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Dr. Jones: You just had a baby and you're feeling a little or a lot overwhelmed. Surely this is common, but is this postpartum depression?

Being overwhelmed with a new baby is common, whether this is baby number one or baby number three, but when does this feeling of being overwhelmed suggest that the problem is more serious for the new mom and the baby?

Today, we're going to talk about postpartum depression. And in the virtual Scope Studio is Jamie Hales. And Jamie is the board co-chair for Postpartum Support International, our Utah Chapter, and she's a clinical manager of the Huntsman Mental Health Institute. Thank you very much for joining us, Jamie.

First of all, let's just dive right in. Well, what is postpartum depression? Why is it something different than just, "Oh my god, I'm sleepless and I'm overwhelmed"?

Jamie: Well, you've hit it right on the head. I mean, those are completely normal things that can happen with pregnancy, right? You're sleepy, you're feeling like you're not quite yourself, but I think that there is a difference for sure between really struggling with postpartum depression versus having what we would typically kind of term as the baby blues.

When we're thinking about postpartum depression, it's really more stuff that doesn't just come and go, right? After a couple of weeks having your baby, if you are still just really not feeling like yourself, and not sleeping when your baby is able to sleep, and possibly more irritable or more depressed, having thoughts of hurting yourself, anything along those lines, it's probably more likely to be heading into the territory of perinatal depression or anxiety versus just kind of a normal adjustment to having a baby.

Dr. Jones: Right. So I think all of us, particularly as new moms, feel like we are imposters, meaning we feel like someone gave me this baby and I don't know what to do. For new moms, we're all amateurs, but it's that feeling overwhelmed with this and being inadequate. "I can't do this. I need to check out. Someone needs to help me." But often women don't reach out for help. How common is this?

Jamie: It is absolutely the most common complication of pregnancy, which is why we need to talk about it more often.

I mean, if you really think about it, as an OB-GYN, you screen women for gestational diabetes. You screen them for gestational hypertension, any of these things that could happen. But it's been relatively new in practice to make sure that we're actually screening for postpartum depression and anxiety.

It impacts 1 in 10 men, which a lot of people don't think about, but it also impacts probably closer to 1 in 4 women, even though the official statistic is 1 in 7.

Dr. Jones: Right.

Jamie: And that's just because it's under-reported, is really what it comes down to.

Dr. Jones: I think the old-fashioned and probably still prevalent practice is you see women, deliver them, you see them for a day for postpartum, and this is the doctor, and then you have them come back for their six-week visits. But by that time, they've sunk or swum.

So, in Europe and in England, there's a midwife who goes and does a mom check. And unless we check at two weeks or three weeks and say, "How are you doing? Do you need help?" by the time six weeks comes along . . .

And a lot of women don't even come to their postpartum visit. We don't pick up as much as we should. So we are counting on the woman or her family, and that's why we're doing this podcast, this topic. When women or their family members see this happen, they need to reach out. So what should they do?

Jamie: I think that absolutely is key. As providers, if we see people, we absolutely want to make sure that we are asking every one of our new moms, "How are you doing?" Not, "How's the baby? How are you healing physically?" We have to really talk about, "How are you doing emotionally?"

And you're right, we may not get women in for those two-week or six-week appointments because sometimes insurance has changed or they're just feeling so underwater already that making it in for one more thing is really, really difficult.

My advice always to family members and to women in general is to speak up. If you really truly feel like your motherhood experience is just not going the way that you would thought that it would, getting around that stigma and actually saying, "I'm struggling. I don't know that this is normal," is a really helpful thing to do.

I think that there are a lot of people out there who have resources, and have the ability to jump in, and try to help you feel better, and to start getting back more to what your baseline was before you had a kid. So I think that that's a big piece.

And then for family members, please, please, please ask and make sure that you are paying attention to the emotional needs of those new parents, because it is harder for people to speak up and say, "I'm having a hard time."

Dr. Jones: Yeah, and it's not necessarily . . . You could have flown through the first one, but maybe you're not flying through the second, or maybe you had postpartum depression the first time and you didn't have it the second. Although women who've struggled with mental health issues before are a little more likely to have postpartum depression. Do I have that right?

Jamie: Yes, that's accurate. You're absolutely right. You could cruise through four pregnancies and not have any real postpartum symptoms. And then with that last one, you do. Or you could have really, really rough postpartum depression the first time and then not have it with your subsequent ones.

So it's important to make sure we're checking in with people during all of these different points in their motherhood journey to see how they're feeling. Dr. Jones: So if a woman has come right out, what do you do? As a reproductive endocrinologist, I think this is potentially the biopsychosocial model, meaning the psychological makeup of the individual matters, the social environment may matter, but there's the biology of having a hormone crash, and some women are vulnerable to that.

So when you think of these three parts that make up any kind of illness we might have, how do we approach this in terms of treatment?

Jamie: I'm really glad that you brought that up, Kirtly. I couldn't agree more. I mean, you do have this major hormone change that happens once you give birth, just the lack of sleep and all of the social factors that can change.

I think for a lot of people, becoming a mother is great, and maybe it was something that they were really excited about. It also could be the opposite. And it can be really tricky, I think, for people to recognize that all of those experiences are valid. So we want to de-stigmatize this as much as humanly possible.

Then you add the other kind of psychosocial factors into it. I mean, if you're in a difficult home situation or you don't have financial resources the way somebody else might, these are all things that could put a woman more at risk for experiencing complications. So it's good to assess really, I think, the full person.

Dr. Jones: It's a thing about humans. We're the only mammal species, we're the only primate species that shares our baby. We are willing, as a social group, to let others keep an eye on our baby. So you can say, "I really need to go for a walk. I need some help. I would love to just have 10 minutes to myself."

But there are people who need an evaluation. And at least for those of us who are OBs, we always think they need to check their thyroid because low thyroid can be a player in this and it's not uncommon. But some women need medication. I would think that even group therapy would be ideal for this, to hear other women struggling. Is that something that's at all available?

Jamie: Oh, absolutely. There are a number of group therapy options out there for people. And I think what makes that so effective as an option is really that peer support. Being able to hear the stories of other women and just recognize that you're not alone in what you're experiencing really goes a long way toward helping them understand that it's not a normal complication, but it's definitely a common complication to experience these things. It goes a long way toward getting that stigma to not feel as acute.

Dr. Jones: So how long does it last? I mean, does it have its own natural course?

Jamie: So I think because of some of the biological factors, there is a course that comes along with it. I mean, we see a lot of people start to feel better again as they get toward the end of that first year, just because there are so many things that come up during that year, so many really positive milestones and also just lots of challenges that kind of come along with the experience of being a new parent.

When we really think about, "Is this postpartum versus something else? Is it pre-existing depression? Are there other complicating factors?" I always think about what was your emotional state and your experience like before you had this baby?

And really, if something changed with your pregnancy or in your postpartum experience and you're having struggles down the road, but you can still kind of pinpoint, "Yeah, that's when things really got to be a struggle," I think it's okay to still refer to that as being a perinatal mood and anxiety disorder.

I have worked with people who are several years out from their birth experiences and they're still sometimes coming in to talk about birth trauma or navigating being a parent, and they're years out.

Dr. Jones: I think all births are pretty traumatic.

Jamie: Yeah, that's fair.

Dr. Jones: This is just me. It's like, "Oh my God, how did that baby ever get out there?" But I think that there are women who come in with this hope for experience, and what happened wasn't really what they planned and they can't let go. They're healthy baby, healthy mom, but they have problems. And so that is a special subset of problems around birth.

Jamie: And I'm really glad that you bring that up, especially that last piece, because what we as providers may think of as, "Oh, that was a traumatic birth," there are some that you can look at and be like, "Yep, on paper, absolutely that was a terrible experience."

And then there are a lot of other people that maybe they don't have that exact presentation of what it could have looked like, but we're not there inside them experiencing it, or even for partners watching it. And it's always important to ask people about what their experience was like rather than assuming just because Mom is healthy and baby is healthy that everything is okay.

Dr. Jones: Exactly. I think it's getting back to asking the mom how she is. But when is this problem an emergency? A woman isn't feeling well, when does either the patient or . . . And sometimes a patient can't recognize it, but a family member say, "She needs help right now, today, this minute."

Jamie: Like with any other condition, mental health conditions can definitely come in varying degrees. I think there's always an argument to be made for if somebody is not doing well, jump on it and get them in and give them a safe place to be able to tell their story and potentially be able to get on medication. Sometimes that can take some time.

What I would say, all the way on the other end of the spectrum, is if you are working with somebody or you have a family member or your partner or somebody else who it seems like they've really lost touch with reality, and there could be some postpartum psychosis onboard, that is something that we absolutely consider to be emergent.

So there is a difference between having really kind of scary, intrusive thoughts. That can be something that can come along with just having postpartum anxiety or postpartum OCD. But if somebody is having all kinds of strange, outlandish thoughts about themselves or the baby, and it doesn't bother them, or it seems like it's something that really truly isn't connected to reality, I would make sure that you check in and get them some help pretty quickly. Same thing with suicide as well, suicidal thoughts.

