Previa Alliance Podcast

Taking the "Scary out of Reproductive Psychiatrist" with Dr. Claire Smith

October 30, 2023 Previa Alliance Team Season 1 Episode 78
Previa Alliance Podcast
Taking the "Scary out of Reproductive Psychiatrist" with Dr. Claire Smith
Show Notes Transcript Chapter Markers

In honor of the season, Sarah is talking to Dr. Claire Smith from MUSC Reproductive Psychiatrist who is a leading voice in the field of perinatal mental health. Sarah and Dr. Smith bring to light why women who are trying to get pregnant, pregnant, or postpartum are NOT receiving the care they deserve when it comes to their mental health and most importantly HOW we are changing that.

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Speaker 1:

Hey guys, welcome back to Preview Alliance Podcast. This is Sarah, and today we know it is Halloween season spooky, scary. Everybody gets a little uncomfortable sometimes when we bring up the P word psychiatry. So we are here to kind of break that down with one of our favorites, dr Claire Smith. She is the all go to reproductive psychiatrist that's going to break this down and let me tell you this is like girlfriend to girlfriend chatting here. So you're going to realize there is no room for scary. So welcome, claire. Thank you, we are so glad to have you. Can you tell our listeners a little bit about yourself and what brought you to this build?

Speaker 2:

So, like Sarah said, my name is Claire Smith. I'm originally from East Tennessee. I went far away for college, came back to Tennessee for med school and was planning to do something totally different. So for any medical or medical adjacent people out there planning to do pathology which was about as opposite from psychiatrists you can get and then at the very end of my clinical year in my psychiatry rotation, I stumbled across this field reproductive psychiatry that some people call perinatal psych and some people just call women's mental health and completely changed my trajectory based on that and went to residency at the medical University of South Carolina in Charleston and then did a fellowship there in reproductive psychiatry and that's where I work now on faculty. And the reason really why this shift happened, that really rocked my world and led me to change course is, well, a couple of things. One, I love women and treating women and I feel really happy in that space. This field is also really nice because a lot of women most women do get better and my job is primarily to help normalize what they're going through and if there's a way to help them feel better faster, that's my ultimate goal and to have a judgment-free zone to talk about all of their options and I see myself as sort of providing them with the information that's out there and helping them make the decision that they are most comfortable with.

Speaker 1:

I love all that and I say with Claire she's like a unicorn, because reproductive psychiatrists we wish they were more in the United States. Also, if you're in larger cities you would find Claire, and if you're more like majority of us, you will have psychiatrists. So you tell just for a minute for our listeners the difference between a general psychiatrist and you, so they would kind of understand that.

Speaker 2:

Yeah, yes, so reproductive psychiatry. It can vary slightly from program to program, but in general that means perinatal. So before, during, after pregnancy and most places it's about one year. Postpartum is the mark at which they would either transition to a psychiatrist if that was necessary, like a quote general psychiatrist or community therapist or whatever else. So we do everything from infertility to any sort of mental health issue under the sun during pregnancy and postpartum and things like I have ADHD and I'm wanting to start a family and I take X medication. Is this okay? What do I need to know to help me decide whether to continue this or not? So basically, before, during, after pregnancy is what we do.

Speaker 1:

I want to point out to our listeners. There is you know people don't talk about this enough with maternal mental health and perinatal mood anxiety disorders, but there is a whole fellowship for physicians to have this because it's such a common occurrence. So I think the fact that we are bringing light to there is reproductive psychiatry that is showing moms that when we experience our mental health issues before, during, after pregnancy, it is validation, it is studied, you are trained to treat this, so there's no shame in this. You know, just like heart attack strokes, right, those doctors know what to do. You know what to do for us. So one of the most common things I hear from previous moms is they are old school and their thoughts a little bit about what an experience seeing you as their doctor is. So real to real talk, what do you want your patients to know? Your goal of them coming to see you is?

Speaker 2:

Yeah, I think the biggest thing I want them to know is that mental health complications are the number one complication of pregnancy. So, more than gestational diabetes, more than preeclampsia, more than postpartum hemorrhage, more than postpartum infection, mental health complications are number one over all of that, and so it's very, very normal. And just because it's so common doesn't mean, though, that somebody needs to suffer through it needlessly. I think that's first and foremost. I mean to give any kind of context. South Carolina is not that big of a state. Charleston is not that big of a city. We do serve South Carolina wide due to our virtual services, but we hit an all time high. I think, maybe May or April, we had over 1000 appointments, wow, between the doctors and the therapists, and so this is a highly utilized, highly needed field, and it's not going anywhere. Our numbers are just going up and up and up. And then, I think, on a more sort of like, what I alluded to before is that this field isn't about forcing people to take medications. It's not about making you talk about things you don't want to talk about, or taking your children away, or all these really catastrophic, scary scenarios people get worried about, particularly if they're not used to dealing with mental health services or they've heard some sort of horror story in the past. This field is very research driven and that research is getting more and more and more sophisticated over time, and so what we do is we present you with the data we have and we talk about what we think the best option is for you, based on not only risk of medication exposure. But the big kicker is risk of exposure, of illness, and active illness is also an exposure, and so we've got to weigh those two things. It's not risk first benefit is risk first risk.

