of any mammal that we know.

Humans give birth to very premature babies. Our babies have no fur. Our babies' eyes open, but they are very unable to take care of themselves. They can't even hold on to you the way a baby gorilla and chimpanzee can shortly after birth.

Our babies are born so prematurely because our heads are so big. If we waited until they were a little more mature, their heads would be so huge they wouldn't fit through our pelvis. So we give birth to babies that are very small, and we're just now at the margins where babies' heads often don't fit through the pelvis anymore. One of the reasons we have as many cesarean sections as we do, and one of the reasons why childbearing is so risky for human mothers.

It's clearly not as risky for most other animals, unless they are bred to make really big calves, as with cattle. So some cattle are bred to build really big calves, but those calves don't fit, and they often have to be pulled with a chain to come out or they'll get stuck.

So we are born with very immature babies that take a lot of care. So humans, we do all this work, our babies stay with us, depending on the culture, for at least 14 and often 18 years. But our work as mothers is never done.

It's risky for us giving birth. It's often met with complications that other species don't have -- high blood pressure, preeclampsia, preterm births, hemorrhage. We tend to bleed much more with our births than other animals do. So we lose our lives because of hemorrhage, infection, hypertension, stroke, blood clots. And the physical demands of being a mother are really quite substantial.

So it's not easy being a mom. It's not easy becoming a mom for some. For some becoming a mom is pretty easy. If you can get that first baby out, you're much more likely to get the next baby out.

Riskiest time for moms is the first birth, and then births get riskier at your seventh, eighth, or ninth birth just because the uterus doesn't contract as well and women are more likely to hemorrhage.

So this baby that made me a mom was a very large baby. He was an 11-pound baby. He did not fit. And had I given birth to this particular child 200 years ago, I probably would have died and he probably would have died. So we are lucky if we're giving birth to large babies to live in a time where, at least in the U.S. of A, in most places, we can get the help to birth our children safely. But being a mom is a risky bit, a very risky bit.

As they're thinking about the physical risks to themselves of getting pregnant, they also make decisions whether this is time for them to bring a baby into the world. Is the environment, the social, emotional, physical environment healthy enough for a baby?

We are wired . . . when there is no food or when it's extremely stressful, we are much less likely to ovulate. So we have a natural mechanism in times of starvation or when things are very, very tough to lower our fertility.

But women make these decisions every day. "Am I the right person right now?" "Is this an environment in which I want to bring a child?" Women make these decisions, and sometimes they make them by themselves and sometimes they make them in the context of their relationships. But the environment into which you're going to bring this baby becomes really powerfully important. And many women include that as they think about becoming a mother.

But there are physical things that happen when you are pregnant to your brain. Most moms will tell you that they are never the same emotionally after they have a kid, that pregnancy wires their brain for attachment, for bonding. And once you've bonded to your baby, you are always on the watch out for them. You are never, ever alone again because your kid is always in your head.

And we now have some very cool imaging studies that look at the brain of pregnant women early in their pregnancy and then in the middle of their pregnancy and then after pregnancy, and we can see the brain is really being rewired in a fundamental way. We are losing connections in our brain that rewire after the birth of their child. And that rewiring is for social connection and for bonding.

Some studies, and once again these are small studies, suggest that women who don't have as much changes throughout their pregnancy and afterwards bond with their children a little less.

So it's an important thing that our brains rewire for bonding because it's not something that just comes naturally.

Now, women who don't have a pregnancy and start living with a newborn, like they adopt a newborn or they are taking care of a newborn, have many of these same phenomena without necessarily the brain rewiring. So there's something fundamental that happens to the brain and the emotional centers of the brain once you've cared for a newborn or you have given birth to a baby that makes your brain forever different around the issues of bonding.

How does this manifest? Well, women will say, "I was never fearful until I gave birth to my child. Now I'm much more cautious. I'm much more aware of risk." For me, I was never fearful of heights until I gave birth to a child, and now I have pretty significant acrophobia. Big heights really make my tummy turn over. And if I see my kid near the edge of a big height, my tummy turns over. That's a brand new phenomenon that I didn't experience until prior to the birth of a child.

Women say they often feel more sentimental because they are wired for attachment that comes as the necessary part of being a mom. They feel much more sentimental. They get teared up at silly things. They cry at movies. They cry at kids' commercials or whatever.

