Speaker 1: 0:10

Hi guys, welcome back to Preview Alliance Podcast. This is Sarah, and I have our favorite reproductive psychiatrist, dr Claire Smith, with us today. I want to preference this, guys. This is not going to be our normal with her, where it's all about education and we're hitting the hard topics. This is a get to know her some more about her first year of motherhood. So, claire, welcome.

Speaker 2: 0:30

Thank you Good morning.

Speaker 1: 0:32

So before our listeners I lose them too much of they're going like wait, what is this? I just want to say we have some really great episodes with you. I want them to refer back to if you're new to us. We have one that we did it was around Halloween of taking the scary out of reproductive psychiatry and then we did an intrusive thoughts one which, if you guys have never listened to that, if you're pregnant or postpartum, highly highly recommend. That is, I think, a crucial one. All moms need to hear.

Speaker 2: 1:00

Yeah, definitely, and I'll talk more about intrusive thoughts in a few minutes.

Speaker 1: 1:09

So we will get to hear. So introduce yourself for the new listeners. We've got several new listeners of who you are and what's been new in your life since the last time we've heard from you.

Speaker 2: 1:16

Yes, so for anyone new, my name is Claire Smith. I'm originally from Tennessee, but I went to residency in Charleston, south Carolina, at MUSC Medical University of South Carolina, and did a fellowship there in reproductive psychiatry and then stayed on faculty there. So I wear a few hats. But most relevant to this podcast is that I'm a full-time reproductive psychiatrist and I delivered on leap day of last year, so February 29th. So we just crossed the year milestone of our daughter, whose name is Inez.

Speaker 1: 1:57

I have been so excited to have this conversation because I was so excited when I found out you were pregnant, and I feel like we always think physicians, and especially reproductive psychiatrists and anything in the mental health field, right, we're kind of like do you guys get this? Do you have these thoughts? Do you panic, wake up and think your kid's crying when they're not? Do you you know? Like all these things? So that's what I'm here to ask you about is tell me about motherhood. Let's go back to pregnancy A lot of things that women we hear experience during pregnancy. You know you've got anxiety, you've got depression, you've got can I do this? What am I doing? All the changes? How was pregnancy like for you?

Speaker 2: 2:49

was pregnancy like for you? It sucked. I knew going into it that I would probably, given my job and the amount of you know, first, things that are very traumatic that I see in terms of deliveries and deliveries that don't go as expected or medical issues or babysitting time in the NICU. But also we see a lot of loss of all kinds, you know early loss and then infant loss and everything in between. So I knew that would probably impact my anxiety level and I was correct. I never announced it, I never said anything on social media. You know we told our friends and family, you know, just just gradually, but otherwise didn't, didn't ever publicly say anything. For two reasons. One, I know how difficult those kinds of social media posts are for women who have had loss or are struggling to get pregnant, and also, I just never felt that I was in a safe space to do so. So it doesn't matter what it was if it was these milestones you know out of first trimester anatomy scan. Third, I mean it does not, I never felt one day of relief at ease, nothing it's. We were very wasn't much excitement in the house. Truthfully, we were both a bit cautious by nature and then this was even more so. It was always like we didn't tell anybody her name, not really out of privacy, but it just felt like if something happens, I don't know, I never felt at ease, like mentally, psychologically, and so that was very difficult and physically, like.

Speaker 2: 4:17

Medically speaking, everything went fine. There were no major complications or issues, thankfully, and I'm very grateful for that. But it was an extremely unpleasant and uncomfortable pregnancy I had. Apparently, I'm pretty sensitive to the changes of progesterone and I had almost like a pseudo gastroparesis. So for anybody who doesn't know, it's like the food won't like when you eat, it won't move throughout your stomach and intestines, so I was in extreme discomfort if I would try to eat. So I essentially ate cereal endlessly, every single meal for eight or nine or 10 months.

Speaker 2: 4:52

And the only other thing I'll add, which I think is one thing that I've always known and encouraged people in terms of advocating for themselves to feel like something is wrong If something, there's something they want to mention. And I got a really good lesson in that, because we tried, for it was five months that I got pregnant and we did like I did ovulation tracking and all that stuff super closely and rigidly because I didn't want to draw it out any longer than it needed to be, and that in and of itself is a bit of a tiresome experience. But I had I don't know I can't remember if I mentioned this before, but I've been pregnant before, years ago, when I had an IUD in place. That was when I was in residency. It was a huge shock, obviously not planned ended up having a miscarriage and because of that and that was me and my now husband and it was, you know, when it was four or five months I was thinking and I'm getting, I'm 34 at that time, so I'm getting close to that range of quote, advanced maternal age and so I asked my midwife, you know, is there, just given that I've been pregnant before, we've been pregnant together before, it's taking a little bit longer, like I'm doing all the tracking really intensely, like, is there anything you want to like?