Speaker 1:

No one ever explained it to me like you just explained it and we'll start to know. I was very wary when I was suicidal for my Swiss pardon to speak up. I just thought it was me. I had a big negative thought about medicine, right. But no one ever before to me said, sarah, you not having depression, you wanted to end your life. So no one ever said that to me. So thank you for saying that, because holding depression, anxiety on you and your body without getting help and we know the data of you, know, I present to payers, I present to employers to say, hey, take listen of this, right Like this. So mental health is physical health. So your outcomes of pregnancies are preterm verse, right Like the hypertension, preeclampsia, if you even want to talk to a child outcomes for many years with behavioral or you know, you see, lack of care or more excessive care goes both ways. So I think that moms have to grasp and society has to grasp right, and you have to have this conversation and we have to talk about this early. So say, when your best friends comes to you and says, okay, claire, I'm getting pregnant, yeah, let's be real, what should I do for my mental health? What would you tell her Like? What would you advise her? Well, it depends.

Speaker 2:

Does she have a history of mental health stuff. Is she taking a medication, for instance?

Speaker 1:

Let's say she's like no medication no mental health history, and she's just hearing it right Cause let's hit on it In the news. There's been a lot of tragic stories lately, so the conversation's happening because we've had some worst case outcomes. Yes, absolutely yes, so.

Speaker 2:

I would probably. There is nothing that she needs to urgently do Some magic thing. She can't go to a yoga class and prevent all the bad things from happening. You know that's unrealistic and that's really really, really important, and that really minimizes the seriousness of what these illnesses are. They're not made up in her heads. They're medical illnesses, like you already said. So what I would suggest would be that if she feels at all like she is not being able to keep up with the things that she normally does, she doesn't have the interest in the things she normally does. If her anxiety starts to feel like multiple times a week and everyday thing it starts to feel happening more often than not, jump on it immediately. That's what I would say. There's nothing special to do but to be mindful and aware of what can go on in pregnancy and how high risk particularly the postpartum period is. But pregnancy is as well.

Speaker 1:

Right, and we try to have open conversations and risk factors with a lot of our moms. So we know risk factors with anything Like we all family history. We're knocking about my personal risk factors. I look back that I didn't know miscarriages, the infertility, nicu, the lack of support my husband was in fellowship, we moved away from everything. So those come into play and you would know that, as her friend be like you know this is you take pregnancy out of this, right, like that's a hard situation. So I think you're gonna look at that too. Right Now, let's say the same friend, let's switch it up. She's on a medication. She struggled with anxiety her whole life. And here's the thing I hear from all these moms you probably hear it too, right, it's like I should stop the medicine. Like there is this conversation. I don't know who started it, I don't know why it started, but it's like pregnancy, everything we've done before it has to stop, right, like our bodies have to just be supernatural and we have to deal with it all Cause, you know, you even like, oh my gosh, should I do this shampoo? Should I get my hair colored? So then, if people are thinking like that, you talk about a mental health medication.

Speaker 2:

Right, right, exactly so, and I can talk about this for just on and on and on. So please interrupt me and make me change course if need be. But if someone I do have this conversation repeatedly, probably every week of my job is that to go way back, our starting point is clinical trial research in this country is essentially men's research. Women have been excluded as a gender from entire FDA clinical trials for decades. Even now, pregnant women are considered a vulnerable population, the same as minors and the same as prisoners, essentially suggesting that we do not have the ability to weigh all of the risks and options and make informed consent. And so when people talk about the lack of data, that's where I think a lot of the fear comes from is because it hasn't existed for such a long time, and even things I learned in medical school I graduated in 2015,. Even some of that is I can see now is inaccurate or at best, you know, some misinformation from overtime. So I usually set that scene of when we start with the COVID vaccine. You know, there was no helpful guidance for OBGYNs, for pediatricians, to tell their patients or to guide their patients on whether to get it or not, if they're pregnant, if they're breastfeeding, and so for this specific woman, I would reiterate the whole conversation around risk versus risk there is no such thing as a non-exposure. Anxiety and pregnancy like sustained, consistent anxiety, put you at risk for things like hypertensive disorders, preeclampsia and so on. Anxiety alone is an independent risk factor for postpartum depression, even if you don't feel depressed in pregnancy. And so when you're looking at exposures, you're one exposure of, say, lexapro or Zoloft or Wellbutrin or whatever you might be on. That's providing you stability. That is far less risky when you're thinking about coming off of it and potentially decompensating. So then we're talking about multiple exposures now, which is always the goal, is to lessen the amount of exposure as possible. Just like we don't want women walking around with high blood pressure, with high blood sugar, we don't want women walking around with high anxiety, high depression. It's the same exact thought process, and so women tend to get this message of you can take it if you really need it, and we don't send that same message with thyroid medication, with diabetes medication, with anything else. I hear that a lot, even from other psychiatrists. So nobody's immune to the thought process, but that's the message women tend to get from the personal lives and even from their providers.

