The Shrink Becomes the Patient: Dr. Sarah Oreck on the Myth of Control in Motherhood
There is a specific, biting irony that lands when an expert gets thrown into the deep end of their own specialty. We like to think knowledge is armor. If we just know enough—about physiology, about psychology, about the statistics of risk—we can somehow outsmart the chaos of birth.
Dr. Sarah Oreck’s interview on The Birth Hour is a masterclass in dismantling that illusion.
Sarah isn’t just a mom of three; she’s a reproductive psychiatrist. She spent years guiding women through the seismic identity shift of matrescence before she ever saw a positive test herself. You’d think she’d have the cheat codes. Instead, she found herself in March 2020, pregnant, washing her groceries with bleach, and realizing that her medical degree couldn't protect her from the primal, suffocating anxiety of the unknown.
The "Easy Way Out" Fallacy
Let’s start with the moment that made my blood boil.
Sarah opted for a planned Cesarean for her first birth. Not for a breech baby, not for placenta previa, but for her mental health. The uncertainty of a vaginal birth during the early, terrifying days of the pandemic felt like too much for her nervous system to hold. It was a decision made with autonomy and precision.
And yet, the intake nurse asked her if she just didn't want to push—if she wanted the "easy way out."
I have to pause here. The audacity is breathtaking.
Major abdominal surgery is not a shortcut. But this moment in the episode highlights a pervasive, toxic script in obstetrics: that suffering is the currency with which we buy our motherhood. Sarah’s response—that she needed a serene, controlled environment to protect her mental state—is a reminder that psychological safety is a medical necessity, not a luxury.
The Science of Worry
One of the most validating things Sarah mentioned was the physiological change in the maternal brain. It’s not just "hormones" making you worry; the hardware actually shifts.
Your amygdala literally grows. You are biologically wired for hypervigilance. Throw a global pandemic and a high-risk pregnancy into the mix, and that biological alarm system doesn't just ring; it screams.
When Values Clash with Fear (The TFMR Story)
We need to talk about the third pregnancy.
This is where the conversation shifts from "birth story" to something much heavier, and frankly, something we don't hear enough of in public spaces. Sarah shares her experience with TFMR (Termination for Medical Reasons) after discovering severe global genetic abnormalities.
It wasn't a decision made lightly. It was the hardest thing she’s ever done.
What struck me was how she framed the aftermath. She didn't just "get over it." She needed heavy-hitting support—medication (SSRIs) and twice-weekly therapy—to navigate the grief. There is a raw honesty here about the limitations of "resilience." Sometimes, you can't just breathe your way through it. Sometimes, you need chemistry and clinical support to survive the loss.
The Golden Nugget
If you take one thing from this episode, let it be this distinction Sarah makes about how therapy helps us make decisions:
"Ultimately, what I really think... is allowing you to make decisions based on values instead of the other things that can sometimes drive decision-making [like fear]."
The Corrective Experience
Sarah’s story doesn't end in the dark. Her fourth pregnancy (third living child) serves as a "corrective experience."
We talk a lot about trauma, but we rarely talk about the healing power of a boring, standard experience. Being able to take the baby to the grocery store. Having an aunt visit. The mundane, beautiful normalcy of a postpartum period that wasn't defined by isolation. It didn't erase the loss, or the anxiety of the previous years, but it offered a new ending.
Final Thoughts
Listening to Sarah, I was reminded that we are all unreliable narrators of our own control. We think we're steering the ship, but mostly, we're just trying to keep the water out.
Whether you’re a first-time mom scared of the unknowns or a seasoned pro navigating loss, this episode is a reminder: You don't have to be a martyr. You can choose the C-section. You can take the meds. You can prioritize your sanity.
And if a nurse asks if you're taking the easy way out? You have my permission to tell them exactly where to go.
Listen to The Birth Hour - A Birth Story Podcast: https://podranker.com/podcast/the-birth-hour-a-birth-story-podcast