Speaker 2: 6:11

Can we look into this at all? You know, I knew I didn't want to. I wasn't going to be someone who was going to do like IVF, iui, anything like that. I knew that about myself, dui, anything like that. I knew that about myself. But I did want to know if there was something. You know, one of those small things that people just go on and on without realizing.

Speaker 2: 6:30

And my TSH was high. It was not. It still wasn't actually high per the regular range, but it was. She said it was out of the range of what they prefer for someone trying to conceive or who's currently pregnant. And so they put me on Synthroid and it takes. Actually it's the time I was pregnant, Didn't realize it. I was about, like you know, a week pregnant at the time, of course, but it takes six, four to six-ish weeks to really start working. And around that time I started to feel really, really bad. It's very difficult to describe. It wasn't just nausea, fatigue, it almost felt like my body parts were not attached. I felt like I had developed some sort of like my first flare of an autoimmune illness or something.

Speaker 2: 7:26

It was it was an indescribable feeling and it was miserable and I could not really get off. I was getting between patients, you know was lying down on the floor, on the couch or whatever, and I actually started after this was going on for several weeks, I started to think really dark thoughts, like I don't really want to, because everyone says, oh yeah, the first trimester it's tough, and I'm thinking, is this really? Is this what everyone's talking about?

Speaker 3: 7:52

Like it's this you know.

Speaker 2: 7:54

And and I was like I don't know, it seems to me to be something a bit off, I don't and, but everyone was, everybody was not dismissing it, but kind of trying to reassure you. It's just the first trimester, yeah, it's super rough and yeah, I started having these thoughts like if this is what it's like, I don't want to continue with it. Not, you know, it was like if this gets worse or doesn't get any better, like would I? I was thinking, would I ever terminate? You know, would I ever? Would I? Would I ever do? Do this behind my husband's back?

Speaker 2: 8:30

That's not really a typical thought for me and so things were getting sort of dark and then one of my friends who's a NICU doctor said I really think you should stop the Synthroid and just see if that's it, because I'm thinking people love their Synthroid.

Speaker 2: 8:46

They're like I'm going to get skinny, I'm going to have you know, I'm going to have some energy and and I stopped it and all of it went away immediately, within like 24 hours, and my husband was like you are a doctor. How did you not feel capable of making that call or or confident to speak with your midwife about, hey, this is my concern? And I was like you have no experience being a female in the healthcare system. Yeah, not that my midwife made me feel unheard in any way. It was my own experience that I was bringing into it of like I'm going to be the complainer, I'm going to sound like I'm I'm whining, I'm a, I'm being a baby. I can't handle it. You know I don't need to go on and on. I know this is probably something that resonates and people can identify with it, but that was like Claire. You do know yourself best and you've got to keep that in mind.

Speaker 1: 9:41

Gosh, and you know, I think you know when thoughts are getting dark and I think and you've dealt and you treat women right when they're having that. So I'm sure there was a part of you that was scared too of seeing what you treat and experience every day and right and like. I think that's important to say. You know it scares everybody if they're experiencing it, no matter what side you've been on it in the education realm of it or awareness of it but that you speak up about it and you go. I don't want this to be like this and it doesn't matter what degree you have, it can happen to anybody.

Speaker 1: 10:17

So I think, that's the number one complication of pregnancy the not talking about of it, and I do think, pregnancy, the first trimester you do have this kind of guilt in general of like well, all these other women have done it right and you're keeping the secret a lot of times between you and your close circle of friends, and so that's hard. And then one thing I was wondering is you know, as your bump grew, how did you feel interacting with your patients and how do you think maybe were they like Ooh, I don't feel, like can I tell you this, Dr Smith? Like is this going to weird you out? Am I going to you know? What was that like?

Speaker 2: 10:55

This is a really good question and for years I have managed this for other employees, like residents who get pregnant in clinic, both for the patient side and the resident side of is there a point at which seeing the lost patients and stillbirth patients is just too challenging for them and we want to be supportive of that? In this case, because things have gone so largely virtual, it was not really an issue until I had to give them the heads up that I was going to be going out on maternity leave. The vast majority of people were really excited for it. It was kind of funny.