Dr. Jones: Yeah. So if a woman is thinking of either harming herself for her baby . . . I mean, we do have mental health professionals in our emergency rooms . . .

Jamie: Yep, absolutely.

Dr. Jones: . . . who are aware and know what to do. So if that's what it takes, you just need to pack everybody up and come right in and get help right away.

Jamie: One of the things that I hear . . . and I'm sure you do as well. I've heard from plenty of parents, "I didn't want to say anything, because I don't want people to think I'm crazy," or, "I don't want them to put me in the hospital or pack my baby away to somebody else." The reality is that is not something that happens very often at all.

Dr. Jones: No. It's very uncommon.

Jamie: Yeah, it's a big fear people have, and I think it's a big barrier to having somebody come in sometimes to actually talk about these things. But that's so unlikely that something like that would ever happen. I mean, everyone's thought is trying to make sure that both you and your baby are being served and taken care of, and nobody likes separating you guys out.

Dr. Jones: Yeah. Well, as we wrap up, I think it's important to know that this is common. I know people want to be the ideal mother, but ideal mothers get depressed. And it's very important for your own mental health and for your baby's mental health, because your newborn is keyed into who you are.

So if you or a family member is depressed and struggling, that baby is struggling too. So all of us need to chip in. It takes a village to get a mom and a baby through their first year. And the more that we are attuned, the more we ask, the more likely we're going to have a healthy baby and a healthy mom make their way to Year 2. What fun.

Jamie: Yep, that is very true.

Dr. Jones: So, Jamie, thank you so much for joining us. And for all of you who are listening, thanks for joining us on The Scope.

If you are a healthy woman, not pregnant, what vitamins or supplements should you take? Is that an easy question or a hard one?

When I had a practice focused on midlife women, some of my patients would come to clinic with a bag full of bottles, big bottles, and little bottles of vitamins and supplements. They would ask me to look at them and help them think about which ones they should take, and should they be taking any others. I would do a little mental eye-roll, but I was grateful that they brought them in to ask about.

Well, now, I look at my little pile of pills at the breakfast table and ask the same question. What is the evidence that any of them do anything for my overall health? And is there a possibility of harm to my body, not just my bank account?

Let's go back to the question. If you are a healthy woman, not pregnant, what vitamins or supplements should you take?

Well, you are a healthy woman. That's a very subjective phrase. And which of the 7 Domains of Health are we qualifying as healthy? Let's just say that your health record has no major medical problems. Many women are healthy according to their chart, but they don't feel the way they feel that they should feel. They want more energy, they want more peace of mind, they want more restorative sleep, they want to be thinner, they want a better sex life, and many healthy women take supplements or vitamins that offer them some of these things.

There's very little evidence that vitamins or supplements enhance the lifespan of healthy women who eat a balanced diet. Of course, many women do not eat a balanced diet and they spend all their lives inside, but we'll get to that.

You are not pregnant. If all women ate a balanced diet with all the iron and folic acid they need, they would not need prenatal vitamins, but many women do not. Some women eat a diet deficient in folic acid, and therefore are at increased risk of a group of congenital anomalies called neural tube defects, problems where the fetus's nervous system doesn't develop normally.

Unfortunately, if you're going to decrease the risk of neural tube defects, you have to increase the folic acid in your diet before your OB prescribes prenatal vitamins at about eight weeks. You should take them before you become pregnant, which means you should plan your pregnancy.

Next, many women have heavy periods and have given up a lot of their iron stores to a previous pregnancy or pregnancies. They enter the pregnancy with low iron and anemia, which gets worse with each pregnancy.

In the U.S., where people have access to food, a lot of food, iron deficiency in pregnancy is uncommon, but some women eat no sources of iron, meaning no meat, or very little and have very heavy periods, so they're iron deficient.

Deliveries are always associated with blood loss, and if you're already low, you can get lower, and that can be a problem. Prenatal vitamins are specially formulated to have extra folic acid and iron.

Now, what are vitamins? Vitamins are organic substances that are essential in small amounts to the normal function of the body of most animals. They act as coenzymes and precursors to normal metabolic function. They are present in natural foods.

Now, there are established guidelines about what's the minimum daily requirement someone should have, and the labels of foods often have what percent of the minimum daily requirement is available with one serving of that food.

The U.S. Preventive Services Task Force has stated that for normal community living women, meaning women not in assisted living or nursing homes, there's no evidence that adding more vitamins can reduce the risk of heart disease or cancer.

And there is some evidence that women who take multivitamin pills actually don't live longer. They don't live as long as women who don't take vitamins.

If you eat a balanced diet, there are no vitamins you should take. Of course, if you're a vegan, you might not be getting the minimum daily requirement of B12, which is in meat and eggs. If you only eat macaroni and cheese, and I have those days, you're at risk of vitamin B deficiencies, and vitamin C deficiencies, but we are talking about women who eat a balanced diet.

Now, what are mineral supplements? Minerals like iron, magnesium, calcium, and zinc, as well as others, have some minimum daily requirements and are found in natural foods. They're usually added in the pills called vitamins and minerals.

There are deficiencies like iron deficiency in women who bleed a lot, and run out of iron, and don't keep up with their diet. But healthy women eating a healthy diet don't need mineral supplements.

Well, what about all those other supplements? Fish oil, melatonin, coenzyme Q, and jillions of others? They are not regulated, there are no minimum daily requirements established, and there's no control over what's in the bottle that you purchase.

For healthy women, there's no need for supplements. And if there were, you would need to be very careful to know what is really in the bottle. If there was a supplement that was really good for something important, you could bet the pharmaceutical industry would jump on it, and produce it, and it would be FDA regulated, and you would know in the bottle. But you don't know, so be careful.

There are certainly some diseases where vitamins, minerals, or supplements would be indicated. People with macular degeneration of the eye may have a small decrease in the progression of the disease if they take a combination of certain vitamins and minerals. It's a small effect, but it's been shown to be useful in randomized trials, so now you can get a pill with that in it.

There are people with pernicious anemia where they can't absorb B12, and they get anemic. This disease is treated with high doses of B12 or injections of B12.

But if you're a healthy woman with a well-balanced diet, and I've said that three times now, four times, there are no recommended vitamins or supplements.

Well, what about vitamin D? Vitamin D is important for our bone health and maybe it has some other effects on the body. We make vitamin D in our skin from sunshine. Isn't that amazing? We evolved outside in the sun, but some of us are inside all the time, and some of us are covered up with long sleeves, and a big hat, and a dermatologist on our shoulder, so some vitamin D would be good. Six hundred international units per day if you're under 70, and 800 per day after that. Of course, there are mushrooms, cod liver oil, oily fish, eggs, or vitamin-D-enriched milk. You get to choose.

But what if you heard from someone, saw on TV or in a magazine, or saw a person who specializes in another type of health practice, and they recommended something? They might say that something supports skin, or hair health, or immune health, or is a substance from another cultural practice, such as Chinese herbal medicine, or Ayurvedic medicine, which is a practice from India. There is no regulatory process that requires that they tell the truth, or that there's really anything in those pills, so be careful.

Be hopeful, because hope is a powerfully positive supplement. Hope and optimism lead to better immune systems, lower risk of cancer, more energy. I am working in my kitchen on a pill for that. But the pills are starting to look a bit like oatmeal chocolate chip cookies with dried cherries and butterscotch bits.

What is in my pile of morning pills? My prescribed pills for arthritis, a baby aspirin to prevent migraine, a vitamin which may slow macular degeneration, turmeric, which might help something or nothing, but gosh, those folks from India are smart, and beautiful, and live a long time, and I'm not that great at cook of Indian food, which has a lot of turmeric. There's some fish oil because it just might help my dry eyes according to the Moran Eye Center. Some of these are for scientifically valid reasons and some are covering my bases with the hopes for good intentions. I call them aspirational supplements.

The decision to take vitamins and supplements that have not been recommended to treat a specific dietary deficiency, like B12, or iron, or folic acid, or a disease is up to you.

Let's say you don't want to eat a well-balanced diet, just tea and toast, or butter and noodles, or just raw veggies. You don't want to be on the lookout for all the essential vitamins in minerals, so just take a multivitamin and mineral pill every day. Good for you.

Let's say that you have aspirational hopes for shiny thick hair, or more energy, and a supplement offers you those things. The scientific data for any claims are very scarce, but you are the only you there is. You get to choose, but choose wisely. Try to get vitamins and supplements that actually might have what they're advertising in the bottle, and not a lot of dust and scary stuff.

But whatever your decision, please tell your clinician. Some of these supplements have side effects in large doses, and some have adverse effects with your prescribed drugs.

Eat your brightly colored fruits, and vegetables, and grains, and think about how good they are for you.

Thanks for joining us on the "7 Domains of Women's Health."

