Why Maternal Mental Health Is Trending

SPEAKER_01 0:09

Hi guys, welcome back to Preview Lions podcast. In light of the latest news, I'm sure everybody who haven't lived under the rock has just been hearing about maternal mental health. If it wasn't from Hayden Pent and Tears' recent passing, who was one of the first ones to talk about post-party depression, to the Clancy trial, which we've all have become group chat warriors trying to figure out if the verdict, I have brought back my favorite reproductive psychiatrist, Dr. Claire Smith. You guys know her, you love her. Welcome, Claire, and thank you again for your time. Yeah, of course. So, Claire, you're like a wild zebra out there, okay? In more ways than one. I love you as a person. But what you do in your profession as reproductive psychiatry, people are like, okay, what is this? Why am I not hearing about this? And don't you think this is the time for the zebras to rise up and like really educate us all?

SPEAKER_02 1:08

So yeah, zebra hive, rise up.

SPEAKER_01 1:10

Yes, this is the time. Like in Madagascar, you know, the little zebra that's like the one that's kind of left, you know, he's so funny. If it's like, come on, bud, you got it. I feel like it's this opportunity to really shine a light that there is true professionals educated to the utmost out there who know truly how to help um maternal mental health. But we're just not talking about it. Right.

SPEAKER_02 1:34

Right. Yeah.

What Reproductive Psychiatry Really Is

SPEAKER_01 1:35

Uh do you I can explain what reproductive psychiatry is if you want? I would love you to say first why you wanted reproductive psychiatry, what it is, and then give our listeners kind of a glimpse of like what kind of patients would come to you.

SPEAKER_02 1:48

Okay. You'll maybe you can prompt me if I forget any of those items.

SPEAKER_01 1:52

Yeah.

SPEAKER_02 1:52

Um, so I was not planning to do psychiatry in medical school, really was not interested in psychiatry, didn't know much about it, didn't think that it was something I would want to do. And honestly, most of that is still accurate. But when I was at the very end of my third year of medical school, which is the year that you do all of your main core rotations in the hospital, I was almost finished and I was doing psychiatry. I was planning to do pathology, which is like way different. That's when you look under microscopes and do autopsies and things like that. Um, and I did a an elective, like a one-week experience with an outpatient, like a clinical, I mean a clinic psychiatrist. And um she had a an informal interest, there not like had gone to a fellowship or anything in women's mental health, particularly for her, it was menopause and perimenopause. But then that introduced me A to outpatient psychiatry, which is very different from inpatient, and B that there was a field that existed called reproductive psychiatry. And so I totally changed my path, um, went to psychiatry residency in order only ever to do reproductive psychiatry. So I'm not interested in general, I'm not interested in inpatient, I'm not interested in seeing men, I'm not interested in any of that. So um that is my path, and I went to residency for four years, and then I did a fellowship in reproductive psychiatry for a year, and now I am a full-time reproductive psychiatrist. So what we do is it can vary from program to program or center to center. Some all almost always, or basically always, perinatal, meaning the period of pregnancy before, during, after, is um is a part of reproductive psychiatry, and that is what I do essentially full-time. However, perimenopause and menopause can also be under reproductive psychiatry, PMDD and other premenstrual issues disorders can be other under reproductive psychiatry. Some have more specific uh treatment for like infertility, you know, REI, umcology, all sorts of things can fit under the umbrella, but the biggest portion is perinatal. And so sometimes you hear the perinatal psychiatry being interchanged with reproductive psychiatry.

SPEAKER_01 4:35

How many people do you think go, wait, I didn't even know that was a thing to you?

SPEAKER_02 4:40

The almost everybody that I if anybody asks me what I do and they ask what kind of psychiatrist I am, and I tell them almost nobody knows what it is.

SPEAKER_01 4:51

And tell listeners who are going, okay, I didn't know. Why don't I know? Why don't people know?

SPEAKER_02 4:56

Well, the um even though 50%-ish of the population are women, and the majority of those women will be pregnant or trying to get pregnant at some point, there has just been a real lack of probably interest and also fear around engaging in care with that population because of the perceived risk in terms of fetal risk, you know, risk to baby. So for instance, if anybody's not aware, from 1977 and 1993, the FDA barred women from participating in any clinical drug research. So women in general, half the population, it's are you're already operating way behind in terms of drug research and clinical trials, randomized control trials, and so on. So it was only the NIH in the early 90s who said, no, we have to look at women because some things are similar, some things are different, but we need this information because of again half the population is women and the majority of those people will get pregnant. And so it's only been in the last probably few decades, like maybe 20 years, that this has been a true academic field. And the interest in terms of medical students and residents, psychiatry residents wanting to go into it, I'd say last five to 10 years. It's growing quite a bit. Um, but that's probably why, and also just lack of there, they aren't around as much. And so you don't come into contact with them as much.