Now, do we know what actually does that? Well, we've known for a long time that the hormones of birthing that include oxytocin, which makes the uterus contract, is really important in bonding in both humans and in other species. So breastfeeding releases oxytocin, and oxytocin is very important in bonding. That emotional attachment becomes important when you get really tired of being a mom, which moms do. They're sleepless. They're exhausted. Maybe they've got one, two, three, or four kids and they're just tired.

The other hormone that we know a little bit more about in birds is prolactin. Prolactin is also important in making milk, and prolactin is also made by the lining of the uterus when we're pregnant, and prolactin seems to be important in bird brooding behavior, the kind of behaviors that made a bird sit on the nest even when it doesn't want to, even when it's hungry. Even when it's snowing, it sits on the nest.

So these two hormones, prolactin and oxytocin, help rewire the brain for bonding and caring for their newborn.

And last but not least, we know that progesterone hormone . . . that's the hormone of pregnancy. Progesterone causes some behavior changes in women that may make them more pro-social, more willing to reach out, more willing to hang out with other women. That's another really important part of being a mom.

Those of us who've never had children, it's always a worry that, "Will I bond to my child?" or, "If I am joining a family, I'm marrying someone who has children, will I be able to love those children?" or, "If I'm adopting a newborn, will I have the same responses?" Well, there certainly is something fundamental that happens to women, men, and grandparents when they are in the situation of now caring for a newborn.

So it doesn't necessarily mean that the baby has to come out the vagina, out the body, or that the mom had to experience all the pregnancy hormones. Because newborns that are given to a mother who didn't birth them, those mothers attach very well. And most everyone who adopts a child will say, "I bonded to that baby the minute I saw that baby."

So remembering that there's something about caring for a newborn that helps fathers bond . . . so fathers bond to their children. Even though they didn't have progesterone, they don't nurse, and they don't birth the baby, they bond emotionally, and spiritually sometimes profoundly with their children. They care for them. They socialize with them. Fathers who have raised their child as infants are much less likely to subject that child to sexual or physical abuse than fathers who didn't raise that child and that weren't involved in caring for that child as an infant.

So adopting a child, particularly from infancy, can lead to the same kind of bonding and nurturing and care behaviors in adoptive moms that it does in biologic moms.

We mentioned that progesterone may have pro-social activities, helping you want to go out and be with other people. We are an incredibly social species, and there are some things about our mothering that we do differently than others.

We're more likely to let other people who aren't related to us hold our babies. So when you go to a party or you're going to a gathering and someone walks up and says, "Oh, that's such a cute baby," many mothers will say, "Hi, do you want to hold her?" Most all other species will not do that. They don't let strangers hold their babies. We are very unique. We share our food with strangers, which other species don't do. We share our babies with strangers.

Well, we are part of this numbers of species who are cooperative breeders. And cooperative breeders are species that have babies, and they can be birds, they can be whales, they can be elephants, where the other members, mostly female, of that species help the mothers raise the kids.

So the social aspect of being a mother is really important. Mothers who raise their children all by themselves with no help, and think about living in the Serengeti or in the jungle, rarely survive and their babies don't survive, because it's so hard to raise and feed a newborn and care for yourself all by yourself.

We see this in wolves and coyotes, where there might be a pair that have the sex and have the birthing, but the other members of that troop help feed the babies. That kind of cooperative breeding where others may help another mother raise their children is ultimate in humans. We are the ultimate cooperative breeders. We have our mothers and we have our grandmothers, if we're lucky, to help us become better mothers.

So, in my own case, my mother-in-law came out to help me the week after I had our son. And she was a very experienced mother. She had six kids and she raised six amazing kids, and I had lots of questions to ask her. Mothering is the last refuge of the rank amateur, as we've been saying. And so I had lots of questions for her.

The gift that she gave me was she looked at me when I said, "Am I doing this right?" and she said, "I can't remember how I did that, but I think you're doing it beautifully." That was her gift.

But she also came and potty trained my kid. So I was not having success in potty training our kid. And we were going away for a long weekend and she came all the way out from far away, she flew in, and I said, "Gosh, Ann, if you can figure out how to do this, I'm not having any luck." He was about 2.5, almost 3. And when we came back two days later, she had managed to completely potty train him in two days. I said, "Ann, how did you do that? I was not having any luck." She said, "Oh, I just told him to pee on this bush, and then we took him outside and told him to pee on that bush, and we made it into a game. And once he figured out that this was kind of fun, then he just knew how to do it." And I went, "That's why you need a grandmother."

We need, as a social species, to help other mothers as they become mothers and we need people to help us be better mothers.