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: Hey, Mitch. Troy's got an announcement that he wants to make, something he wants to tell us.

Mitch: Oh, really?

Scot: Are you excited about it?

Mitch: I'm quite excited. I always love surprise announcements.

Scot: All right, Troy. What's the big announcement?

Troy: Well, Mitch, I'm going to preface this by saying, do you remember that episode we did a while ago about Dr. Turok's male contraceptive gel?

Mitch: Yes.

Troy: It doesn't work.

Mitch: Oh, no.

Troy: I'm just kidding. I was not part of his study. But I'm having a baby. My wife and I are having a baby.

Dr. Jones: Yay. Congratulations.

Troy: This is our first child.

Dr. Jones: Congratulations. Oh, are you in for a ride.

Troy: Oh, I don't think I have any idea what I'm in for. I'm extremely excited. Yeah, honestly couldn't be more excited, but definitely a bit nervous. Baby is due in September. We are just super excited. And I have to tell you the way we announced this baby, and I think, Scot, the way you found out.

Scot: I mean, I'd kind of call it finding out. There were still a lot of questions.

Mitch: Exactly.

Troy: Like, "Really, is this a joke?" Yeah, so we ran . . . Laura had this all planned out. When she told me, I came home from this late shift at 3 in the morning, and she gave me this gift bag that had the positive pregnancy test, said, "Hey, it's an early birthday present." I opened it and was like, "You've got to be kidding me. Wow."

And so, anyway, she had planned this out. We had already planned a marathon. She ran in a shirt that said, "Baby's first marathon," and then sent the picture out to the family and it took them forever to figure it out. I had to then send a close-up of the picture, and still no one responded.

And then I had to say something that says, "I promise this is not a late April Fool's joke," because it was April 2nd. And finally my sister-in-law, not any blood relatives, my sister-in-law figured it out and said, "Wow, you're having a baby." So baby is on the way. We're super excited. Yeah, due in September.

Dr. Jones: Wow. That is going to be wonderful. It's wonderful.

Scot: Today on "Who Cares About Men's Health," we thought maybe you might be able to use a little bit of help. I think as guys . . . I don't know. I can only speak for myself and men that I've observed. It seems like during that nine months we are like, "Well, we don't really have much to do."

Troy: Yeah. "This is easy."

Scot: But maybe we should be looking for something to do. I don't know. So that's what we're going to talk about today. It's the "Soon to be Dad" episode. "Who Cares About Men's Health" is about information, inspiration, and a different interpretation of men's health. Today's crew, as usual, he brings the MD, Dr. Troy Madsen, and dad-to-be.

Troy: That's right. Bringing the MD and bringing the baby soon.

Scot: Bringing the MD and the D-A-D.

Troy: D-A-D.

Scot: I bring the BS. My name is Scot Singpiel. And Mitch Sears just generally makes the podcast better. Mitch, how you doing?

Mitch: I'm doing pretty good. I'm excited for Troy.

Scot: All right.

Troy: Thanks, Mitch.

Scot: And Dr. Kirtly Jones is an OBGYN. She is part of our scoperadio.com family. She does the "7 Domains of Women's Health" podcast. And she is an expert on this sort of thing, not only the technical aspects, but also from maybe what your partner might want. Any dad-to-be support mechanism that you might be offering? I don't know. We're going to find that out.

So, Dr. Jones, do you find that the statement I made about guys during those nine months just kind of think, "Well, I really don't have much to do," true or not? Should we be thinking that? What's your take on that?

Dr. Jones: Well, it can be, but you shouldn't be thinking that. So in the first trimester, and we don't know exactly where Troy and his partner are in their trimesters, it can be pretty rocky because there can be a lot of nausea. And so, when someone is throwing up all the time and they can't eat, there are things . . . First of all, you feel a little guilty because you are half of this creation, but not the part that throws up all the time.

There is something called couvade syndrome where men experience all the symptoms of the pregnancy. They even go into labor. There's a special hut for them. So in some cultures, the men act out all the symptoms of nausea, and vomiting, and back pain, and you name it, and then labor. And then the women just go on about their lives and work in the fields, etc., and raise the kids.

So men can walk away and we know all over the world men walk away from a pregnancy, leaving the pregnant person to deal with all of it. But if you're a pair, and if you're listening to someone throw up all morning, it would be, "What kinds of things can I bring to you? What kinds of things can we have in the house that might make your tummy settle a little bit better?" That's kind of helpful. "I heard that ginger worked for you. I've been reading up about this. Can I bring you some ginger?"

Scot: Troy, would you like to practice that? I'd like to hear you say that.

Troy: I'm just fascinated by this couvade syndrome. So these are men who are actually experiencing all the symptoms of pregnancy? And they're not doing this consciously, it sounds like. They're actually experiencing this.

Dr. Jones: Yeah. It's not a common thing. It's in some cultures and not in others. So clearly there are issues. Some partners want to go over the top and order everything by the time they're 12 weeks, and you've got hundreds of dollars of baby carriers. Guess who gets to pay for it, maybe?

So how much are you going to be in the physical domain? And in the physical domain, your partner is probably going to be experiencing whatever she might be experiencing, but being supportive, like, "Can I help you lift that? I know your back has been really sore. This is getting farther in pregnancy."

If she says, "Gee, I want to go skydiving," you're not going to say, "Is that the best idea?" There are some things that she won't do with you or she won't feel like doing with you.

So by trimester, first trimester is nausea, vomiting, the things that happen physically that you could be helpful with in terms of just saying, "Oh, gosh, that's so awful," and maybe, "Tell me what I can do to help."

Scot: Let me jump in quickly. So we also sent an email around to some women who just recently had babies in the office. And the thing you just said was one of the answers that came back. It said, "I think, for me, it's knowing how . . ." This is what they wish that their husbands knew.

"I think, for me, it's knowing how difficult pregnancy can actually be for women. There were some days I couldn't get out of bed because I was so tired or sick, and my husband didn't really understand at first what was going on. He thought I could just do the same things I did before pregnancy. Eventually, he got it, but pregnancy can do wild things to your body that I think a lot of men don't understand."

Dr. Jones: And it can do wild things to your emotional life as well. So people can feel overwhelmed. They can cry easily. Things about mommy hormones. So just being understanding that things are not going to be the same, and the pregnancy is just the first nine months of the rest of your life that's not going to be the same.

Troy: That's encouraging.

Scot: I was going to say we're like three minutes in. How do you feel now?

Troy: I know. I'm kind of speechless really. But we are in the second trimester now, so things . . .

Dr. Jones: Things are pretty good now.

Troy: Yeah. Laura really had a great first trimester. Definitely the fatigue and nausea. I tried to offer what I could. I'll tell you, just being the very independent person that she is, she did go out and buy all of those things for nausea herself, and I should've done that for her, but . . .

Dr. Jones: No, no, no.

Troy: Yeah, she had her stockpile.

Dr. Jones: You can just say, "Wow, good for you. You're doing an amazing job."

Troy: Right. But yeah, certainly she had plenty of nights where she was just very, very tired, and just fatigued, and didn't have a lot of energy, and just needed a lot of sleep.

It is definitely a process, though, of understanding that and really trying to kind of understand exactly what the other person is feeling, and the emotional impact of this as well. Like you said, definitely a process of trying to figure that out, especially for someone who's going through this for the first time.

Dr. Jones: Women lose their entire sense of their bodies, and some people relish this whole transformation of their body, but some people don't. "Gee, does this baby make me look fat?" So I think it's how do you approach the change in your beloved's body? And mostly you just say, "I think you look strong. I think you look wonderful."

Women often feel quite insecure about the changes in their body, and it's appropriate because they've been invaded, and just being supportive in how they may not feel quite themselves. "What can I do? What can I do to help?"

And then, of course, in the third trimester, when someone is carrying 20 . . . It's like carrying a fanny pack that's got 25 or 30 pounds on your . . . not on your fanny, but in front of you. So you could imagine carrying a 30-pound pack on your waist in front of you. It puts you off balance, and your back can get sore, and you have reflux, and you have heartburn. Some people have problems with carpal tunnel and other things. It's just saying, "What can I do to help? What can make it better?"

Scot: Troy, practice that. Let's hear you.

Mitch: Right now, I want to hear it.

Troy: Yeah. What can I do to help, and what can make it better?

Scot: Yeah. There you go.

Troy: There you go. Yeah. And I think for me, too, a lot of it has been trying to just even identify those things without having to even ask that question. Just looking around and saying . . . As we've talked about before on this podcast, we tend to have a lot of animals at our house. We foster a lot of animals. It's her job. She's the director of an animal rescue group. So just trying to say, "Hey, I'm just going to clean up after these animals and do what I can here to help out."

I find it's a little bit of a tough balance because, like I said, Laura is a very strong, independent woman, and I don't want to come off as patronizing in any way either, like saying, "Well, you're pregnant. You really shouldn't be lifting that," things like that. She's going to lift these animal crates, and she's going to do this stuff. So I do find it is a little bit of a balance there too of . . .