Speaker 2: 11:34

These people that have struggled, these women that have struggled in every way, shape and form, were still so excited and happy for me, which I found to be really humbling and kind of interesting but really profound. But my lost patients or my infertility patients, that was a tricky conversation that I was trying to really give a lot of thought in advance of how I wanted to break the news to them. And there are some times where I had planned to at one appointment and, like whatever was going on that day, I knew it was really not the time and it was a decision of do I prolong this another few weeks to let them know, or do I bring it up at what feels like not ideal timing and that kind of thing, but it was the maternity leave conversations that had difficulty to them.

Speaker 1: 12:24

Yeah, and was there any point? Any of them may have said, oh gosh, I hope what I just didn't say or I hope you have a different experience to me Do you feel, like you know, sometimes I think we have that like we want to make sure we don't trauma up on you a little bit, like you know?

Speaker 2: 12:40

Yes, but not not all that much I think that it will, but it when it did, it was usually my patients who were the loss and infertility patients who were, I think, maybe internally going a bit above and beyond of how they maybe normally would have reacted. Do you know what I mean In terms to try to mitigate any of my discomfort? That's what people who have experienced loss do on the regular, you know is like mitigate other people's discomfort of what's going on with them. But it wasn't. It wasn't too bad, and I've had some of my patients, particularly loss and infertility patients, who want to meet her, which I found to be really touching and sweet, and I know they're being genuine and I've done that, which is, you know, not really too typical for a psychiatrist and patient relationship, but I've just trusted my gut for those scenarios.

Speaker 1: 13:44

So I think another question that a lot of people have is how did you prepare mentally? You know, you've seen it. You've seen the pregnancy complication sides. You've seen the postpartum issues. You know, from psychosis to depression to anxiety, you name it. So all this is running through your head of you know the risk factors. You know your own risk factors. You've had your experience in the first trimester with the Synthroid. So what were you doing? Because I, you know, I think that's everybody's like well, what did Claire do? You know, what did she do to prep herself? Or like, what conversation should you have with people that you found helpful? Or you're like, ooh, I should have done this a little differently.

Speaker 2: 14:23

For postpartum, for actually after delivery. So I'd say a few things. I did meet with a therapist the dynamic she was lovely, but therapist she was lovely, but speaking of qualifying things, the dynamic was a lot of like well, you would know this, well, I know, you know this. Well, I know I'm telling you something you already know. And I really wanted A to be challenged and B to be treated like any other therapy patient would be, and so I had done that while I was trying to get pregnant and then I didn't see anybody throughout pregnancy. I do have a psychiatrist.

Speaker 2: 14:58

Now that I've been seeing for several months, I can get into that in a bit more detail and why I started to see her.

Speaker 2: 15:03

But I planned my mom came down for a full month, which I know not everybody has that opportunity, so that was immensely helpful.

Speaker 2: 15:13

I had a lot of conversations with my husband about how I felt like we should approach particularly nighttime and feeding overnight, in terms of shifts and that kind of a thing. I had plans that I was looking forward to, that I had made already and I also was in advance. I did things like put all my bills on auto pay, got my dog groomed, you know all those things to take care of, kind of minor housekeeping stuff. And then I did reach out to night nurse companies in advance and again, I know that is definitely not something that's available to everyone, but I did want to be open about it because it's a huge difference. We did not have a night nurse consistently or every night or anything like that, and not until she was maybe three or four weeks old. But we did have night nurse help here and there over the first couple of months, which that felt to me as long as it's not going to financially ruin me.

Speaker 2: 16:16

I was willing to pay and my husband was as well whatever we needed to to get some respite once or twice or, when we got lucky, three or four times a week.

Speaker 1: 16:28

Yeah, and then how was your delivery?

Speaker 2: 16:31

My delivery. I really was. I was. She was measuring large, which I know a lot of babies do, and it doesn't really mean much. But I was on top of that. I had a preexisting fear of having a C-section because, a I've seen it in medical school and it's so brutal and, b the recovery can be so hard and complications and infections and things like that, much less my fear of having to get put on general anesthesia and the worst case scenarios. You know, I can catastrophize a little bit. So I was really concerned about a C-section. Oh, one thing sorry, I went to pelvic floor PT.

Speaker 1: 17:10

Oh.

Speaker 2: 17:10

I love that you mentioned that.

Speaker 1: 17:12

Yes, and that is a. We are big components of pelvic floor PT. I that, yes, and that is a big component of pelvic floor PT? I think yes, and most insurance should cover that. You may have to be a little creative with your OB or even talking to your physical therapist about kind of diagnosis situation. But where there is a will there is a way.

Speaker 2: 17:29

Yes, I was just about to think how do I say this without incriminating my midwife?

Speaker 3: 17:34

Yes, I was just about to think how do I?