Speaker 1:

Oh my gosh, I love that. I love how you said that, because that is, I've never put it two together like that. But I felt like because I had a medically high-risk pregnancy, yeah, and I was like you do whatever you gotta do to me to keep baby and me safe, right, mm-hmm. And no one ever said now that anxiety, that the high-risk pregnancy, I mean who I walked around like a ticking time on clearly, and no one ever said carry an anxiety, sarah has its own consequences, or like they. Just like I was just forced to accept like of course you're gonna be anxious about this. You know this could end very poorly.

Speaker 2:

Right, exactly, and I talk a lot about lowercase A anxiety and uppercase A anxiety. We all experience anxiety. Pregnancy is stressful, it is what it is. I'm not saying those women are doing harm to their babies, but when you start to get the uppercase A anxiety, that's when you're considering these additional risks.

Speaker 1:

Give our listeners just a little quick example of uppercase versus lowercase in pregnancy, because I feel like I was always uppercase. Yeah, yeah, yeah.

Speaker 2:

And that's okay. Some people are, and that's when we're like, listen, I'm telling you, I know it makes you, you know you feel apprehensive about this, but I really think medication is a good idea for you to consider when you've got that uppercase anxiety all the time, and that's what it is. It's something where that you feel like is starting to impact your level of functioning or your ability to function More days than not, consistently elevated, consistently high. If you have a few days that are stressful or you're just feeling tearful or you're moving and that's very stressful, that's lowercase A anxiety. Yeah, I'm worried about childcare and this new transition for my family and am I ready? Those are all normal questions that we don't need to pathologize into a disorder, but uppercase A anxiety is consistent, persistent and impacts your ability to function.

Speaker 1:

Right. So let's say so, your friend and she, because we have had this. I've had a lot of moms come to me and they take themselves off or their OB decides let's take off this medicine, and then we have really negative outcomes and then we're trying to rebuild and we're trying to, I mean, take months to get us back to a spot where we should be. And we see a lot too in the first time, master, with that influx of hormones. That's a very I say that's like a really roller coaster ride for a lot of our moms. Yeah, and do you see more so and not? Do you think that's because maybe they were on medicine and they immediately are like, hey, I gotta go off? Do you think that makes it worse or do you think it's just like, do you think there's any correlation? Cause I'm seeing that a lot, which is a lot of previous moms. Is this a first trimester?

Speaker 2:

Yeah, I'm sure there's got to be. It's a very, that, very beginning. But then also in between, the in between time where, if you are sort of unfortunate enough, but also in some people, are really reassured by feeling nauseous. You know, when you're in between, the morning sickness, which we all know, is not restricted to the morning, but if you are experiencing nausea or vomiting, that then gets better. But before you're showing, before you can feel kicking. That is also an incredibly stressful time period where you just feel like something's going wrong. I can't, I don't have the feedback that's telling me I'm still pregnant, everything's going quote, normally. But yes, the beginning as well, certainly, and I think that a lot of that can be. When they women find out they're pregnant, they stop their medication because they want to or because someone told them to, and then the wheels kind of come off shortly thereafter or can I?

Speaker 1:

absolutely I both pregnancies, you know, did you describe me? I'd feel nauseous and I'd be like, okay, that's still good, right. And then, yeah, it was really hard when you can't fill the baby, and I don't think people talk about it. And then now we scans around that time, right.

Speaker 2:

So that's a high stress.

Speaker 1:

So what can moms do before? So they're listening and we're hearing this mom and she's on medication, she's pregnant and maybe for OP is not receptive of her. Knowing both options, what would it be another? What could we help empower her to gain more information, ideally, finding you, save you Right? What can she do? Cause I feel like moms are always like, well, I tried, but no one heard me or I couldn't figure it out, and they fall in this like care gap.

Speaker 2:

Yeah, and I'm not sure if this has been something discussed on this podcast before, but PSI postpartum support international was an excellent resource, that it's a website you can go to and has just abundant resources, even groups of their own information. Mother2babycom is really helpful in just like a quick snapshot, easy to read fact sheet about different medications in both pregnancy and lactation and fertility. It takes the kind of difficult to understand dry, academic, researchy language and distills it down into easily understandable guidance on or safety profiles of medications in pregnancy. So probably those two things are where it would start. And postpartum support international can also connect you if there is anybody in your area, even if it's not in your city. You know, now with post COVID virtual is pretty much an option for most practices.