Dr. Jones: Oh, absolutely. And if someone is getting cranky, all you need is someone telling you what you should be doing or shouldn't be doing. By the way, do you foster cats?

Troy: We do.

Dr. Jones: Great. Do I need to give you the toxo talk?

Troy: We're well aware. Yes. I've been cleaning all the litter boxes and . . .

Dr. Jones: There you go.

Troy: Yeah. I am the designated poop scooper in this home. Litter boxes, dog poop, you name it. That's my specialty.

Scot: Troy, we brought Dr. Jones on not just so we could tell you what we think you should do, but so you could also ask questions. I mean, why have a podcast if you're not going to utilize it to your own benefit once in a while? Lord knows we've done it with this one, so . . .

Troy: Oh, I know.

Scot: Did you have anything that you wanted to ask Dr. Jones about? She is really the expert on all of this.

Troy: So many questions. As I've read about pregnancy, I kind of feel like we're in the eye of the storm right now. It sounds like the first trimester obviously can be pretty rocky, and Laura did great and did not really have any significant vomiting, but some nausea, fatigue. And now everything just feels good, and everything is going well. What's coming up next? What's the third trimester going to be like?

Dr. Jones: Oh, it's that 30-pound pack that's hanging off your belt. So, number one, if everything is going well, and her blood pressure stays wonderful, and she doesn't have any leaking of her amniotic fluid, and it's a perfectly healthy pregnancy, it still is . . . people tend to feel a little bit more fatigued. It's hard to find a nice place in bed, because you're kind of rocking and rolling trying to find a nice place.

And of course, she's going to be very pregnant in the hottest months of the summer, and so finding a cool space in your bedroom is going to be important if she wants it.

And then when it gets to lifting the 30 pounds that's on her waist, and then anything else, just say, "How can I help? What can I do?"

So I think probably she's strong. Anybody who just ran a marathon in pregnancy is very strong, and she's probably going to cruise through her third trimester really well. Not all women do that. For some women, they have back pain, headaches, carpal tunnel, swelling feet, things that make them feel enormously uncomfortable, and then there's labor.

Troy: Probably the most intimidating part to me is thinking about that process, labor, and what to expect there, and how do you deal if there are complications. And again, the challenge for me is I just see everything that goes wrong with everybody's lives.

Scot: In the ER, yeah.

Troy: In the ER, yeah. I do, and I see the bad outcomes. I will tell you, I had a very emotional experience recently, and it's just crazy the timing of this, of caring for a baby who just was delivered right outside the door of the ER. With a baby on the way, that's something else. I mean, you try to push your emotions aside.

And fortunately, everything went beautifully, could not have gone better. But 6 a.m. on a night shift to have that happen. So I definitely have felt the impact of this emotionally where before I might not have felt that as much. I was like, "Oh, wow."

Dr. Jones: So you felt different?

Troy: Oh, yeah. No question about it.

Dr. Jones: So you already are emotionally a new guy. You're a new guy because of what's happening.

Troy: Oh, without a doubt.

Dr. Jones: And it wasn't a cognitive choice. It just happened.

Troy: Yeah, without question. So I guess in terms of when labor comes and when that time comes, what do we expect at that point? What do I expect as a father-to-be, and how can I be supportive through that process?

Dr. Jones: Well, I think that's another situation where you're going to need to take your partner's lead on this. For some women, they want to take classes, they want their husband there doing back massage, they want someone helping them do counting with them.

My husband actually, as a neurologist, had some experience in hypnosis. So he and I practiced hypnosis, and he did hypnosis through the first 20 hours of my labor until the 11.5-pound baby was really not going to fit, and we had the baby, had a C-section.

But he was right there for me. And it was hard watching someone who's completely in control all the time and needs to be in control lose it. So it's just being there. But let her ask you. Let her tell you.

The paradigm that you see on TV, which I've seen so many times, is the couple are working together, they're doing great, and then she gets in this magic situation called transition when it's just before she's ready to push, and she's screaming, "Get out of the room. I never want to see you again. Don't you dare touch me." You guys have seen that on TV, haven't you?

Scot: Oh, yeah.

Troy: I've seen it in person, yeah. In emergency medicine, I've had to deliver at least 10 babies. I spent a month on OB, and I've seen it all. So when I say I've been there . . . But it's so different as a healthcare provider, and then when you're there and seeing this person you love and you care about go through this, I think that's the challenging part.

Dr. Jones: It is.

Troy: How am I going approach this? And obviously, there's that part of me that can very easily switch into clinical mode and doctor mode, and I don't want to do that. I don't want to try and be the doctor in the room and trying to be very unemotional or clinical. But at the same time, I'm concerned that I will feel a little overwhelmed by this as well.

Dr. Jones: You will, and you should. It's overwhelming.

Scot: Overwhelming how?

Troy: I'm sure I'm going to experience a lot of anxiety going into this and, "Is everything going to go well? How are things going to turn out?" Certainly a lot of very deep empathy for Laura as she's going through the labor process, and just wanting to do anything I possibly can to ease that process for her, and wanting to be available to her to whatever I can offer.

Yeah, there's going to be that excitement leading up to it, just the anticipation of this new baby. I'm concerned about feeling overwhelmed with this. Like I said, I'm the kind of person who likes to keep my emotions in check, no doubt.

Scot: If you are moved to cry . . . Are you going to be in the room during the delivery?

Troy: Oh, I'm sure I will, yeah. I joked with Laura that I'm going to deliver the baby, but she didn't like that idea. I told her, "I'm an expert. I've done this. Trust me."

Dr. Jones: Ten times.

Scot: Is that because you want to save some money? Is that what you're trying to do?

Troy: Exactly. We're going to save a little cash on this kid, avoid the hospital copay.

Scot: That's right. Some guys do their own plumbing. Troy delivers his own kids.

Troy: "I got this. I got this."

Scot: If you find yourself emotional, like where you might cry because it's such a beautiful moment, are you going to fight that back, or are you going to let that happen? And, Dr. Jones, what do you think about that? Is that what a guy should do or not?

Troy: Scot, I would love to tell you I'm just going to let the tears flow, but I know myself too well, and I'm going to try and hold them back. I'm going to do the same thing I did when we first had our ultrasound at 14 weeks, and I saw that baby and that image of the baby. Laura looked over at me, and I sure tried to hold them back. And afterwards she said, "Were you crying?" I said, "No, I wasn't. Of course not. Why would I do that? Eh, maybe a little bit." So I'm sure I'll try and hold it back.

Dr. Jones: Well, even if you do, you can say, "Well, I'm overwhelmed." You don't have to let the tears fall if they're not right for you. I mean, we've seen it all. And sometimes the experience is totally scary. It is very scary. And of course, I'm a former OB, so I also think of all the things that can go wrong. And a first baby, it just never always goes as you hope. It's just a little different in some way than you hope.

But what you want is you want to be with a team that you completely trust, and that's the biggest thing. Whoever is there with you, wherever you choose to have this baby, you want to be with a team that's going to be there for you. So you don't have to be the doctor in the room.

Scot: Now we're going from Troy being DIY to Troy recruiting like he's the general contractor. He's recruiting his crew. Going around to his friends.

Troy: I've already done that. As soon as Laura told me that night, the next morning I emailed someone I know well who's done lectures for our residents, who has been the OB for several of my friends and colleagues, and I emailed her that first morning and said, "Please, I'm scared." I didn't say, "I'm scared," but I'm sure she could tell I was scared. I was like, "Will you be our OB?" And she was wonderful and got right back to me. Yeah, I'm very happy to be working with her and have her caring for us and for our baby.

Dr. Jones: Good. Well, I think that you are . . . you know what's going to happen. You're going to let her run the agenda as she's pregnant in terms of asking you for what you need, and letting her know that, within the limits of you taking weird hours and call, you're going to be there for her.

And then what happens is after the baby is born, the first couple of months, where there's a baby up all the time, do you help out with that? Does she help out with that? How much breastfeeding are you going to do?

Scot: Yeah, Troy, do you help out with that?

Troy: I'm planning to, trust me. I'm all in on this, and she's made it clear I'm helping out with this too.

Mitch: I mean, he's already a poop scooper.

Troy: I'm already a poop scooper. Diapers are going to be easy. That's going to be a piece of cake. That will be a relief from what I usually have to deal with.

Scot: Dr. Jones, I cut you off a little bit there. You were leading into breastfeeding. Where's Troy's involvement in that, though? He can't help there, can he?

Mitch: Yeah, that's actually one of the questions from our new moms, was how do men help during that process?

Dr. Jones: Well, they can bring the baby. So if they're not co-sleeping, and there are lots of opinions about whether babies should sleep in the bed, but if the baby is in a crib nearby, you go get the baby, you can change the diapers for the baby, the mom can breastfeed and put . . . How you work that out is a rhythm that every couple establishes.