Speaker 2: 17:35

how do I say this without incriminating my midwife? But, yeah, so I was. That was one thing I was really really pushing for was I want to see pelvic floor PT before I deliver. So I started, maybe like mid third trimester 30, 32 weeks somewhere in there and so that was really really, really helpful and I encourage any pregnant person I know to do that if possible. So I was, yes, concerned about C-section and I also wanted to stay out of the hospital for as long as I could because I just do not like the hospital from you know all the rotations and stuff that I've done. So once I went into labor and you know it starts and you're like, am I just did I eat something? Yeah, or is this labor? And then a few hours later it obviously you know it starts and you're like am I just did.

Speaker 2: 18:14

I eat something bad, or is this labor? And then a few hours later it obviously you know it shifts into something else and you're like, no, this is labor. And so I tried to labor at home for as long as I could and I probably overdid it. And so once I got to the hospital, I was five centimeters and I was in extreme pain. It took a long time to get an epidural. That was never a question in my mind. I wanted an epidural. I knew it, and I should have gone in earlier so that I know how the hospital works. I know how it works, so that's my bad. So it took about two hours. I went around 9 PM and it took about two and a half hours to get an epidural. To two and a half and I was in. Anybody who's either intentionally or unintentionally experienced dilation at 10 centimeters knows it's an indescribable pain, and so I was not really. I think I was not even fully conscious you know I definitely couldn't speak.

Speaker 2: 19:17

You know nothing like that. And by the time I got the epidural placed I was pushing, you know, five or 10 minutes later. So that was not, that was not my intention, I was not trying to be a hero and I certainly don't have amnesia about what that was like either no-transcript techniques, and I probably overdid it with laboring at home and probably underdid it with pushing in an effort to not tear, and I didn't tear. But but then they you know I delivered ended up delivering on my side Cause they were like, okay, she's de-selling a little bit, let's try and get her out, she's just right here, let's really go for it. And then, yeah, she was out. Delivery overall was okay. You know, if I did it again, I would certainly do it differently, but everybody was healthy and fine. So I really have to be grateful for how it all went.

Speaker 1: 20:37

Yeah, because I'm sure you see a lot of traumatic birth patients and have these experiences. So I'm sure that in the back of your head you just know things can go differently very quickly. And I think there's something I've read the other day that they're saying now, 50% of pregnancies a woman will say that part of their delivery to them was traumatic and just the. Did you feel like anybody was like Claire afterwards? My gosh, that pain, you did it. Or do you feel like you know I've heard a lot of people describe it's like you're laying there, you know, and it's like these people around you, the baby, the pictures, and you're just like I'm a vessel, Like how did you feel after?

Speaker 2: 21:14

Yeah, it was strange, it was a bit of a surreal experience and I think that that's that's how I felt for a lot of it, about trying to get pregnant, about being pregnant, delivery and then having a baby. It feels so just like a part of life, I guess, and almost mundane. So just like a part of life, I guess, and almost mundane, but it's not. It's such a unique and surreal experience, and delivery in particular, I mean, it's just wild, whether it's easy, breezy, or whether it's complicated. I did, it was, it was. Yeah, it's a lot of buzzing around. You know, I'm thinking alternatively, like what does she look like? Is she okay? How is Josh? What do I look like? What's going on down there? Did I tear? Are they stitching me up? Like, am I going to bleed out? You know I'm having these like just snippets of like not even full completed thoughts. And then, once everybody was gone, and it was the skin to skin time, that felt much more peaceful.

Speaker 1: 22:18

I remember you texted me a picture of her and I was like, oh my gosh, this is amazing and she is a doll. So how did you know? I always tell people and I've got right now in my life three friends who they're in that first like month, month and a half. Yeah, I always tell people I feel like that first three months is really, really hard. And I know, your mom was there for a month and I feel like it is kind of when the help leaves a little bit and when your family leaves.

Speaker 2: 22:54

How was that crucial period for you? What was your experience like? Well, firstly, I was. I have just heard so many times how people are so nervous, fearful to leave the hospital in the cocoon of everyone around you that can help and knows what to do, and I was expecting that to happen with me and I was surprised that I was just ready to get the hell out of there as soon as possible and just like get home and get it figured out and get started. And yes, my parents had gotten there that day or the day before. Obviously my in-laws had come in and it was like night and day.

Speaker 2: 23:27

I delivered and I felt like myself again. Obviously, that doesn't last, but I felt like myself in terms of I could eat. I could have cried from happiness that the first meal I had went smoothly and had no pain. I felt physically so much better. I was having sciatica those last several weeks and stuff like that and so I felt much better than I thought I would. Physically. It helps to have not had teared. I was worried about the recovery. It did get very to have to wear the big underwear and the pads and you know I can only wear some. There's only so many options of pants to wear when you've got that situation going on.