Speaker 1:

Yeah, and I will say, you know, if it's always so, people, it's okay if your provider does not align with you to seek another provider. Oh yeah, I think there's a hard line. Sometimes different providers choose, with their knowledge and comfort level of mental health medications to your pregnancy and postpartum.

Speaker 2:

Yes, yes we are. I know we were discussing this early, but we're at a kind of a transition point, I think, where the need is so great and it can't really be ignored anymore, and so non-psychiatric, non-reproductive psychiatric providers are realizing I've got to get comfortable with this and understand what the algorithms are. And we're at a sort of a funny point where some people are really diving head first into that. Some people are a little resistant. It's some confusion, some misinformation. I think we're on the right trajectory for non-health providers to be comfortable in that space. We're just not quite there yet and that can cause even more anxiety.

Speaker 1:

Yeah, I will say there is a postpartum support international. If you love your OB or we have maternity deserts, right, this might be the only OB for X amount of miles for you and you have this question about the medication, you could always refer your OB. Postpartum support international has a reproductive psychiatric line they can call in and you could even say can I be a part of this conversation in here from a reproductive psychiatrist like Claire? Let's talk through this. And now you're going to have, with this podcast, some terminology and some language that you can bring to advocate for yourself 100%.

Speaker 2:

No one's going to advocate for us except for ourselves. That's an unfortunate lesson I think we've all learned as women and as patients at some point in our lives, particularly around pregnancy, and I mean not just mental health symptoms, but physical symptoms, pain and things like that. We're frequently dismissed and ignored. So I mean that's huge. You've got to advocate for yourself because you cannot be sure that anybody else will.

Speaker 1:

unfortunately, no, I think that's so true Now. So when do most people come to see you in the pregnancy journey? Where would you think they that, more so or not, they're going to come in?

Speaker 2:

Yes, and so we and I exist sort of in the OBGYN sphere. Our clinic does. We have a whole division of MUSC with different doctors and therapists, and so there's a very easy way to come in internally. But then we also have, like this line you're talking about with PSI, where you can call in as a provider or as a patient. We have that for our state so anybody across the state patient or provider can call. They don't need a referral, they don't need to be at MUSC anything like that and be triaged by one of our social workers and scheduled or whatever they may need. But as far as when I most commonly see women, it really varies. Some women it's early, early, Some are. You know, I was on ex-medication, I stopped, I'm in my second trimester, I am struggling, I need some help. And some women have no mental health history whatsoever. They've had their first baby and they've realized that something is really not going well and they have, they've talked their OB or pediatrician or just themselves or family members and that's how they come in. So it really varies widely. We see women who come in before they're pregnant and we see women who come at 10 months postpartum.

Speaker 1:

Now we haven't touched just yet. So the people who are going through IVF or they're going through like trying to get pregnant, that is a very mentally taxing time. Yes, yes, incredibly so. So when they come to you there, you know, would you expect their relationship to maintain with you guys through the pregnancy and postpartum if they kind of established early on?

Speaker 2:

Yes, I would. I mean, it can always be case by case and it depends also what the woman feels like she needs and what if she's good with just a check-in or just kind of establishing, and then she can come back if and when she is pregnant or if and when things get worse or whatever might be. But yeah, that's included in our umbrella of what we're doing. I have I wouldn't say it's a huge amount of our patient population, because MUSC does not have an REI or reproductive, you know, or like an infertility program or fellowship, but I personally have probably two or three patients that fit that category.

Speaker 1:

Yeah, you know, we first got pregnant, then we had a loss and then we struggled to get pregnant again. Yeah, and I think that story is a lot with a lot of people is that time and what you're carrying? I always tell people you get baggage as you bring into pregnancy, like we're carrying our anxiety or I'm carrying like some underlying conditions in pregnancy. You throw those hormones and it gets really kind of messy. So let's talk a little bit about the mom who everything was great during pregnancy, right, she was like trucking along. Yeah, postpartum cubs, yeah, and okay, the difference between baby blues and postpartum. Let's just we'll just talk about that for a second in case our listeners have never had this explained to them. So, cause I think some people get that really confused, right, they're like, they're like they're comfortable during both times. So let's just make it very clear what baby blues is versus postpartum depression.