Troy, you're used to sleep deprivation. And maybe your partner is really good at it, maybe she's not. So how you begin to juggle that is something that each couple finds their own way. I'm sure you're going to do great. That's the reality, is when there's love, you guys will do just fine.

Troy: Yeah. Again, for me going into this . . . And we've talked a bit about how this is going to look once the baby is born, and how all that works. That's kind of the approach I'm trying to take. I'm going to be available. I'm very fortunate that working through the university, I do get paternity leave. I'm absolutely taking it, and I want to do everything I can to help Laura, whatever it means in terms of sleep deprivation or getting up in the middle of the night.

And like you said, my hope is just that we can figure out how that works and how that looks exactly over those first couple of weeks. And I guess that'd be my question, too. Do most couples then . . .

Dr. Jones: Couple of months.

Troy: It's a couple of months to find that pattern? Okay.

Dr. Jones: Well, the baby is always changing. So they call the first three months of a baby's life who's born at term the fourth trimester, because they are still on truly autonomic phase. They just sleep, and poop, and eat, and that's about all they do. And then at about 2.5 to 3 months, they come up with a smile and then everything is perfect as soon as they smile at you.

But it's hard because just when you think you've got Plan A, the baby has changed, and then you have to say, "Oh, I guess we're going to work with Plan B." It's just being flexible.

It's being aware that moms don't always feel on top of their game emotionally after a baby is born. They can feel kind of overwhelmed. They can feel like their independence is gone. Some women have postpartum. Everybody gets baby blues. It's a period of a day, or two, or maybe even a week when they say, "Oh, this is really hard." But postpartum depression affects a lot of women, 20%, when Mom's mood isn't really enough, isn't up to the task, and she needs more support.

You just kind of have to be aware and ask her, "How are you feeling? Is there anything I could do for you today?" As long as you're talking, as long as you're emotionally available to each other, you'll do it fine. It's amazing. It's the last refuge of the rank amateur of this parenting thing.

Troy: The last refuge of the rank amateur.

Dr. Jones: Right. So do you know if you're having a boy or a girl?

Troy: This is a girl.

Dr. Jones: Congratulations.

Troy: A baby girl on the way.

Scot: Really?

Troy: Yeah, a baby girl.

Dr. Jones: Wow. Congratulations, It's just magical. It's going to be just magical. Not that boys aren't magical too. They both are.

Scot: Are you sure about that? I was wondering this morning, I was like, "I bet you they're going to have a boy."

Mitch: Yeah, same.

Scot: I mean, might want to double-check that.

Troy: We've got another ultrasound coming up shortly, so we'll have them take another look, make sure they got it right. They seem pretty confident.

Scot: Yeah. So there was one other one. It's "Should new dads go to the appointments during pregnancy and after?"

Dr. Jones: I think that's what the partner wants. My husband was a resident. I was not going to have him . . . This was in the old days when residents never, ever, ever . . . they didn't have an IV, and if they didn't have . . . straight out of the operating room. They did not miss a day. So I was not going to ask him to go to any of my appointments. I think you do what she wants.

Troy: Yeah. And she's asked me to go, and I've been able to go with her. So, again, yeah, you're right. I think it just depends on your situation.

Scot: And what's your role in those appointments then? Is it just to be there? Is it to remember things that have been talked about?

Troy: I mean, I think my role has been more just to be there with her, and I really have tried not to . . . Again, avoiding going into doctor role. I've been trying to just be there as husband and future father and just be there with her. I've tried not to ask a lot of questions or anything like that. Let her ask the questions she wants to ask. Let her OB talk to her, and not feel like she has to be talking to me because I'm the other doctor in the room or anything like that. But yeah, it's really been just being there. And that's what it's been so far, just being there with her and she . . .

Dr. Jones: Well, if you have a question, it's a good thing. I mean, I really liked it when husbands had questions. So if you have something to ask, then it's appropriate to ask.

Troy: Yeah, for sure. And the good news is everything has been so straightforward so far. I really haven't had to ask anything, and Laura has asked the questions I think that needed to be asked.

Scot: Oh, you're grading her now?

Mitch: That's what I was going to say, yeah.

Scot: She's asked the questions that she needed to ask.

Troy: I had my checklist in my mind and she passed.

Mitch: Backseat doctoring.

Troy: Not at all. I mean, I think they were just questions that we talked about beforehand that she had. And that's probably why I'm there too, because she may have had some questions in her mind. But yeah, we really have talked a lot about those things beforehand, and she's asked me questions.

And then in this case, I don't want to be the doctor to my baby or to my wife, so I've just provided my opinion but have tried not to steer the conversation when we're with the OB.

Dr. Jones: Of course. You're a natural already.

Troy: I wish. I feel far from it. Like I said, I feel inadequate. That's how we started this episode. That's probably a good summary.

Dr. Jones: Thank you for using your words.

Troy: Yes. I feel inadequate. That would be the absolute best word to describe how I feel.

Scot: Congratulations, Troy.

Troy: Thank you.

Scot: Yeah. On behalf of Mitch and myself, this is your baby present.

Dr. Jones: Oh, great.

Troy: I could not have asked for a better gift. This is my man shower. You guys just held a man shower for me. I couldn't have asked for a better man shower.

Scot: Yes. Dr. Jones, thank you so much for being on the podcast and talking to our nervous new dad, and thanks for caring about men's health.

Dr. Jones: What a treat. Talk to you soon.

Troy: Thank you.

Dr. Jones: Bye.

A baby that is wanted and planned for, a child by choice and not by chance, that is what modern contraception offers men and women. But you have to know what's out there, how it works, and where to get it. This is really important now more than ever.

This is Dr. Kirtly Jones from Obstetrics and Gynecology at the University of Utah Health, and this is the "7 Domains of Women's Health" on The Scope.

Women and men all over the world have wanted to plan their families for thousands and thousands of years, but methods used in Cleopatra's time in ancient Egypt probably weren't as effective as what is available now. If no method of contraception is used, women in sexual relationships that would make them pregnant could expect to have more than 11 babies. That's in these days of good obstetrical and pediatric care, where women are less likely to die in childbirth and babies are much less likely to die in the first five years of life. Eleven babies sound like too much? One more baby sounds like too much right now?

Let's talk about contraception. It's an egg and a sperm problem. You need to stop egg production, stop sperm production, or stop the sperm from getting to the eggs. These are the main ways that modern contraception works.

About 50% of unplanned pregnancies happen to people who are "using" contraception but using it incorrectly. This is the most common reason that methods like abstinence or periodic abstinence, think natural family planning, or methods like barrier methods like condoms or diaphragms actually fail. They weren't used correctly or at all. Methods that you have to think about at the time of sex are more likely to fail because you're more likely to fail to use them. If you combine two methods, abstain during your fertile period and use condoms all the rest of the time, your chance of getting pregnant by accident is much lower. Two methods are better than one, and this is a combo where men can be the important user. You can get condoms most anywhere, and anyone with some smarts and gumption can figure out their fertile period.

So let's talk about hormonal pills, patches, and rings. They are considered moderately effective methods or ones that have an annual failure rate between 1 in 10 to 1 in 100. That means if women use them, the chance of getting pregnant is about 1 in 10 to 1 in 100 per year. Of course, you might be at risk for pregnancy for multiple years, so these chances literally add up. Considering a lifetime of contraception using these methods, it was calculated that women would have about two unplanned pregnancies. These methods work by blocking ovulation and by changing cervical mucus so sperm cannot get to the eggs, but women don't always take the pills, or patches or rings correctly. They miss some days or they stop for a week as directed, but they stop for longer than seven days, and they are very likely to ovulate. But you could team up with your sex partner and use a moderately effective method and condoms and get much more bang for your buck birth control-wise.

Hormonal methods aren't right for everyone, and you should know by reading up or asking knowledgeable clinicians if they're right for you. Now, there may be immense hormonal contraception on the horizon, transdermal hormones to block sperm production. If it has about a 10% failure rate per year, and women taking the pill as they will, not perfectly, have a failure rate of about 10% per year, if both members of the sexually active couple use the method not perfectly, the failure rate would be about 1 in 100 per year. The two methods multiply in terms of their effectiveness. If they both used effectively, if they both, men and women used hormonal methods effectively, it would be about 1 in 10,000 women per year, and that is effective contraception.

Now for highly effective methods, these methods have failure rates of about 1 per 1,000 women per year. They are so good because you don't have to think about them and using them correctly almost always happens. These include copper IUDs, hormonal IUDs, and hormonal implants under the skin. The hormonal implants' primary method of action is to work by blocking ovulation. The IUDs' primary method of action is by blocking sperm. Copper in the copper IUD kills sperm on their way up to the egg, and the hormonal IUD blocks sperm from getting through the cervix. The IUDs and implants are highly successful at preventing pregnancy but require a trained clinician to put them in. They last a long time, the copper IUD for 12 years, the hormonal IUD for 5, and the implant for 3, but they are immediately reversible as soon as they come out.