Speaker 2: 24:07

you know that kind of stuff and the leaking and whatever of that got. That wore on me definitely after I was home, no doubt about it. So I don't want to paint it as all rosy, but in terms of immediate aftermath I was just so relieved to not be pregnant anymore. Truthfully, and then having my mom here was incredible. She didn't help overnight. She had offered to and I told her I didn't want to. That was too much of I thought. If the worst case scenario happened and my mom fell asleep and smothered Inez, she would never forgive herself and I would, I would, I would, I didn't. I didn't even know that she would survive that. I was like she might. Actually this is so morbid and trigger warning, but I was like she might kill herself if that happened and and I wouldn't want to lose my baby and my mom Like that's the kind of level of thoughts you know, thought process that was informing my decision making, and so it would be up to us at night, which she was a relatively, you know, on the spectrum of babies.

Speaker 2: 25:09

She wasn't colicky, which I was very grateful for. You know things like that. But it was not easy. But I knew that in the morning my mom would be there and I could step away to either shower or even run to the grocery store, take a walk you know, whatever I needed to do, and that makes all the difference in the world.

Speaker 2: 25:28

But, yes, when she was gone and I still had two more months of maternity leave, that was brutally rough and my husband has no paternity leave to speak of. I delivered on a Thursday in the middle of the night and he was back at work on Monday, and so that was a difficult time for us. Definitely, and I also expected that and that was a big fear of mine that came to fruition.

Speaker 2: 25:54

We had some really difficult weeks in there and what really surprised me was the monotony of maternity leave. And it's not that I was dying to go to work, it was more so like I can't sit any longer. Whether it's napping, burping, breastfeeding, bottle feeding, I can't like I'm in physical pain sitting in this position, you know, and that was very difficult that stretch of months before going. Not that it was easy to go back to work and pump and all that, that's another conversation entirely. But yeah, that was a tough few months.

Speaker 2: 26:34

And the week after my mom left Sarah, I think I I think I told you about this she had a brief episode at home where she stopped breathing and like froze in space, she went rigid. It didn't last long but when she came to she still wasn't really breathing well, and you know, I feel teary even talking about it now called 911 and a bunch of paramedics stormed into my home and it was really really really scary and we went to the ER and an ambulance and of course that then triggered a whole host of I can't leave her alone, I'm going to sleep with her in the nursery and I ended up doing that for months and months and months, and just the last one, a lot of the more intrusive type thoughts really began.

Speaker 1: 27:25

As you know and I always tell people this I'm like the things that we encounter as moms, right, and like this is our baby, this is everything, and the worst happened and you experience it and it's trauma and even you know if you already had fears of something happening to her, like if your mom fell asleep, right, so like your brain was already. I feel like. You know, I remember my first intrusive thoughts and it was related to my oldest will dying in his sleep, or I did have thoughts of like my mom fell down the stairs with him and he broke his neck and she would not ever be okay, and it's. I feel like if you've never been pregnant in postpartum and you're hearing this, you're going, my mind wouldn't connect that way. Well, your mind connects that way instantly and you're kind of like, how did I go there?

Speaker 1: 28:11

So how did that impact you? Because you know this is intrusive thoughts. You know what was happening and how that was affecting your life and probably your marriage. What was happening and how that was affecting your life and probably your marriage, and you consider, well, how am I going to go back to work? And so how did that lead up to where we're at today?

Speaker 2: 28:29

So after a little while I realized I was doing my best to not thinking like I don't need any help, but thinking I know what to do. I know what to try to do At least I'm not going to prescribe myself medication but in, I know what to do. I know what to try to do At least I'm not going to prescribe myself medication but in terms of behaviorally and cognitively, what to try to do. And I'll give a like a brief trigger warning again, because my, my intrusive thoughts were really quite morbid and gruesome. I didn't have any thoughts of intentionally harming her which you know, as we both know, is very common but what was happening was when I'd be giving her a bath and she'd be splashing around. All I could think about on a loop was what happens when a baby is being drowned in a bathtub and how are they acting and struggling and trying to fight back in their little four-month-old, three-month-old, two-month-old body?

Speaker 2: 29:26

Or when I was changing her, getting her PJs or whatever, and she'd just be kicking or flinging, or things that babies do when you're holding them down, like how babies are fighting, when they're being smothered, and those thoughts would.