Speaker 2:

Yes, and this does happen a lot and I think that there is. I mean, I would rather people get referred because they're struggling at one week or 10 days or two weeks postpartum, rather than wait and wait and wait and then they've realized well, no, it hasn't got any better Now we'll refer. So in med school it's always stuck with me that one of our endocrinology professors said if, like the female hormonal system and neurotransmitters and all of those things, hormones tends to be this like slang, derogatory term, almost like hormone, she's hormonal or it's the hormones. And in reality it's an incredibly complex system for women, even much more so than men. And our professor was like our men would never survive pregnancy and postpartum if they had the same hormone shifts that we did, and I firmly believe that. But those shifts are going to create mood instability, tearfulness, feeling emotional, feeling depressed. I mean you will feel exactly like what major depressive disorder feels like If you're a new time mom or a first time mom, there's a lot of anxiety about keeping this little thing alive, obsessively watching the monitor, watching them breathe, things like that. That, if persistent yes, we might be talking about something that's in the disordered family, but gonna be pretty normal in your first couple of weeks, and so when I see someone that early on unless it's something that includes suicidality, certainly, or something that feels just really severe, or they have a long history of depression and so I know that they're gonna be high risk for it anyways I'm generally avoiding starting a medication until the first couple of weeks in, and so we can see where that trajectory is going. Of course, if mom wants to go ahead and get started on one, I'm never gonna say no, but that's generally a good timeframe is around a month. Ish, patients don't follow textbooks. So I just wanna reiterate that. But if around four weeks or so, it's not that you are feeling fine, it's that you start to just feel like you're not treading water quite so much or it doesn't feel like an everyday, all day oppressive type of mood or anxiety symptoms that you're having. You're just feeling like, okay, I'm getting into groove of it. It's still exhausting, I'm feeling still emotional, it's difficult, but I'm getting the hang of it and I feel like I'm doing a little bit better than I was one or two weeks out. That's what baby blues looks like, Whereas postpartum depression is not getting better, it's probably getting worse and or is gonna be more severe symptoms.

Speaker 1:

Yeah. So I always say and to our moms, I'm just like it, will baby blues go away? And the research has 80, 90%, I'm like 100%. 100% of my friends and me have had baby blues. Like everybody's gonna have it. And for me it hit, usually like three, four days postpartum it kind of hit, and then day seven would be like oh my gosh. And I don't know if that had any correlation with, like, my milk really coming into or what happens around that. But I do want to. We'll talk on this in a second. But weaning and milk it comes into play. No one talks about this either. So that's a huge thing. But baby blues goes away. So you're not gonna. I tell people, though, you have to ride that train. It's very unfortunate. You have to get on to your destination to see if it's gonna get better or worse. Yeah.

Speaker 2:

There is some of that, unfortunately. You can sort of think about it in terms of if, say, you were in a car accident, you're probably gonna be a little scared or anxious around driving for a little while. You might have some memories that are bothering you about it for a little while. If that's still going on, or you feel like you can't drive, or you feel like you're just having nightmares or you're avoiding things sort of the difference between acute stress symptoms and PTSD that it's kind of a similar mirroring for blues and postpartum depression. You expect these things. After such a massive physical transition, hormonal transition, life transition. You've got to give yourself a bit of a break in terms of the expectations you have on yourself and how you're gonna be interacting with the world around you. But yeah, exactly, some of it is just waiting and watching.

Speaker 1:

Yeah, Now what's interesting is we've had a couple moms recently who they've stopped breastfeeding, like I mentioned earlier, and one specifically said to me I thought I was good, I didn't think I was gonna get depression, I was not anxious, I weaned and, holy moly, this hit hard.

Speaker 2:

Yeah, yes, I see that and I see the opposite too. I see women who are really struggling and it also is layered with the fact that typically breastfeeding is not going smoothly for them. They're struggling with latch, they're struggling with supply, they feel like a human milk machine and it's just not working for them and they're feeling a lot of shame and guilt around weaning. And then they do and they feel a lot better. But you're exactly right, some women are doing okay, they wean and it's like bam, where did that come from?

Speaker 1:

Yeah, see it all the time and no one's. I don't feel like people are. We're talking, hey, this period of time postpartum depression, postpartum anxiety if you've had a traumatic birth, these may be the things, but no one's telling you the weaning part and I think there's a huge. Well, we do know it's biodirectional. If you're breastfeeding and depression, right, so it can. If you're struggling, you're already assuming like I'm not a good mom. Why can't I do this? Everybody seems just to be able to put the baby there and feeds and moves on. What am I doing wrong? Yeah, yeah. So as a second child, I decided from my own mental health I needed to wean and to go to formula. So I think that if you're a mom listening on this, your mental health is more important than how your child is fed. People may still very strongly against that statement I just said, but I truly believe. Healthy mom, healthy baby.

Speaker 2:

That's like 100%. I have that conversation a lot with women and a lot of it seems like they were just sort of waiting for someone, anyone to say, have you considered weaning? And just like the relief that they feel. Even being able to vocalize that and work through the shame and the guilt around it can be very helpful. And sometimes you know they're not ready and they decide again in another couple of weeks or couple of months. But they know that the option's on the table and it doesn't mean they're a bad mom.