Now, all contraceptive methods have some side effects and risks, but none have as many risks and side effects as an unwanted pregnancy. Uh-oh, did you just say, "Oops?" Did you forget to take your pills? Did the condom slip off or stay in his back pocket? Was sex forced on you and you weren't using anything? Emergency contraception is for people who had unprotected or under-protected sex. They are pills over the counter or by prescription, that must be used in the first three to five days after the unprotected sex act, and the earlier, meaning the next day or the day after, the better. The copper IUD and hormonal IUD can also be used for emergency contraception, but they aren't FDA approved for that use, and you have to find a clinician to place one in a timely manner.

Using contraception means some work on your part. You have to know what you can use and want to use. You need to know where you can get them. You need to know how you can pay for them. All this information is available from many sources, but an overall good resource is bedsider.org. Many clinics around the country provide contraception on a sliding fee scale based on the ability to pay. Most insurance plans pay for a significant amount of the cost of contraception. There's a national family planning grant called Title X, that provides low-cost contraception to anyone who needs it, and it's available in most states. But you have to lace up your boots or put on your flip-flops and do it. Children deserve to be by choice and not by chance now more than ever. Thanks for joining us on The Scope.

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: Troy, I've got a question for you.

Troy: Yes.

Scot: Are you emotionally available?

Troy: If I even knew what that meant, I would know how to answer it. Let's start with that first. I don't even know what you're asking me, Scot. Am I available to your emotions? I don't know.

Scot: Mitch, are you emotionally available?

Mitch: I guess it's how . . . I think I'm more emotionally available than I once was, but again it's . . . Yeah, I don't know, man. Maybe.

Scot: Troy, it sounds like Mitch knows what that means.

Troy: I know. Mitch apparently got past Step 1, which I haven't.

Scot: We might have to defer to him. This is "Who Cares About Men's Health," giving you information, inspiration, and a different interpretation of men's health. "Emotional Availability: I Guess It's a Thing." That's the name of this episode.

Today's crew. He brings the MD. It's Dr. Troy Madsen.

Troy: I'm trying to be available to you, Scot. Yes, I am here physically. I don't know that I'm emotionally available, but I am physically available today.

Scot: The BS to his MD, that's what I bring to the show. My name is Scot Singpiel. And he just generally makes the podcast better, it's Mitch Sears.

Mitch: How are you doing today, Scot?

Dr. Jones: Very nice.

Mitch: Look at me. Emotionally available. Boom, boom, boom.

Scot: And that lady voice you hear on this very manly podcast is one of my most favorite people ever. She is the host of one of our sister podcasts or brother podcasts. I don't know if they have a gender really. But "The Seven Domains of Women's Health." You can find that on thescoperadio.com. It's Dr. Kirtly Parker Jones. Welcome, Dr. Jones.

Dr. Jones: It's an honor to be here.

Scot: All right. Troy, I'm going to tell you how we ended up at this place of emotional availability. We were on Dr. Jones' podcast about men and crying, which, conveniently, when we told you about it, you're like, "Oh, I've got something that day."

Troy: I promise I did have something that day.

Scot: Yeah, I'm sure you did have something.

Troy: I did.

Scot: So Dr. Jones brought up . . . she said, "You know what?" We said, "We'd love to have you on the show. What could we talk about?" And she said, "Well, why don't we talk about emotional availability in men for their partners?" And Mitch and I are both like, "Yeah, that sounds great." And then Mitch and I both went to Wikipedia to find out what that meant, and we still don't know.

So, Dr. Jones, let's start right there. What does being emotionally available mean? And how does that tie back into health, men's or otherwise?

Dr. Jones: Great question. It might mean things to different people differently, but I would consider that emotional availability is a state of mind where you are able to recognize the emotions in your own self. Then you might be willing to express them, label them, and help regulate them. And then, with the practice of understanding your own emotions, you are more able to understand, or at least listen, to the emotions of your partner.

So, developmentally, it's been suggested that because girls are raised to be like their mothers -- now these are old-fashioned developmental theories -- they are more tied in with their mother's emotional state. Boys are raised to be more like boys, therefore not like their mother and therefore somewhat distant.

So you can say that the issue of emotional availability is a new one, but it's as old as "men are from Mars and women are from Venus." It's the difference between men and women. And I think that those sexual stereotypes need to be thrown away because there are certainly women who are not emotionally available and there are lots of men who are.

Troy: So why is this referred to as emotional availability? Because it sounds like it's a lot more . . . like you said, really the first step is it's more emotional awareness, like understanding our own emotions, and I guess then it makes us available. But sounds like it's a lot of awareness involved.

Dr. Jones: It is. You have to be emotionally available to yourself first. So there's some work to be done or you need to raise them that way in terms of your children. There's a great Crosby, Stills &Nash song, which none of you have even heard because you're too young. "Teach your children well, their father's hell did slowly go by." So I think we need to teach our children to be emotionally available by our own examples and by verbalizing how we are feeling, and so our children can feel.

Once you are emotionally available to yourself, then you are more willing to be emotionally able to listen to, reflect, work with your partner's emotions.

Now, I consider it kind of a girly whine. "You're not emotionally available to me." But in fact, if you're not emotionally available to yourself, this concept of emotional intelligence, then a lot of anger, fear, anxiety goes unaddressed, and it makes people sick. Their immune system doesn't work so well. Their blood pressure goes up. A lot of chronic diseases in men might be tied to inner frustrations, anger, fear, anxiety that they aren't labeling, expressing, and able to process.

Now, when you live with someone, it's nice to be able to at least empathize when circumstances make them sad and reflect on them. You might ask your partner, "Would you like me to be emotionally available to you?"

Scot: Oh, boy.

Troy: Yeah, that was going to be my next question for you. How effective is this really? And do you recommend it? I totally get being aware of our own emotions and recognizing them and acknowledging them, but it seems like it may not go over super well if we're saying to our partner, "You seem really angry right now." I don't know. "I sense a lot of anger."

Scot: As Dr. Jones was talking, Troy and Mitch, I'm sensing this recurring theme that we've talked about, right? That sometimes as men, we don't recognize what our emotions are. We don't label them. We don't really think, "Well, why am I feeling this?" We don't sit with them. We don't want to deal with them, right? And we know the detriment that has on our health, but I'm starting to see that maybe that could have detriment on relationships, which ties back in to emotional health again.

Before we get to Troy's question, Mitch, you wanted to ask something?

Mitch: Oh, yeah. As you were explaining being emotionally available to yourself, it really kind of rung true with me because I've been starting my own little mental health journey. And one of the things that I kind of ran into is one of my very first meetings with my latest therapist was like, "Hey, I have a tightness in my chest. I don't know what I'm feeling. I can't think straight, whatever." And it took him talking me through the physical sensations to recognize the emotions that I was feeling. He's like, "You sound like you are anxious. You sound like you are worried. You sound like you're whatever." It's like I couldn't even recognize that in myself, right?

And what was interesting about it is that constant anxiety, that constant kind of stress and worry that I was experiencing, but not recognizing, I wasn't aware enough to figure something out to fix it.

And secondly, it was taking a real impact on my health. I was having everything from problems with clenched jaws, to higher blood pressure, to all sorts of issues that immediately started to change as soon as I started to at least recognize the emotions and was able to start problem-solving, which I think is the step I was trying to jump to without even recognizing what the problem was, like a typical man.

Dr. Jones: Wow. Mitch, that's amazing.

Scot: Do you feel a little like a Neanderthal that you're like . . .

Mitch: Yes.

Scot: . . . "What is this strange emotion? Oh, it's anxiety."

Mitch: I do.

Scot: To me, it sounds silly, but you know what? I found myself in that same situation, too. It's kind of crazy, isn't it, that we wouldn't know what these emotions are?

Mitch: Well, I felt dumb and embarrassed almost. Luckily, I love and trust my therapist, but there was this kind of situation where it was like, "Ugh, what do you mean? Of course, it is." I've been dealing with this for a year now, and, "Oh, of course it is. Duh."

Dr. Jones: Well, remember, for men, they may have had it modeled. So the only primary emotion, which is love and happiness, and fear and anxiety, but the only one you may have seen exhibited in your life was your father's anger, or maybe your mom wasn't available either. So that's the only one you've got that you might actually have a label to, because you saw the men around you get angry. And that one you get, but there's a lot more inside.

Primary emotions are ones that immediately cause a physiologic response. And if you have the physiology, but you don't have the word, then you can't really dig down into why this is happening. Is it good or is it bad? I mean, I hope you kind of know when you're happy.

Mitch: Sure.

Dr. Jones: I hope that one comes up and you're like, "Wow. I feel happy," instead of, "Gosh, why does my chest feel a little bigger and why do I feel I can have more air? Oh, maybe I'm happy."