Finding Competent Care While Pregnant

SPEAKER_01 6:42

Many states do not have a you, um, which a lot of people may they're going, okay. And I think it's an important part, especially if listeners to hear this part, is it's so blurry, and we're seeing it in the trial. We're seeing it just when you're maybe looking for any kind of care, is sometimes people put blanket statements of what they cover, right? Maternal mental health is sh is like the hot buzzword now, right? To say. And there's different levels of training, there's different levels of exposure. Um, kind of just kind of talk about what if if you, if they can't get to a you, a reproductive psychiatrist that specifically says they're fellowship trained or you know, has that title, and maybe they're assuming a psychiatrist would do, or a psychiatrist should have had this experience, right? Like, um, how do they walk through those muddy waters as a patient?

SPEAKER_02 7:38

Yeah, it's difficult. The exposure to general psychiatry residents varies drastically. Some have literally zero, some have the opportunity for a lot of exposure, like my program does, um, or MUSC's program does, I should say. And some are somewhere in between. Some get lectures, but no clinical experience. Some get lectures and clinical experience. So it can be, it can be really hard. But I do think that most psychiatrists or mental health providers, like maybe your option is a nurse practitioner or a PA, you know, that those are the realistic options for a lot of people, particularly if you have Medicaid, um, is just asking what their comfort level is in perinatal psychiatry and treating pregnancy and knowing what to do if pregnancy occurs, because half of them are unplanned. Um, and there are a lot of psychiatrists, as much as I appreciate and love all my colleagues, they're they're my biggest problem because they will start medications and just sort of they have no idea what to do if and when someone gets pregnant, and then they freeze and say, stop all your medication, or I don't know what to do, you'll have to find, you have to find somebody else. And that's not always an easy thing to do. And so patients can get the runaround, get the wrong advice, which is usually fear-based advice, um, but lack of that exposure and training, like you're talking about. So I just asking, they should be able to say pretty truthfully whether they are or are not comfortable.

SPEAKER_01 9:09

And I think it could be very honest of saying, hey, I, you know, have how many postpartum severe postpartum depression patients have you treated? Um, are you comfortable with, you know, a history of bipolar and me being pregnant? Um are you capable? Have you ever treated a postpartum psychosis woman? Have you ever been exposed to that during residency? And it's uncomfortable to ask these things because you A, you don't want to like assume you're gonna have that, but if you know your risk factors, I think it's those, it's that we're at the point of lack of true um maternal mental health care for moms that you have to go in almost assuming you're at a negative and you have to figure out what works for you. Like you're not a surplus, it's not like pediatricians, where a lot of times you can throw a rock and hit one in most towns.

SPEAKER_02 10:02

Right. That's what I was thinking while you were talking, is it probably feels uncomfortable to ask those questions because A, you know, as a society, we really aren't ingrained to question doctors. Um and you feel like you're interrogating them or you're being difficult or those types of things, particularly women. Of course, we struggle with that. Um, but also, like if say this person says no, maybe maybe that's what you thought your only option was. It's like you said, you're not just hanging on the trees everywhere. So sometimes it can feel like you have to accept whatever it is in front of you and you don't have the option. But I do think those questions are important.

SPEAKER_01 10:43

And then I think it's gonna blow people's minds too, when they it's just the lack of exposure of, I mean, let's think about how many people who are moms who are severely depressed or severely anxious um or PTSD from traumatic birth don't go in and get help, right? They they suffer at home in silence. So, I mean, if you think about that, when you think about psychiatric residents or if it's PA and P and they're in their rotations, it's not like we're coming in for care. So the exposure is a a flawed system on both ends, right? Like we're not making it easy for care. And then again, it makes total sense that you may never see that. Um, and I think it's mind-blowing to people that like this is where we're at in 2026 for Bollem Smith Health.