Speaker 1:

No, and that's just. I always say how you delivered your child to this world and how you feed your child. Okay, no one should judge you as a mom based on that and you shouldn't judge yourself. I want to touch on with you traumatic births. That's been kind of a lot that's coming. I think it's now there's some good Instagram accounts that we're kind of talking about it right, I have had two traumatic births and no one ever had shared previously with me like their experience or how that could affect my mental health, how that would be my risk factors. I think that it goes back to like what you were saying in the beginning. We have not been allowed to be in on this conversation about anything for so long, so no one's looking at the mom and her birth experience and saying that was really scary, that was traumatizing, you had no control. That's not okay. What happened to you and this after effects? So do you have any patients that you've kind of had to work through like their trauma and needed you?

Speaker 2:

Oh, yes yes, yes, yes, absolutely. We see a lot of trauma in clinic, whether it's pregnancy loss or whether it's a traumatic labor delivery experience, and whether that is literal physical trauma and an urgent emergency section or hemorrhage or whatever, or if it's simply just an unplanned C-section that can create a whole lot of trauma. That I think as doctors we see. C-sections happen all the time. Obgyn see it happen all the time and so you can understand how people get a little desensitized to it. But yes, just a simple question of what was your delivery like? Tell me about it. You would be amazed at what people experienced that you might not know just from looking at the chart and how they're feeling about it and how they're still reeling from it and having some residual issues and wanna talk it out.

Speaker 1:

Oh yeah, yeah, I still get off around my children's birthdays and one just turned two and one's me five in August, so I think and my husband's a physician, I'm an art so he does a whole different line of work and he's even said that he'll describe something that happened to him during that day procedure, surgeries and stuff and I'm thinking, oh my gosh, and to him he cares very much. This is not whatever, but he's very compartmentalized with it and I try to tell this to moms. I'm like these people are seeing it every day. This is you, this happened to you. Your life, your child, is a healthcare system kind of failure. It set us all up for right. Yep, 100%. And they're trying to save your life or your child's life, right? And sometimes there's not a conversation piece of like this is what's gonna happen or not. So we've had a lot I think and, like you said, trauma is whatever is trauma to you, right? So it could be my circumstances where we have like with the fastest D sections for a hot minute or it's. She did not want that and this happened to her.

Speaker 2:

Yes, oh yes, 100%, and it can be just. I had an interaction with one of the providers taking care of me in the hospital that really made me feel invalidated or uncomfortable or even unsafe, and that can cause a lot to surface, particularly if you have a history of trauma in the first place. It can just add layer after layer.

Speaker 1:

I think it goes back to that. I think these moms have been trying to say something's wrong or that's not what they want, and no one listens.

Speaker 2:

Yeah, yes, and there is a difference between having a birth plan and thinking it has to go that way, and any deviance from that means that I was a failure and or it didn't go the way I wanted. And sometimes you know you can have a birth plan, but best to be a little flexible. That's different than what we're talking about here.

Speaker 1:

Totally. Now, where do you hope this filled that? You're I know you're working hard in research. Where do you hope this is gonna go? So if I talk to you in two years and I'm like Claire, what's changed? What do you hope? What do you see?

Speaker 2:

A few things. I will say that I see so as part of my job at the hospital. I also interview any prospective general psychiatry residents who have expressed an interest in this field to give them just the details about what we offer. You know, so on, and I will say it's a growing field and the interest is really exponentially growing. That's reassuring because I think number one, we need more of us around and, honestly, probably one of our biggest goals is that reproductive psychiatrists can be there when you need them for things that are not responding to your first line treatments, for things that are really complicated, for stuff that you really don't expect a non-little health provider or a non-specialist to handle, but that primary care doctors, obgyns, midwives that they can become more comfortable, like we're saying, in treating all this population. So there aren't these deserts where people don't know what to do and there's nowhere to send them. I think that is my ultimate goal is that we don't have 1200 appointments a month because other physicians and providers feel comfortable. They're not afraid of pregnant women, you know, or women who have had babies in the last year.

Speaker 1:

You know, it's exactly what you said. I've had a friend she's a different part of the state and she said to me I think they were afraid when I got pregnant because of my past history and she was like it's not something I didn't already know, and the woman knows right. She's like we know what our history is, but I think even feeling, like your provider's, uncomfortable with what you're bringing into it.

Speaker 2:

Sarah, we have. I mean, it is a regular occurrence where I see a new patient who was just cold turkey, dropped by their psychiatrist or their primary care doctor, whoever else. I don't mean to harp on these, this is what I see consistently. This unfortunately happens because they got pregnant and that's it. Wouldn't give them any more refills. Thankfully we have this resource in our state, but that happens everywhere, everywhere just because they get pregnant. All of a sudden, it's like you're not a human being anymore. I don't know what to do with you.

Speaker 1:

No, I felt that. You know, I searched, I went, I was suicidal. I called around to several places and they said wait, you're post-hardim, wait, and I'm like, so, like that challenge, I don't think people talk about it enough and like it's out there. So you have to know we do have the odd stack against us, but again we go back to advocating for ourselves. Right, post-harm support international. If you are in the state of South Carolina, you are a lucky duck because you have your guys' program there and right, you can tell your provider no, no, no, you call this hotline. We're gonna talk about this, right, I know other states are trying to do that, but you have to know, like this is our most vulnerable period of a woman's life for a mental health condition, is the parenting period, yes, yet no one is backing her and supporting her without her trying to say, hey, I shouldn't fill this way, like I don't have to just take it, yes, and this is a very sort of hard and serious topic, but it's the reality.