Speaker 2: 29:40

They would just be haunting me all day. I would get a little bit of a break, but they would just go on and on and on. And so finally, I asked one of my sort of mentors, a therapy mentor from residency, if she had any recommendations for therapists. Particularly it'd be great if it was a psychiatrist who also did therapy, so that we could have the medication conversation. But also I don't know how else to say this it's kind of like an equal playing field. There's not so much, there's less chance of the dynamic being weird, as she recommended somebody, and so I've been seeing her since.

Speaker 2: 30:16

You know, at some point in the in the fall probably at least six months, if not more than that because as a result of what happened with Inez and I wasn't able to leave the room, she was doing fine. I've been totally reassured by not only the pediatricians in the ER but all my friends who were pediatricians, about what it was that happened and why it happened. I wasn't moving on from it as I knew I should have been, and yeah, so I still see her. Now I'm decreasing the frequency. I'm overall doing better, and I tend towards rumination and a bit of obsessiveness anyways, and so this was just magnifying that to a really, really big degree.

Speaker 2: 31:00

So I'm back to my baseline level of rumination that is comfortable yeah.

Speaker 1: 31:07

And you know, I think it's sometimes such a disservice to like doctors in general and I see this and even their family members right Of like you just want to be a patient. Like I just want to be treated, don't you know, tend, you don't know what I do for a living, like I had this really traumatic experience with my child. I'm postpartum. Like that's all you need to know about me right now, and I think I hear that a lot. I've experienced that a lot. Well, you should know, you will know, and so I think that's important. But thank you for being so transparent and vulnerable because you know that's the only way we ever make progress and someone to say, yeah, and what was some of the behavioral kind of you know, or what kind of thought did you try before this? Like someone's like, okay, what did you try, claire? Because I have thoughts and I don't like those thoughts. So what was some of those like techniques that you did try?

Speaker 2: 32:02

It was a lot of distraction, a lot of mindfulness type stuff. I would sometimes. What's helpful for me is visual imagery in terms of, you know, the putting the thoughts and like, making them almost a like a tangible thing and putting them in a closet or closing the steel door or those kinds of a thing. That is what I was trying and it would be helpful, but just wasn't enough. I think it was just too, you know, severe.

Speaker 1: 32:35

Did your husband understand it?

Speaker 2: 32:37

or did he?

Speaker 1: 32:37

No no.

Speaker 2: 32:39

I told him about it because I, because I know that people keep this in themselves, because it sounds so scary, and excuse the phrasing, but crazy you know, to people who haven't experienced or or know someone who has.

Speaker 2: 32:55

So I felt it was really important to tell him what was going on. He didn't react in a way that was like, oh, you need to go to the hospital or you shouldn't have, or anything like that. He was more like Jesus, claire, like just think about something else, you know, just that kind of dumb advice. But yeah, it was. It was support in that. I'm glad that you're trying to get this addressed and yeah, please see someone. But yeah, I think he was a bit shocked by the actual content. I know he was a bit shocked.

Speaker 1: 33:25

Did you share with your coworkers at all? You know cause it's this field and what? You're going through and feeling you know cause. You're returning back to work, right, and you're postpartum, you're serving moms. You have so many hats you wear in your job. Did you ever share and reach out for support of someone who gets it? Or was it a friend, like cause? I think it's important to share, like how do you find those people that you can be honest with and it's like picks you up with you?

Speaker 2: 33:52

Yeah, yeah, all of the above honestly, I'm I'm fairly my work colleagues. We are a pretty supportive group, which is really nice. The three of us who are the main attendings in clinic all had babies back to back to back.

Speaker 3: 34:08

We all.

Speaker 2: 34:09

We thankfully all had enough space. It was about four months each of buffer and so we would come back and somebody else left on maternity leave and that happened three times. And so I am fairly we are fairly close as far as work callings go, and so I can't remember the details, but I'm certain that I had to. I definitely told them about when I had to call 911 and that I was still struggling with that, and my friends I told all of my close friends what was going on. We had a trip planned to Croatia when Inez was six months and I was looking forward to that.

Speaker 2: 34:44

Also very, very difficult leading up to it. That was like the height of difficulty with Josh, of the intrusive thoughts. I had not seen the psychiatrist yet, but I had it scheduled for when I was getting back and it wasn't an intervention, but they were telling me on the trip you are really not yourself, we're worried about you. I'm glad you're getting help, you know, and I told them in detail what was going on and it was. They're all doctors, so it was um, and it was very, a very supportive environment.

Speaker 3: 35:14

Several of them are psychiatrists, so they can't, really don't really have the option to be anything other than supportive and one's an OB so and the other is NICU.