SPEAKER_02 11:34

I know. I mean, when you think about, I mean, if you think about OBGYNs and how much they have on their plate, how overworked they are, how little time they get in their appointments, they check in with somebody if they're if the delivery was uncomplicated, say there's nothing noteworthy in their history once at six weeks, and that's it. And they've got 10 minutes to do so or 15 minutes to do so, somebody really has to be motivated to say something, you know, because they know that's going to probably create a longer appointment, more talking points. So you're again being difficult, it's not that big of a deal. Everybody goes through it. And so the people who seek care are either so dysfunctional, um, that that that their family or spouse or kids are even noticing, um, or it's clear in the appointment, or um there that it just never happened to them and they're so freaked out by it. But yeah, I mean, mental health complications of pregnancy and postpartum, it's one in five, and you don't even scratch the surface at seeing that many people.

SPEAKER_01 12:40

No. So I guess it's a good

A Real Day In The Clinic

SPEAKER_01 12:42

point to ask. So, okay, walk us through a traditional day as a reproductive psychiatrist. Um, kind of start to finish who you see, what it may look like to you. So we're just again trying to normalize that if you do are lucky enough, say if you're in South Carolina, you have access to NUSC's, you know, programs, or if you're up north, there's some great programs there, or North Carolina, Chapel Hill. What my whole goal here is just to bring awareness, maybe someone is in med school and they're like, that's a great option for me. Or um maybe it's providers that want to seek out more training because they're like, oh, I so because I think again, they're like they kind of think, Claire, you go in and you see a patient and she is the epitome of um, you know, her hair is like static electricity, she looks disheveled, she can't function. Um, you know, some people be like, oh my God, do you restrain her? Do you sedate her? Like, I think people have this whole vision of what a bob gets to Claire at. Yeah. Yes.

SPEAKER_02 13:40

That is really few and far between. I mean, the majority of patients we see are high functioning or relatively average to high functioning, you know, have a job, have other kids. Um, you know, you're not seeing them on the street and thinking that's a crazy person. You know, it's people that are just like, I'm I've I've been able to manage whatever maybe you want to call it anxiety, or they assume they have anxiety, never asked about it, never talked about it. It's helpful in some scenarios. They've always managed well. Another postpartum, and they can't sleep because they're watching the monitor all night, or they can't sleep because they're just doom scrolling about SIDS, or they won't they won't let anybody else touch the baby or care for the baby and take any time for themselves to shower, to run an errand, whatever. And that is when we see them. So it is a lot of people who've never seen a psychiatrist before, who have no prior mental health history, never taken medications, and maybe not interested in medications. We got we see a lot of people who only want to engage in therapy. And then we do see people who have long mental health histories, more severe mental illness, more chronic mental illness. So it's really the spectrum, but there's a lot of that middle ground of people that would you would perceive as quote unquote normal. Um now, my typical day, I do almost all outpatient. So some programs will have inpatient, like an inpatient perinatal unit. Those are very rare, but there's a couple in the country. Um, some programs, some reproductive psychiatrists will see consults, like women who are admitted to LD or the postpartum floor or the internal medicine floor or what have you, um, and they need a psychiatric consult for some reason. Our general consult liaison team sees that, and I feel very strongly about not shifting that to us. We get curbsided and sometimes we'll be involved and ask questions and things, and but I want our general residents to have done those consults in residency, and I don't want them to be funneled to a specialist uh personally. So, what my day is usually like is I do a lot of education. So I have I supervise a lot of residents. Um, we have a big psychiatry program. This year we have 17 residents in clinic between third and fourth year residents, so that's good. It's the majority of third years and a couple of fourth years. Um, so we're trying to do our part certainly in educating the general psychiatrist. Um I am supervising them seeing patients, and I will see my own follow-up patients. I might see I two half days a week see intakes. So patients that are new to the clinic, I see them myself. And then other things are more administrative and other roles that I have. But it's a lot of patient care or supervision of patient care in an outpatient outpatient setting.

SPEAKER_01 16:38

Do you see that fear in the resonance of like, okay, well, what's if I miss something? Or, you know, because now, you know, we have, I think it is mom baby, right? Um, it is special population according to like the FDA and research, and we are right. And but I think it's the fact that now it's vulnerable. And I think it's that, what if I don't ask the right thing? What's if she admits to filling what I fear she's filling? Do you see that in them?

SPEAKER_02 17:07

Oh my gosh, yes. Particularly so uh for context, we're at the end of August right now, and July is when the new academic year starts. And in psychiatry, it's very delineated first two years and second two years of residency, to where their third year is their outpatient year, where they're really truly first in an outpatient setting like this, certainly engaging in therapy, so on and so forth. So, not only is that new, but this population is very new. We are really particular about our supervision in terms of always being available. We're not doing other things, I'm not seeing my own patients when I'm supervising, stuff like that. So that we are easily accessed down the hall. And yeah, there's a lot of questions, a lot of double checking of seemingly very simple things, which is how it should be. But yeah, a lot of fear and uncertainty. And then the learning curve is big and they it's incredible how they're doing at the end of the year.