Speaker 2:

Suicide is the number one cause of death within the first year postpartum in our country, and the fact that our screening is so poor, our resources are so poor, it's a disgrace really. Yeah, and I don't think, though, a lot of people much less doctors are aware truly of that statistic.

Speaker 1:

They're not and I've actually just trying to advocate and get more resources to. Moms have said that and they look at me and they go. Is that right?

Speaker 2:

I'm like yes, they're right. Yeah, they don't believe you. Yeah.

Speaker 1:

They don't. And I'll say, you know, post COVID, down there numbers were hearing one in three postpartum depression, postpartum anxiety for moms and they're like I thought it was traditionally one, five, one and eight and I'm like what we've went through the past couple of years. Okay, we're all having a baseline of anxiety after COVID. So, why would that not be worse with hormones? And I think what's important too is you know people think okay, well, postpartum depression, anxiety, that can only happen in the beginning of postpartum, or they don't even like talk about like depressive symptoms, anxiety symptoms start during pregnancy, right, so like we are just. But our moms, the highest rate correct me if I'm wrong of suicide is between nine to 12 months postpartum. For that delay, kind of later, his postpartum depression does not get better. That's why something without treatment and resources, it gets worse. So they also have had people say to me I was really confused when my mom came back asking for something at six months postpartum. I didn't know why. When her baby turned one she said this was the worst year of her life. And she was. I'm like they just don't talk about it. They don't know.

Speaker 2:

No, and the highest risk for overdose is six to 12 months postpartum. It's I mean, it's multiple things, but your protective factors can be a little clearer for you when you have a teeny, tiny little infant and you're still just trying to get through each day. When you are, for some women, back at work, like you're out of your postpartum really small bubble, like the world keeps turning, you're expected to turn back with it. That's where a lot of that comes from, even though you'd expect it to be immediately postpartum, which sometimes it is. But that transition point of when you're kind of getting back into life can be very difficult.

Speaker 1:

Yeah, and I've heard that a lot is. I'm now back to work and the village of our hope in the beginning has left, has gone, it's gone and you're here and you just attributed it to like oh well, when the baby sleeps I'll feel better, right? When the baby's not teething, this will go away, right? I don't know, you just put in your head all these little steps that's going to make it go away, that it just doesn't. And again, I think too, no one's telling her it's how long it can last. So then she's dismissive of her own feelings and then she starts looking and saying it's just a me thing, it's not a mental health thing.

Speaker 2:

Right exactly. I do not remember the percentage off the top of my head I haven't looked at it in a little while but there is a non-small percentage not a huge percentage, but not a teeny percentage where postpartum depression symptoms persist at two years, even if you haven't gotten treated or addressed in some way. So I see women who are coming to me in their second pregnancy, third pregnancy, and they're like to be honest, I felt this way after I delivered with my first and, yeah, I might have plateaued a little bit, but I never really felt any better. I think I've essentially been depressed since then. That makes me really, really sad, but it's not uncommon.

Speaker 1:

I was going to say, because most people tend to get pregnant a couple of years after their child. You're like, well, I'm in these child-rearing ages, let's just get through these trench years, and I've heard that a lot from our moms, our previous moms, is gosh, I wish I would have had you guys. And then again I didn't know, there was no name. So let's just real quick, hit on this. So I was very scared to get pregnant again after my experience of postpartum depression and I did not have a you or someone with your knowledge to go to to say what, okay, to the mom who she suffered, right, she's, she had postpartum depression, postpartum anxiety, okay, even postpartum psychosis. Right, like if you had something. She wants to get pregnant again, she wants more kids. What would you suggest to kind of what you know? Is it get finding a great provider, like yourself? Is it having open, honest conversations? What can she? Because that's a hard decision, right? Because I was like, do I want to get to that point again? Like I have a child now? Like what's, if I feel this way?

Speaker 2:

Yeah, I think it's a really valid question and I think you're right, it's not one size fits all Same thing, for if you had a really complicated pregnancy, strictly medically speaking, or had really serious issues with nausea and vomiting the whole time, you're going to think hard about doing it again and that's really normal, whether it's mental health or strictly physical health. But I would say, ideally, in a perfect world, you have a provider, even a specialist, like what we do, that you can at least establish with, make contact with, do that, intake appointment, you can check in. What's a trimester? If things are going really well, you know just, you have that connection there and they're there right away if you need it or if things start to decline. Yeah, yeah, have that plan. Yeah, yeah. Have a plan in place. I think that's exactly right. Have a plan in place and know, not just for you, but for your support people, whether that's friends, whether that's family, whether that's a spouse. This is what happens. We've seen it before. This is what happens when I start to feel worse or my depression episode starts, and even if I can't recognize it, somebody else can and we can address this quickly.