Speaker 2: 35:23

So, yeah, I was pretty open with it and I'm even like I give a reproductive psychiatry lecture to medical students every six weeks and I've even told them about it, like when I get to the postpartum OCD and intrusive thought portion of the lecture. I agree with you, I think it's I've almost, it may be almost like a way that I can try and it's a defense mechanism of how to deal with it and trying to spread awareness, at the risk of being a bit maybe TMI in terms of the boundary between attending and student, but I find it to be really, really important to be open about.

Speaker 1: 35:58

No, absolutely. How has your experience with this now, when you treat it's like is there, do you look at them differently? Is there anything in your practice now, from your experience, I mean, we've had she's one, she's over one like you've been through that first year, which is hard, and you've been dealt some cards that most people haven't been. So now in your practice, what do you think's changed? Like what's clear, different now?

Speaker 2: 36:21

now, in your practice. What do you think's changed Like? What's clear, different now? I mean, I think, in terms of really practically speaking, I understand much better the development and stages of what's happening over the first year. So if I have a patient, for example, who their baby is nine months old or 10 months old and they are still getting up repeatedly throughout the night, or feeding them up repeatedly throughout the night, or feeding them multiple times throughout the night, now I really know that that, like that, I need to ask more questions about that Before prior might be like yeah, well, babies get up throughout the night and so how can we address it?

Speaker 2: 36:54

You know otherwise and how can we provide support and problem solve outside of the actual issue. But now I'm like well, why is that happening? Why is that baby eating three times overnight at nine months old? So that kind of a thing I have a much better understanding of, and I think this may sound a bit cheesy, but I think that it's and this is not meant to sound like there's a divide between people who are parents and people who aren't. However, I do think it's very difficult to really understand what the. I think love is a really inadequate word. It feels something much more like primal than that, more like transcendent than that of like I was born with, inez. You know you're born with all the eggs you're ever going to have.

Speaker 2: 37:46

So she's been with me and I I was. When I delivered, I felt this profound sense of deja vu, like I had met her before and I recognized her face. And I don't. I don't believe in past lives. I don't think that I did. I think it's just a product of that. I don't even know what the right terminology would be for it. I think anybody who's listening knows what I'm talking about.

Speaker 3: 38:12

But we get it.

Speaker 2: 38:13

The connection that you have with your kid and even though it waxes and wanes and sometimes things are really tough and that's not the prominent feeling and that is completely normal and okay too and I'm not saying it was this burst of fireworks and love either. You know that people when they don't experience it, they think oh is something wrong. It was just like this kind of, again, surreal experience of like I there is like an otherworldly connection that I will die for you, and so I think that I can truly appreciate that now, even though of course, you hear about it all the time when people talk about their kids and and why certain people would do what they're doing or think how they're thinking or whatever, based on what's going on with their kid.

Speaker 1: 38:58

No, totally. I love that. And let's on a lighter note, like what has been some things that you're like okay, motherhood shook me on this, or you know why didn't y'all tell me this. Like what has been some of those moments.

Speaker 2: 39:12

You know that's a really good question. I think there's been some things that are positive and things that are negative. Again, the monotony of maternity leave. I felt like nobody. I mean it's probably because I see people who are really struggling and so they would give anything to have it feel monotonous. But even my you know my friends because once I express it they're like oh yeah, it really can get if everything's going relatively well.

Speaker 2: 39:37

You know it can be a bit boring and I was like what? Well, you know people. Just it's shocking what people do not talk about and experiencing the it's. It's so crazy what happens over, like developmentally over, and now, being one, it's, you know, she's got it's like a little person that I can actually communicate with. But I think I really understood a bit better, like how you're going to cling to every little milestone or like, oh my, God I think she smiled at me.

Speaker 2: 40:17

You know she grabbed this strawberry from my hand. You know, like you're just anything, you're desperate for anything Like we are progressing, we are getting beyond this, but I think just the really help, like if you're breastfeeding and particularly pumping, like how tethered you are. You know, I've I've that's not like it's brand new knowledge, but I don't think that is really discussed all that much, at least I. In hindsight. It doesn't feel like that was something that people talk about a lot, but that was really difficult. Those are the biggest examples I can think of.

Speaker 1: 40:52

And then now you know you are full blown. From one to two to two to three, it goes so fast You're going to hit. We'll have to bring you back for toddler years, claire, when that whole thing happens, when they really get their personality and shake your world up. But you know something, so what? I guess it's a good point to ask you this question what would you tell Claire, who first found out she was pregnant, with her knowledge that you have now? What do you wish you could have said to her?

Speaker 2: 41:25

You know it's an interesting question because I was telling my psychiatrist the other week that I've been having this. I really think we're one and done for many, many reasons, but I have been having this like nagging feeling of wanting to do it again, almost because of my competitive nature of I can do better, I can have a better experience.