So here is a little story. Once upon a time, a long time ago, I was very pregnant and I was shopping at a local grocery store at the time when they still had magazines and books and things. I stopped by and I saw a book. I saw Dr. Spock's "Baby and Child Care." So I reached up to take it off the shelf and a woman came up to me, older woman, put her hand on my tummy, which is what people do to pregnant people, and said, "Oh, don't buy that book." She said, "Just talk to your mother." And I said, "Well, my mom is not available. She raised her children on three continents with Dr. Spock, and I think we turned out okay. Thank you very much." And I bought the book.

So Dr. Spock was the bible, as it were, for new moms who didn't have their own moms around. Evolutionarily, humans are unique in having mothers become grandmothers and have really critical roles in the raising of their grandchildren, either providing more calories so the mom, who's trying to make more babies, can actually make more babies. So grandmothers and other mothers are really important to helping young mothers grow.

So here on the studio is Jessi. And Jessi is well known to me as a librarian at the University of Utah Health Sciences Library. Librarians are my favorite people because they're so curious. They're just born curious. She is a young mom, although probably more experienced than I am because she has two kids. I only had one. But I have longer time being a mom.

Dr. Jones: So, welcome, Jessi.

Jessi: Thank you, Dr. Jones.

Dr. Jones: So, Jessi, we talked a little bit about you being a mom of a 6-year-old. And things are happening with your 6-year-old during these times right now. Can you talk about that a little bit?

Jessi: Sure. I've noticed over the last few months things that I would kind of characterize as some rising anxiety. She doesn't want to be left alone, even in our house. Or at night, she seems to be really afraid that we're going to have a house fire. And I'm trying to figure out, "Is this normal developmental processes for her, or is this something to be a little more concerned about and talk to her doctor about?"

Dr. Jones: Right. Well, it's normal almost in that over 6% and up to 15% of children have anxiety. Only a small percent, maybe 6%, actually need to come to the physician about this.

So tell me a little bit more about when she comes to you. She gets up in the middle of the night to come to your bed?

Jessi: Right at bedtime. So, at first, I thought it was a stall tactic. But now I hear real fear. "What if the fire alarms don't go off? What if our doors won't open and there's a fire?"

Dr. Jones: So this is a developmentally appropriate time for a 6-year-old with a growing brain to be able to connect the "what ifs." And so she's now old enough to be able to see if something happens, something else might happen. So, developmentally, it's a time for her to make that connection.

Now, the anxiety that comes with it is the part that's really uncomfortable probably for her and for you. So do you ask her how she's feeling?

Jessi: I do. And I think it's hard for her to articulate. It mostly comes out as, "I just feel really scared."

Dr. Jones: Have you tried to help her articulate that a little bit better? "How does your tummy feel? How does your heart feel? How does your head feel? How do your muscles feel?"

Your gift to her is twofold, I think. One is that you are there for her. But number two, you're going to give her the gift of self-management. That takes time and practice.

I'm going to introduce you to the Yale RULER project. Have you heard about this?

Jessi: I haven't.

Dr. Jones: So the Yale Center for Emotional Intelligence tried to come up with some practices that would particularly help families and children develop emotional intelligence. And the RULER stands for Recognize . . . that's the R. U is Understand, L is Label, E is Express, and R is Regulate. And the RULER project actually helps moms and dads and children work together to become emotionally intelligent about how they're feeling.

So she recognized that she's feeling really scared. But it would be helpful for her to recognize in words what parts of her body feel scared. She knows that you're there for her, and she comes to you when she feels anxious. Or you're labeling it as "anxious" and she's labeling it as "scared." But she knows that you're there for her. You're there for her physically. Does she want a hug? What does she want from you when she comes to you?

Jessi: Yeah, she definitely does not want to leave my side.

Dr. Jones: And it's you and not your husband? Is there only one person who can do . . .

Jessi: Dad is around, but she really is seeking Mom.

Dr. Jones: Mom? Okay. So she knows she can trust you, although she's got this concern that you're going to go away or that she might be left alone. So rather than trying to tell her, "Oh, I'll always be here for you. I'm never going to leave you" . . . you can certainly say those things, but drill down a little bit more into how she's feeling. Why is she feeling that way? What happened that made her want to be more worried that she might be left alone?

Now, this helps her connect her cognitive understanding to what's making her scared. So maybe she saw something on TV. Maybe your alarm went off. Has your alarm gone off unnecessarily and you had to change batteries?

Jessi: It did, although that was actually a little bit reassuring for her. She said, "Wow, that's really loud. I can hear that." I know this started when a firefighter came to their classroom to share about safety plans for the family.