So you may not have had it modeled for you. It may not have been taught to you, or bad things could have happened when you were growing up that made you stuff everything down. So, for men and for women, the difficulty of being emotionally available to yourself is that you either didn't have it modeled or you stuffed it someplace because it hurt.

And those kinds of things in a relationship . . . I think your concept, Troy, if you say, "Gee, you look like you're angry," what I have learned from my husband and a 50-year relationship is that I cannot guess what he's emotionally feeling because sometimes I guess wrong and it does not go well.

So if I say, "How are you feeling?" or, "Are you feeling something hard right now?" then he might tell me. I want someone that when I start to cry or when I get upset about something can come over and at least put his arm around me. He doesn't have to say, "Oh, I see you're so sad because something has happened to our son," or your car isn't working, or whatever. At least I want him to come over and recognize that I am feeling sad or I'm feeling anxious or worried, and he'll put his arm around me, which says, "I know you're not feeling very good right now and I'm here for you."

So that's what being emotionally intelligent . . . I want him to at least recognize when I'm in emotional distress. And likewise, if he's in emotional distress, I'd rather not walk around the house on tenterhooks thinking, "Oh my God, what is wrong? Is it my fault? Is it his fault? Whose fault is it? Did I do something wrong?" It's better for me to kind of know.

You don't get to 50 years together unless you've kind of, sort of worked things out, unless you're just strapped down and you have no choice.

Troy: It sounds like then you're saying in terms of emotional availability, it's one thing for us to identify the emotions in ourselves, but it's maybe not the best idea to try to identify the emotions in others. But at least make ourselves available to them and at least tell them that maybe something seems off and at least open the door if they want to talk about those emotions that they're experiencing.

Dr. Jones: Exactly. Because if you come up to me and say, "Gosh, I think you're angry," that's going to piss me off.

Scot: No, no, no.

Troy: Even if you are angry.

Scot: It's always a question. "How do you feel about that? How are you feeling?"

Troy: Exactly.

Mitch: One of the things that I had trouble with for a long time is I'd be . . . I'm a chronic projector, and I'd be like, "Are you mad at me?"

Dr. Jones: Exactly.

Mitch: "Are you mad that I did something like this?" Then I'm also assuming, right? I'm assuming you're feeling a certain way and I'm also assuming that it's my fault, right? And that's not a good dynamic to have with anyone.

Dr. Jones: No. Don't assume that you know what they're thinking. But being emotionally available means, "I feel like something is hard right now. Can we talk about it?" or, "Is there something I can do to help you with this sense at being unease, lack of ease?" "Well, yeah, the planet is exploding and there's global warming and we're getting shot in streets and . . ." "Wow. Yeah, boy, that is awful. Do you want to talk to me about that some more?"

Scot: So what I'm getting here, emotional availability, first of all, as men, we have to begin to recognize our own emotions and identify things other than anger.

And I loved what you said. A lot of times we talk about when you need to seek a health professional, whether that be a licensed clinical social worker or somebody else. And a lot of times, as men, we talk about to have some tools to deal with things.

But I think another thing that Mitch just pointed out is to maybe start recognizing emotions that we've never been taught about as men before in some instances. A lot of men maybe have, and I think things are getting better. I don't know if you'd agree or not, Dr. Jones.

Dr. Jones: I do.

Scot: Yeah, as we move forward. I can speak from my own experience. I came from very stoic people. So I probably don't know half the things I feel most of the time. So the first thing you've got to do is recognize your own emotions, and then that's when you can start to become emotionally available to somebody else. Show us what that might look like.

Dr. Jones: Well, how it might look like in yourself, it's what I call the RULER project, which we've done a podcast on actually, which is recognize that you're feeling something that's uncomfortable or something. You're feeling something. Understand what it was. What was the trigger that made you feel that way? Can you label it? Can you give it a word? Can you explain it or express it to others?

That's the step that . . . if someone in my family were upset and they said, "I'm just feeling upset. I'm feeling so sad," or, "I'm feeling really angry," those are the kinds of things that really help someone not get in your way. Or, "Can I help you with that?" or, "What can I do to make this better?" which you probably can't, or, "I want to hear about this because you're important to me."

That's what it looks like when someone is able to say, "This is what I'm feeling and it doesn't feel good," or, "This is what I'm feeling and it feels really good," or, "I'm really happy. And it makes me anxious because I'm so happy."

And then the other person is able to then say, "That explains why you've been stomping around the house all day," or whatever. That kind of opens up a little bit of a dialogue so that people can value each other.

And for guys, in particular, for who modeling emotional intelligence has not been really made clear to them, there's been a lot of shame. So if you feel anxious or if you feel sad or if you feel fear, it's not been okay.

When I look at the uber sort of masculine men on movies, those guys are just . . . I think of the new Jack Reacher. I think, "Wow. I would never want a relationship with that guy. I see his anger. Boy, oh, boy. But I don't see anything else in him."

So I think that many people, men and women, are looking for a long-term relationship, which means, "I want someone to be part of my emotional life, not just my physical life. Not just my cooking or the house that we share. It needs to be a little bit more than that."

Now, once again, not all women are terribly emotionally available, and some men are very. And for some women, they may attach themselves. Women say, "Well, why do I pick these guys? Why do I keep picking these guys?" Well, they also may have this kind of distance modeled for them in their father and it's all they know.

Or they think that not showing emotions is strength and they want to attach themselves to strength because they are anxious. They're not self-confident. They want that burden laid on the guy in their relationship or the other person in their relationship. And having one person be the strong one and the other one being the emotional one. That's kind of hard. You ought to share this stuff.

Mitch: I had a question kind of relating back to mine. I love the RULER technique. I think that, for me, I really appreciate acronyms and strategies and whatever. But that L, that label, I have run into feelings that I don't have a name for, and the best I can do . . . And it's probably modeling and I have to work with my specialist to kind of figure out what it is. But you come up with, "I feel oogie. I feel meh. I feel blah."

And so is there . . . I don't know. I just feel like such a novice here where it's just like, "Is there a guide?" Is there something that I can see all the feelings I could be having or emotion should I should be having and I can kind of point to that.

Troy: It's like the pain chart, the little kid pain chart. "That's my pain right there."

Mitch: The sad face.

Troy: The sad crying face. Yeah. We need the equivalent for men's emotions or something.

Dr. Jones: Well, there actually is an emotional wheel.

Mitch: What?

Dr. Jones: So the people who looked at primary emotions say, "These are the ones that have physiologic consequences and they're immediate." So they happen to you even before you can give it a label. It just is an immediate response fear. Maybe love, happiness, anxiety, you know when it happens because it happens so fast. There are secondary emotions which are combinations of primary and secondary emotions.

Now, what they might feel like? Any strong emotion can raise your pulse and raise your heart rate. Although true Agapeic love, I think, actually can make your . . . I mean, the love of a child, the love of a very good friend can bring your blood pressure down. Holding hands with someone that you love, that actually brings your blood pressure and your pulse down. And they've done this in MRIs and they've looked at what parts of the brain are activated.

Getting a good therapist is a really . . . You say, "I don't know what the name is I'm feeling, but this is how I feel. This happened to me, and this is why I felt like that." If you could say how you feel and you understand what made you feel like that, you might be able to come up with words.

Oogie, I need a little help with oogie. I got oogie. I can kind of feel oogie. I feel oogie below my diaphragm. It's not above my diaphragm. I don't feel it in my heart. I feel it below my diaphragm. Well, what were the things that made you feel oogie? If you told me what made you feel that way, I might be able to put a label on it.

But there is a very beautiful wheel, emotional wheel, that gives people a . . . I can send you guys a link for this and you can work on it, if you'd like. You can spin it around, see how you feel.

Scot: How do you start that conversation if you're the partner and you're thinking . . . Well, actually it could go either way, right? So you're the partner and you're thinking, "You know what? I would like to explore this idea of emotional availability in my existing relationship." Or you're the partner that maybe you're thinking, "I wonder if my partner actually would find more satisfaction in the relationship out of this." I mean, it could work either way. How would you start to progress forward? Because even that name carries baggage, right? Emotional availability to some people could sound . . .

Dr. Jones: It does. It means somebody isn't. It means blame, blame, blame already.

Scot: Or it could just be like, "Oh, that's touchy-feely, I'm not into that."

Dr. Jones: Well, you can just say, "I've been thinking about this." Either one, the person who's got more emotions or the person who's got less emotions, "I've been thinking about this and our relationship is important to me. I do or don't want it to be . . ."

"It's uncomfortable when you cry at the table, but I don't want to shut you off or I don't want to be blocked off from you. So I'd like to learn how to talk about this." This is the guy who sees his wife cry about stuff or his girlfriend or his boyfriend or whatever, and he just doesn't get it. But he loves this person. So, "I see you cry and I need some help. I need some words. Are you willing to work with me about that?"