Speaker 2: 41:45

I don't want to have this bitter idea of pregnancy but being so miserable, and I want to try again. I want to try to have a better mindset, I want to try to have a better attitude. So I think that, if anything, I would try to tell Claire that it is what it is. It will be over at some point. You've got to try to, like, bring more positivity into this experience wherever you can, because I was like we talked about at the top of the episode. I was apprehensive, nervous, anxious, not excited. I wasn't feeling terribly connected to her because I wanted to protect myself from you know, even now it feels like her and I barely made it.

Speaker 2: 42:30

There was nothing major that happened. I feel like we are lucky to have both gotten out of this alive. That's my true thought, and I would really like a redo of that, because that is, it's just kind of a crappy way to look back on it.

Speaker 1: 42:45

No, that's. But you know, I, I resonate that and so many people resonate of like for whatever reason of it being like. I mean I feel about people who have like hyperemesis gravidi. I'm like, oh my God, how could you ever do that again? Or I was so anxious from 20 weeks on. Honestly, I was anxious all of it with both boys, because I had had a miscarriage and I didn't allow myself. I remember one of my best friends had to be like I haven't even seen a bump picture of you and you're like six months pregnant, like send me a picture, and I was like, no, because then it'll be real.

Speaker 1: 43:18

So I think it's so common, but I think people don't talk about it either. Right, because we're supposed to be so grateful and blessed and you know, yes, well, now you're healthy. You're both healthy. You know all those things that are so not helpful that people say that occurs. But I love all this conversation and I love you being a mom and I think that it is going to be so impactful, not only just for the people in your circle, but like all the residents, all the medical students, all your patients, that they have you. Who's in it? You're in the trenches, you're living this motherhood. You're doing the balancing of the schedule of like what pediatrician visit you know soon. You're in the trenches. You're living this motherhood. You're doing the balancing of the schedule of like what pediatrician visit, you know soon you'll have the play dates plus your work, plus life, and so much value comes from lived experience and it does it really does.

Speaker 2: 44:08

You know I've and you don't have to include this but one thing I was I thought of while you're talking about you know your how the anxiety wax and wanes. One thing that I really that I thought that nobody else had this experience, I guess, is how unsettling I guess is the best word between when you find out you're pregnant and when you have your first OB visit feels like a fricking eternity and I'm like does nobody want to check that I don't have an ectopic pregnancy?

Speaker 3: 44:36

Like what's the?

Speaker 2: 44:36

deal. Nobody's given me any of this like first trimester info, like what to avoid, what not what medications can I take, and that, I think, was the thing that surprised me, pregnancy wise, the most. The whole thing was difficult, but that was very, very I wasn't sleeping. I was really anxious. You know, my heart rate was just like chronically elevated. Getting to that first appointment was extremely stressful.

Speaker 1: 45:02

Yeah, I felt like every appointment to me felt that way, like I was just like you know, every point. It's like I would have you know. Well, end of wills. I did basically live in the MFN appointment. I lived in their office. That's what I felt like. And we even like joked me and my MFN not too long ago, because we're still friends, because unfortunately I said well, you know once, I almost die on you once, we're always together, you know we're never losing each other and that, like you know, dark humor, way we love to cope.

Speaker 1: 45:38

And I was telling her I was like, well, thank God I didn't have preeclampsia. And she's like if you would have had that or gestational diabetes, you would have literally lived in the hospital with me, like that's. I was like that was to the point. But yeah, I, you know, and even I remember James, the C-section. We got bumped like an hour and I was like oh, no, no, no, don't take off my monitor. Like please don't take it.

Speaker 1: 45:48

I wanted, I felt like you, like I was never like home, safe in my mind, and until, like, I saw them and heard them cry, like it was a weird, odd period to live that way in your mind mentally and people were like you didn't enjoy it and I was like, no, I honestly probably didn't, no, I definitely didn't, and that's hard. But again, these conversations that we have and you're so open, you're so great about it, and again, you're such a force for mom's mental health and we appreciate you and we'll have you back and we'll talk more things but that sounds good. We appreciate you always. Okay, listeners again, if you have not heard the first two episodes of Claire, please go back and listen to them. They are so great and you'll love her just as much as we do. So, guys, till next week.

Speaker 3: 46:36

Maternal mental health is as important as physical health. The Preview Alliance podcast was created for and by moms dealing with postpartum depression and all its variables, like anxiety, anger and even apathy. Hosted by CEO founder Sarah Parkhurst and licensed clinical social worker Whitney Gay, each episode focuses 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. We're here to help.