SPEAKER_01 18:04

And then what are some typical okay? Cause I think I always wonder, it's like, okay, so what would you ask me? You know, kind of like are, you know, what is appropriate? And I think that could be helpful from listeners if maybe they've never been asked this, if they're really struggling, because I think sometimes you get a screening thrown at you, right? And you may have your baby with you, or um, you may have that comfortableness of it, or they you're not anxious, are you? Like that might be how you're asked, or you're not having thoughts of harming yourself, right? Like all that um leading questionnaire of like, nope, you're not, I'm not gonna let you answer that today. What are some things that you teach residents? And just good for listeners to hear of like, what is an appropriate kind of different way to check in besides the normal, like throw a scale at you?

Better Screening Without Leading Questions

SPEAKER_02 18:52

Well, uh, this might not be exactly what you're asking, but one thing that we do here that's um grant funded is text message screening instead of that paper screening or certainly in-person screening, like you're talking about, like the rooming nurse at the OB follow-up is again, she's very busy, you know, and she's trying to get a whole bunch of people. It's it's double booked, you know, and she's she's typing it on the computer, she got her back to you, and she's saying, feeling okay, feeling safe at home, not depressed, not how you know, those questions, like questions that are like universally not accurate. Uh, though the responses to those questions are are not valid, and people don't tell the truth. Um and there's been really, really good results with text message screening because people would just tell the truth a lot more um often. But not leading the question um is is the probably the single most important thing. A lot of normalization, a lot of um like it's I do a lot of explaining, you know, like so the questions have a context and it doesn't just feel like a box checking session. Um, so a lot of education, a lot of normalization, but honestly, being straightforward, um, not being around the bush, you know, when people pick up on you being like tiptoeing around these questions, then they don't want to answer them. So being straightforward and um clear is also very important.

SPEAKER_01 20:22

No, I love that. And you know, people always I remember training from the VA days about asking, they're like, there was this fear of like if you ask someone if they have thoughts of harming themselves, that that would make them act on it when research and everything knows that's not true. Um, so having a provider that does ask about your thoughts and intrusive thoughts and almost normalizes if you are having intrusive thoughts. And just for a second, hit on what intrusive thoughts are because if someone's not, we have a great episode we did together a while back, but if someone's new to us and they're like, wait, what's an intrusive thought?

SPEAKER_02 20:54

Okay,

Intrusive Thoughts And Postpartum OCD

SPEAKER_02 20:55

so intrusive thoughts are really common in in the postpartum period. Um, basically everyone will have intrusive, upsetting thoughts about harm coming to their baby on accident. These can be things that make sense, like I'm so afraid of slipping down the stairs. I'm just having this intrusive thought all like visual, you visualize it. It's like this vivid imagery, and that's why it can be so upsetting of like seeing the baby fall down the stairs. You're you're running it through your mind. It can be bizarre. It can be, I have this intrusive thought that I'm going to somehow leave my baby in the oven. I'm gonna somehow set them on the stove. Like that's completely irrational. But and they may know it's irrational. They know it's strange, and um, and that's why it's so bizarre. But it's really upsetting because they have no control over it. That is the main piece of intrusive is they can be reality based, they can be strange, but it's um it just feels like it comes in your head, you can't control it, and typically it's upsetting. Distressing. And then in postpartum, it actually 50% of new moms will report of intrusive, upsetting thoughts about harming their baby on purpose, which really scares people. And it's actually very common. And that's something that I know is wildly underreported, but is screened, should be screened for at basically every postpartum visit, with the context of okay, there's this thing I'm gonna ask you about. They're called intrusive thoughts. This is what they are. They're actually very common, even though they sound very scary. Um, have you been experiencing anything like that? And then it's amazing how many people will endorse that they are, but they don't tell anybody. And then the last thing I'll say about intrusive thoughts um is not always, but it can be a part of a broader picture of something called postpartum OCD, where which is these intrusive upsetting thoughts, but it can, you know, thought the themes of death, of all sorts of really dark stuff.

SPEAKER_01 23:02

Yeah. And then do you see when you ask and normalize and not running out of the room like they imagine Claire's gonna do when they disclose how they really think um that you see almost like a weight lift off patients when they say it?