Dr. Jones: So you have a safety plan. And once again, helping her engage her smarts helps her move away from her fears in her tummy or wherever it's manifested in her.

Helping her, if it's not a go right before, is to spin a story of, "What would happen if . . ." Because she's already doing the, "What happens if . . ." What would you do so that she can actually spin her own story? Or, "Can you tell me a story?" Can she make up a story about an animal or something that might be in a situation like hers? So make her engage, again, her cognitive processes to think about this rather than, "I'm just scared." It's moving away from the unfortunate circular thing that's happening in her brain. Those are things to try.

There are kids, of course, about 6%, who really are crippled by their anxiety. And that's where help can happen. That's where talking to your pediatrician, they might give you some other clues, some other ideas to do with her.

These are difficult times. How are you feeling? So this is the next step in terms of how are you feeling when she comes to you and is scared?

Jessi: Well, I remember being scared as a child too. It was a different fear, and I remember not being heard or sort of my fear validated. And so I want to both say that I hear her but also not make her fear seem any more real or likely to happen.

Dr. Jones: That's exactly the right thing to do. And that's part of the Dr. Spock "you know more than you think you do" about taking care of this little kid.

Jessi: So even though I'm not getting wound up with her about the same thing that she's worried about, there are other things that I find myself worried about. For example, in this last year, we've had some loss and really serious illness in our extended family, people that are important to her. And I want to be able to show her that it's okay to feel worried and sad about those things that are happening and that I can feel worried and sad too. But I also don't want to put her in a position where she is more worried about me, because she is a very, very sympathetic, empathetic child.

Dr. Jones: Good for you and good for her. Well, I think that the same thing is if you practice your RULER outside . . . so she might come to you and say, "Mom, are you sad?" and you can sit down, if you have time, and say, "I am sad, and this is how it feels to me. I'm not afraid and I'm glad to be sad because it means that I love someone and this is how it feels to me. You don't have to be sad for me, but I want to share that with you so you know that being sad is a perfectly healthy thing to feel when somebody we love is sick."

This is a very verbal child and she's very emotionally empathetic.

Jessi: Yes.

Dr. Jones: And so letting her watch you express these emotions in a way that's calm and understanding and, "This is okay. It's okay to feel this way. We should feel this way . . ."

Jessi: I like the idea of modeling the RULER with her because I do see that she very much picks up on how I react and respond to things. And being so verbal, I think that will help her a lot.

Dr. Jones: But knowing that you're there, that you don't downplay or overplay, you don't reroute her whole life around her fears, because that's a mistake too, and you check in with yourself at the end of the episode and say, "How do I feel?"

When I mentioned that I had some experience, our kid was dangerously anxious from the time he was an infant. And I could say I wasn't really great at checking in with my own emotions. I would say that he taught me emotional intelligence, or we learned it together. And he's now a strong, loving and brave man who runs toward trouble to help people, instead of away. And I'm really, really proud of him for all those reasons. But it took me some time to check in with myself and to be the grown-up in the room. And I really wasn't early on. It took me some time. So, Jessi, you sound like you're way grounded already, and that would be terrific.

Jessi: Well, thank you. It's always a work in progress.

Dr. Jones: Well, that's the other thing, is that motherhood is the last domain of the amateur. Even if your mom were around, it's your kid and it's your relationship and we're all real amateurs at this. And so, having an open mind and understanding that no one is perfect at it is . . . I think that's helpful too.

Jessi: We could do this every week.

Dr. Jones: So, remember, neither of us are experts.

Jessi: That's right.

Dr. Jones: Yeah. Well, thank you, Jessi.

Jessi: Thank you. Thank you for your time.

Dr. Jones: You're welcome.

Well, I'm honored to have the opportunity to talk to a younger mom, and I'm fortunate to be an older mom. But in fact, it's the community of mothers that help us raise our children and help us raise our community so that we can even be stronger as families and community and nation and a planet. So it's the older moms and the younger moms who rule the world as far as I'm concerned. So it's all of us mothers together.

If it's hard being a mom and it helps to have other people, what does it cost? What do you think? Here's a pop quiz. What do you think it costs in the United States for a married couple, average, middle-class, to raise a kid from birth to 18? Any ideas? Well, while you're thinking about the number, I'm going to give it to you, and this is based on data from the Department of Agriculture.

Now, don't ask me why the U.S. Department of Agriculture got into the cost of rearing humans. I could get raising cattle or pigs or chickens, but they figured that it costs about $284,000 for a middle-class family to raise a kid from birth to 18. Single moms, poor single moms, spend about $170,000 from birth to 18 to raise a kid.