Speaker 1:

That is the conversation that actually me and Bill had. Was I hit it very quickly Very well from him, which I mean he was in fellowship, so it was great. It was easy for him to hide things when you're working and saying hours. But it was like, if you notice me fixating on this, if you notice I stopped going to this, which you know I love to do, if you notice that you're watching him but I'm not sleeping because I'm fixed, you know, then you had to have these uncomfortable conversations of is not your fault that you didn't recognize. It Is not my fault. Didn't speak it right, like now it's a us conversation, right?

Speaker 2:

Yes, I totally agree. I think that's invaluable and I think that, unfortunately, what happens sometimes is the motivating factor for treatment is that there hasn't been a discussion. And so a spouse or a parent or someone is like you're being really moody, you know, you're being really snappy at all of us, Like you're something's wrong with you, you have bipolar disorder. You know using these terms just like wildly and accurately. And then they come to us and they say well, they told me I was doing X, Y and Z and I guess I am raising my voice for my kids and I don't want to be doing that. And if you are aware of this beforehand and you know the names for it, you can put labels on it and you know that it's nothing uncommon or there's nothing wrong with you. That can save a lot of distress and can get you to care faster.

Speaker 1:

Name entertainment. We say that a lot. Like you know, I felt that I was like, okay, I know this was. I mean, I was far in rage with my second and very untouched about, but just to say, hey, this is what I'm experiencing versus gosh, I've turned into an angry like snappy person, right, that helped me a lot. But I want to have you back because this conversation is it's so much, should be limited to a timeframe, but because we have to be the voice that moms hear, because there's so many contradicting negatives shameful, just suck it up, gaslighting, whatever you want to call it that they're hearing, that they have to find this conversation to take into their pregnancy postpartum journeys.

Speaker 2:

Yes, I agree, Totally happy to be back. You know how many times I've heard postpartum depression didn't exist when I was a mom. you know when I was having kids and I'm like, okay, that's not true, it's not a 21st century illness, but yeah, there's a lot of that out there and I think the discussion is happening more and more, and even on social media, like you mentioned at the beginning, in terms of, you know, Instagram can be a little worrisome the sort of Instagram therapist and the Instagram experts but there is a lot of value in that shared community and shared experience. But podcasts and books and I think it's coming a long way. We just still have a long way to go.

Speaker 1:

We have the conversations continuing. We always ask our guests this so what would you tell? You know a mom to be the vice that, like you wish, like she could know, and you know we've heard everything from raise your eggs early to put your oxygen mask on first, to whatever. Just you see these moms. This is your passion. Just that word of wisdom. And it doesn't even have to be like doctor wisdom, right, it can just be like female to female. Yeah, that's what you say.

Speaker 2:

I think, in terms of non-doctor and non-medical advice and the things we've already talked on in terms of advocating for yourself and being aware and making a plan, it's probably that you are not meant to do it alone, and the reason why there's this cliched saying of it takes a village is because it literally does, and human history would show that. But for some reason, we're in this portion of human history where we think that moms need to be able to do it all on their own and you will need help and you also need to ask for help. Yeah, not only that, but you need to accept help, and so if you don't accept help at some point, people will stop offering help and that can get really scary, really quickly, and that's probably my biggest piece of advice.

Speaker 1:

I love that. Where were you before? I mean, I'm from East Tennessee too, so I was like what's clear to tell me that when I was pregnant, I needed that, I needed that. So moms hold true to that, and I don't care how old your kids are right now, like that is Exactly. Oh, okay, well, this has been. We took the scary out of it. Yeah, this is, I know, this conversation. That's what you gotta do is you've got to talk through this uncomfortable and we're going to keep having this conversation. I'm not going to let Claire get too far away from our listeners so we can share her knowledge, but, claire, it's an honor, thank you for being on with us.

Speaker 2:

Oh, thank you so much for having me Happy to be here.

Speaker 1:

All right, okay, guys, till next time. Maternal mental health is as important as physical health. The previous Alliance podcast was created for and by moms dealing with post-partum depression in all its variables, like anxiety, anger and even apathy. Hosted by CEO founder Sarah Parkhurst and licensed clinical social worker Whitney Gaye, each episode focused on specific issues relevant to pregnancy and postpartum. Join us and hear how other moms have overcome mental health challenges, as well as access tips and suggestions on dealing with your own challenges as moms. You can also browse our podcast library and listen to previous episodes at any time. Please know you're not alone on this journey, thank you.

Understanding Reproductive Psychiatry
Anxiety and Medication Use in Pregnancy
Understanding Baby Blues and Postpartum Depression
Challenges and Goals in Reproductive Psychiatry
Supporting Maternal Mental Health