SPEAKER_02 23:18

Yes, a lot of people start crying and makes me almost feel a little teary talking about it because people feel so relief, relieved that they they've consent, they've convinced themselves that they are they've become a monster, that they're a pedophile, that they like could do something like I don't want to, I don't have any desire to. This is horrific to me. But like, what if I just wake up and do it? And you know, that's the nature of intrusive thoughts and why they're so bothersome. But just understanding what they are, it's essentially this evolutionary need to ensure the survival of your offspring that's kicked into overdrive and a bunch of other complicated factors. Um, but yeah, a huge amount of relief and just gratitude for understanding.

SPEAKER_01 24:07

What do you think, besides talking about trees of thoughts, which we do, um, and when you're trying to get pregnant pregnant, what else would you wish if you could, you know, change things, you know, now that everything's a topic, like what else do you wish moms would know that you think would probably take a heavy load off just like again, that that it's so heavy to carry that alone and it it it it spirals you and it's hard?

SPEAKER_02 24:32

Probably that there is you know that postpartum period, motherhood, breastfeeding, all there's as many different experiences with that as there are women in the world, you know, there isn't a one-size fits all, and I don't think it helps to scare somebody, and I don't think it's helpful to um to sugarcoat either. I think uh, you know, a middle-of-the-road realistic approach, but also just how sometimes it feels very surreal. Sometimes it's just so bizarre how difficult it can be, or say some, I guess what I'm trying to say is one specific experience that someone might be having, lots of other people do have. Whether it's like this feels so monotonous to me, or whether like this breastfeeding, I hate it. I hate breastfeeding. And you feel like you're on an island alone and you see everybody on social media and whatever. So I just that the experiences you're having, I promise you, are widespread.

SPEAKER_01 25:36

Yeah, no. And then what let's say the rare case, because I'm sure listeners, now postparm psychosis has become the hot topic, right? How many postprim psychosis women do you see traditionally in a year?

SPEAKER_02 25:49

Not many. I might see between myself and supervising lots of residents, so that's gonna be, I mean, hundreds of patients in a year. Um, maybe even a thousand patients or more in a year. I might see I might see a handful of people who have a history of postpartum psychosis. And I might see one to three who like were discharged from the hospital and need follow-up, or there's a question of postpartum psychosis. It's very rare.

SPEAKER_01 26:30

Yeah. And then the key here too is if someone did experience that, they go to emergency room. This is a true emergency. They're not always going to be postpartum psychosis. I think it's like people always see the tragedy, right? They never see the people who have experienced it and been treated and now functioning, now fine. That's a chapter, that's a small little chapter of a long series of books. Right.

SPEAKER_02 26:56

And the thing about postpartum psychosis is it's rare and it's very scary and it's an emergency for good reason, but it's very treatable. Of all of the things that we treat, it's got some of the fastest treatment and best treatment for, you know, in terms of long-term uh remission. So that

Postpartum Psychosis And What’s True

SPEAKER_02 27:17

is the one silver lining about postpartum psychosis. Very treatable.

SPEAKER_01 27:21

And then when you hear about, you know, depression and anxiety and research shows, right, so that a mom can suffer, people people tend to say, okay, well, postpartum's three months postpartum. Absolutely not, right? Just so if a listener's going, okay, I'm eight months postpartum and I'm still depressed, Claire, or I'm hitting in a year and wow, the anxiety is still like very much present. Um, what's the misconceptions about when they're truly out of the, you know, out of the field of it? Like, no, this is now just anxiety versus depression versus like where is that? Because people always blur that.

SPEAKER_02 27:59

Yeah, it's and it's blurry and it is blurry. In terms of what's considered the postpartum period, I'd say most people subscribe to the 12 months definition. However, in reality, we all anybody who's had kids or had a loss or anything related to it knows that at 12 months you don't magically become like you don't revert back to who you were postpartum. It's kind of silly. In terms of what can what sort of um diagnoses can be attributed to specific changes in pregnancy or postpartum, I'd say that's reasonable, the 12 months. Um especially if someone, if someone is continuing to breastfeed and things like that, that's gonna prolong everything that's going on, you know, without going into too much detail. Um but we so our clinic, the eligibility is 12 months postpartum. Okay. Um, and that's that's the a common one for these types of programs around the country. And I've had more than one person say, you know, not not being, they're being, they're joking, but they're like, this is one year, you know, that's ridiculous. It should be two years, it should be what that should be definite, you know. Um, but in terms of there, there can be a tricky line between postpartum depression, which has, you know, uh one of the prevailing theories is these hormonal changes that happen after delivery, and and someone developing depression three, six, nine months, whatever down the line, because they've gone back to work, or some other life stuff has happened that is is contributing to a true depressive episode. That is where I think the muddiest line is. But postpartum depression, if untreated, most people will feel better, but a very large minority, like 20%, would still have symptoms at two years postpartum. That's why it's so important to screen for and to treat.