And then if you're the person with more emotions, "I've been thinking about this and I love you and our relationship is really important to me, but I need to feel that you're tied with me to the things that I feel strongly about. Can we talk about it? I cry at the table because I'm sentimental. All we have to do is talk about my family or our son, and I start to cry, and I don't want you thinking it's sad because it's not sad. It's sentimental. Can we talk about what words I use and how it might make me feel and what I want from you when I feel like this?"

So I think it's better than rather than saying "you" words . . . You guys already know this. "You do this, or you don't do this, or you are feeling this." It says, "This is the way I feel. And can we talk about it?"

I think it would be good if we had a long-term relationship based on the support of each other's feelings, not just our physical needs, or our financial needs, or our spiritual needs, or you name it. I'll go through all the 7 Domains without you guys even knowing it.

Troy: See, Dr. Jones, I want to take a moment here just to put this in perspective. Our most recent episode was on poop.

Dr. Jones: Yeah. And you know what? Your emotions can come right through with your poop, because people who are really anxious can get diarrhea.

Troy: I'm just saying this is hard even for me to think about it. So I am empathizing with any man out there right now who is listening to this and hearing you say these things and saying, "These are things we can say to our partners." This is a stretch. This is tough.

And I agree. I have definitely taken the approach of, for whatever reason, you kind of push emotions down. And it's hard to acknowledge those emotions in a partner and ask them to express those emotions. I think maybe we are afraid of what they're going to say, or we're afraid of being responsible for those emotions or triggering those, or whatever it might be. But yeah, this is a lot harder to talk about than poop. I'll say that.

Scot: So, Troy, question.

Troy: Yes.

Scot: Question for you, Troy. All those things that Dr. Jones just said, if that was coming from your spouse, would you, as a man, with your history, cringe a little bit? Would you be like, "Oh, boy, here we go. I don't know about this. This sounds pretty intense"?

Troy: I would cringe a bit. Yeah. I will say, honestly, I feel like . . . and maybe Laura will disagree. She'll listen to this and be like, "No, you haven't." I will feel like I've made progress there.

I think, like you said, Dr. Jones, the key to this is just acknowledging your own emotions. Often, I've really tried to acknowledge more, "Okay. When am I feeling anger? When am I feeling anxiety? And what's the root of that?" And a lot of times it gets down to, "Oh, I'm sad and it's coming across as anger," or, "I'm anxious. I've got a shift coming up in the ER and I'm feeling anxious about it. And that's coming across as, again, maybe as anger." It seems like a lot of these things come out in men as anger, and I've definitely felt that in myself.

Dr. Jones: They do.

Troy: But again, hearing you say those things, I think, for me, emotional availability has been trying to be more aware of my emotions, and often what the root of . . . Even what may seem the emotion, there's a deeper root to that. And then be willing to express that and talk about it. But it's hard.

Dr. Jones: It is, but the work is worthwhile. Maybe Mitch can even speak to this. It gives you a much broader palette with which to paint the tapestry of your life. When you have some words, some colors to explain the things that you've seen . . . You have a powerfully rich life, Troy, in what you've seen and how you deal with that, the words you use or how you color that, what an amazing life you would lead if you had a little bit of contact with those.

Mitch: And from my perspective to "man it up a little bit" is another tool in the toolbox, right? No, if you don't have the right socket, you can't fix a certain thing on your car.

And so, for me, I knew that I was not in a good place and it wasn't until I was able to actually recognize, discuss, and talk about, even to myself just in my head, the emotions I was feeling, there was no way for me to actually start to work to fix it.

And so if that's the very baseline of at least my . . . Yes, I'm living a more full life. Yes, yes, yes. I feel it every day. But for a part of me, not feeling like garbage all the time and being able to know that I'm taking active steps to fix it, and all it took was a bit of acknowledgement and a bit of vocabulary, has been night and day within the last year.

Dr. Jones: Yeah. Amazing.

Scot: Would you say that there are two aspects . . . I'm picking up two aspects of emotional availability. I think Troy has kind of hit on one, right, which is a man's ability to talk about what they're feeling, thinking, etc. But it's also a person's ability, whether a man or a woman, to be receptive to the emotions of another person. And we haven't really hit on that as much. How can somebody start to work on that?

Dr. Jones: Well, I think once you've learned . . . getting back to starting with yourself, if you can forgive yourself . . . When you say, "This emotional response is normal. It's natural. It's real. I'm an intact human person, and I forgive myself because I felt angry or sad or whatever," then when you realize that someone is feeling that way . . .

In fact, it's often not about you. I think you're afraid you're going to get the downstream effect if you recognize, or at least, "Gee, it looks like things are harder. I feel like you're having a hard day. What can I do for you?" And if they break down and cry, then just go put your arm around them. You don't have to do anything bigger than that for a start. And then if they unload all of it, just say, "I'm listening. I hear you." That may be all that it takes.

Scot: So instead of avoiding it and pretending that's not going on in your life, maybe just acknowledging it would be a good first step.

Dr. Jones: Or don't analyze it. "Boy, I got into trouble." "Oh, I see why you're so angry." "Boy, you could be angry because your dad did this and then your boss did that and you're feeling inadequate. Boy." No, that does not go well because that's all those "you" words. "You're feeling this and you're doing that."

Say, "Wow. I'm so sorry. Can I sit with you a little bit? Talk to me about it." Don't try to analyze. Let them use their words. Just let them know that you're seeing and you're hearing and you want to be there with them, whatever they're feeling. You're not going to run away from it.

Scot: Let's wrap this up. Troy, what did you take away from the episode and what's something that you're going to try based on what you learned today?

Troy: You're putting me on the spot, Scot.

Dr. Jones: Never, never, never do it.

Troy: I know there's someone is listening to this episode.

Mitch: Oh, no.

Scot: What does that somebody want to hear?

Troy: This is really putting me on the spot. That someone probably wants to hear that I will say exactly what Dr. Jones said. Number one, I will not say "you." I will not use a lot of "you" words, which I sometimes have a tendency to do, like say, "You seem angry," or, "You seem sad." And rephrasing that as . . . I wish I could remember exactly how you said it.

Scot: That would be helpful.

Troy: Yeah. "Something seems off." I will say it that way. I'll say, "Something seems off. Is there anything you want to talk about?" Maybe rephrasing things that way and being willing to say that, first of all, and then saying it the right way.

Scot: How about you, Mitch?

Mitch: I feel good that I'm kind of on a journey. I keep using that word. It's so overused. I'm just glad to know that the kind of work that I'm doing right now can lead to a more colorful, more interesting life, and recognize that, as an individual, I feel a lot more than just anger, right? And being able to recognize that, talk about that. I'm hoping that my relationships can be a lot stronger.

Dr. Jones: Yeah, and especially your relationship with yourself. The inner voices that you have that aren't always supportive, they're not always nice voices that you hear, and saying, "Wait a minute. That's not me. That's my inner voice that's saying, 'You're not good enough,' or you're this, that, or the other." Being able to forgive yourself for when you feel a certain way so that you can process and move ahead and take a deep breath. Take 10 deep breaths. It's just a lot easier. You will find yourself feeling better. Mitch, you put it better than I possibly could.

Scot: I think the thing I'm going to take away is I tend to ignore other people in my life, meaning when . . . I don't want to ask, "Hey, something doesn't quite seem right. You want to tell me about it?" because I'm afraid of what I'm going to hear, right? I'm not going to be able to deal with "I'm sad" or "I'm angry" or "I'm whatever." But I think I'm going to try to be brave, and I think I'm going to try to start acknowledging that and doing that and seeing how that works out for me.

Dr. Jones: Be brave. I think about that.

Troy: I like that. Yeah.

Dr. Scot: The firefighters who ran toward the burning building of 9/11. Be brave. Being available is being brave.

Scot: We'll do that, right? Men will run towards the danger like that. But if we think that somebody we care about is angry at us? Oh, man, we're not going to bring that up.

Troy: And I'm also going to say I will not tell whoever this individual is, who I happen to be speaking to, that I'm running toward the burning building on 9/11.

Mitch: Oh, no.

Dr. Jones: Don't do that.

Troy: That would not go over well, but it's a good analogy. We do have to be brave.

Scot: Well, Dr. Jones, I think this is a step in the right direction hopefully for any guy that wants to maybe become more in touch with their own emotions or be more supportive of the emotions of those in our lives. And sometimes our best lessons on the men's health podcast come from wise women such as yourself. So thank you for caring about men's health and being on the show with us today.

Dr. Jones: You're so welcome. It's been great.

Scot: Hey, congratulations. You made it this far. You even made it beyond the end. This is Scot from "Who Cares About Men's Health," and it just dawned on us that if the topic we talked about in this podcast is something that's important to you, and you'd like to perhaps get some emotional availability in your relationships, and you don't know how to have that conversation with your partner, use this podcast as a tool.

Tell them you heard it. Let them listen to it. That way you're starting from some sort of a common place. And then let the discussion go from there. So use this podcast as a tool and share with somebody in your life that you think could benefit from it.

All right. That's it. For real, we're gone this time. Thanks for listening. Thanks for caring about men's health.