Now, this isn't everyone, but you can imagine when we were more social living in a community, we co-housed with our grandparents so we didn't have to buy a bigger house necessarily when we had a kid because we were living in a larger house with our parents. You can imagine that when we lived in a community, we shared clothes and we shared food. It was a lot cheaper to raise kids than it is now.

Now, we have nuclear families who need their own apartment. And when they get an apartment and they have a kid, now they need a little bit bigger apartment. And of course, they have this little two-seater car, and now they need a four-seater car, so they have to get a bigger car. And so the costs of raising a child get to be very substantial.

Now, the good news is you don't have to pay it up front. You pay it out bit by bit. So if you're taking $284,000 and that's over 18 years . . . and I'm going to go right to my little calculator here and I'm going to turn it on and put 2, 8, 4 . . . that's in thousands, divided by 18. That equals about $15,000 a year.

That sounds like a lot, but if you divide it by 12, you get about $1,000 a month. So $1,000 a month to raise a kid? Well, that's what it costs for daycare and food and education. Because even if your kid is going to public school, it still costs for activities and books. And of course, you need a bigger car, and the bigger car uses more gas, and a slightly bigger house, so your rent is up. So it's about $1,000 a month.

Well, let's divide that by 30. And that equals about $41 a day. Is that right? That's what it costs to raise a kid with a middle class family here in the United States. That's a lot of money.

There is a calculator for this, and there's a CNN calculator. If you go to Google, if you Google "CNN money calculator how much does it cost to raise a kid," you can plug in your income, how many kids, one, two, or three, and where you live, and they will calculate what it costs to raise a kid from birth to 18. Just in case you want to do your own numbers.

So, when people come to me and they are having a hard time having a kid, they say, "Gee, we were thinking about IVF, but in-vitro fertilization is so expensive. Ten thousand dollars? We're just not going to be able to come up with that." And in the back of my head . . . I'm not saying this out of my mouth. This is the back of my head. I'm thinking, "Oh, honey, you have no idea how much kids cost. This is just getting you pregnant."

And I remember having a conversation with a couple who were coming and just deciding that they weren't going to try IVF because it was too expensive. And I said, "By the way, where do you live in town?" and they said, "Oh, we live in this neighborhood," which happens to be a pretty expensive neighborhood. I said, "Now, what kind of car do you drive?" "Well, we have two cars, and we have a Range Rover and we have a BMW."

Then I didn't say anything more, but I thought about the couple who came to us, a couple who were poor. They were working class. They both worked two minimum-wage jobs, and they came in ready to pay for their IVF procedure and they had it in cash, in 20s and 50s and 10s. They had all their money saved up. The primary focus of their lives was to have children. They saved and they saved, and they moved in with their friends so they didn't have to pay rent. And that was their primary motivator.

So, for some couples who are making the decision to have children, the financial part is a big part of that decision. But for many, many people, it's a profound emotional and social and biological decision, meaning, "I don't know how to be an adult if I can't have children. I'll sell my truck." We had somebody who sold his very precious pickup truck and got a used car because that's about what it cost for them to go through an IVF cycle. And having a child was the most important thing.

I think anyone who has born a child will say there's something cosmically spiritual about having another person inside you who responds to jumping up and down, responds to loud music, response to any one of our number of things. Having another person inside you brings you close to all other women in the planet, brings you close to all living creatures because you're adding another creature to the planet.

But I would say that it's not only, and in fact, maybe it's only partly carrying a baby inside you that makes you a mother. The spiritual nature or the spirituality of motherhood is being connected to something larger than yourself. And in the process of being connected to another small, vulnerable person where you nurture and grow that person, it's actually one of the most spiritual, complicated processes in the world. This business of nurturing vulnerable young people to be better, to grow is a profoundly spiritual experience.

So we have a kid and I thank him every day. And every Mother's Day I send him a little card because he's the one who made me a mother. And he's the one who helped me learn more about being a person and being a grown-up than anyone else. So this is dedicated to him and to all the children who helped us become mothers and helped us to grow into that role.

And as usual, I'm going to end with a little haiku.

Who is a mother?
Do you help nurture others?
We all are mothers

I want to thank everyone for listening. And for those of you who haven't listened to all of our episodes, please go to womens7.com, and let it launch a conversation for the women in your lives.

Happy Mother's Day for all of you mothers on the planet, male and female, old and young. Happy Mother's Day to you. Thanks for joining us on the "7 Domains."