When Postpartum Ends And PPD Lingers

SPEAKER_01 29:55

If you wish, you know, one what could be one change you think OBs or OB friends could do that you think would make an impact?

SPEAKER_02 30:03

I wish that we could see everybody at two weeks postpartum. I think that would have the biggest impact. And yes, it would, in terms of when you think about screening, you want to screen as many people, knowing that some of those people won't truly be positive, right? That's the point of a screen. It's not confirmatory. So if you're screening so early, could it be blues and it's going to clear? Sure. Could it be somebody adjusting and they're and it's going to get better over the next couple weeks? Sure. But if it doesn't, you're in a totally new position. So I think being ahead of it, being proactive and doing the screenings and checking in, having like a 30-minute postpartum visit at two weeks, I think would make a big difference. That and knowing the exact um like referral option, phone tree, whatever that exists for you, and to know exactly what to do to, you know, not waste time.

SPEAKER_01 31:00

Now, what about a partner or a spouse? What do you wish they knew for this that would be helpful for mom's mental health that you think would actually move the needle?

SPEAKER_02 31:08

I could talk about that for the next three hours. Um, so much. I mean, I I wish that spouses or partners, I wish everybody took some sort of a class together about what happens postpartum physically, like bleeding, leaking, healing, what it's like to have your milk come in, what it's like to breastfeed it.

Two-Week Postpartum Visits And Partner Support

SPEAKER_02 31:36

Obviously, they nobody's gonna, it's not their fault they can't understand it exactly if they're a man, but you know, understand to the best of their ability, that in addition to what the what's the literal, like basic science changes that are happening, what's the hormonal changes, what is typical, what is not typical, what somebody needs, you know, a I think all just like basic crash course on particularly what postpartum is like and the things that could come up would be very helpful. That is like who knows if that will ever happen, you know, that's gotta be funded or covered by insurance, or people have to be willing to go. But in a perfect world, in my mind, that's required for all partners or significant others.

SPEAKER_01 32:15

Yeah. Okay, so let's take it to a bigger level. What would be like federally or legally or boards, like if we're talking like dream vision here, that if people call their senators, they call their representatives, right? What would you say could actually because they're they're like, okay, well, what would I say that would make a difference, you think, for us?

SPEAKER_02 32:37

Um well, paid maternity leave, a um at least three months. I mean, that would be the bare, bare minimum in my mind. Um I think it being a requirement of psychiatric and pediatric and an obstetric training. Um, and again, that's a way bigger can of worms in terms of what does that look like? How do they have access to that person? If they don't have a reproductive psychiatrist, how do they give us training? That's a bigger, that's a bigger problem. Um and we need to do better at our clinic is uh particularly at this time of the year with new residents and people on vacation and summer and stuff, is drowning. And um, for us, we like to see patients within two weeks, a new intake. And right now we're sitting around six weeks. For us, that's very long and unacceptable, but there really isn't anything to be done about it. And part of that is because we see a lot of people who really don't need the specialty care. It's just somebody who like isn't sure if their patient can take Zoloft while they're pregnant, or doesn't want to prescribe their viance while they're pregnant, or doesn't know what to do, you know. And so I think education of PCPs of obstetricians could help reduce the volume. And so, and but also be able to serve people who are in a you know mental health desert.

SPEAKER_01 34:04

Yeah, yeah, like Alabama. All this stuff, I mean, so what do you and final kind of like what do we see? Say, let's say that the hated pantyers passing, who was so open. Um, we've got the Clancy chart. We've got this huge

Paid Leave And A Moment For Change

SPEAKER_01 34:19

momentum. What do you see as an opportunity for mature mental health right now? Like, do you think this is where we rise up, we all share our stories and we make change, or do you think we this may unfortunately fall back? And this is one of those like, well, we had an opportunity, but we did take it.

SPEAKER_02 34:34

I know. I've been thinking about that actually because I'm seeing so much discourse, not not only of course on social media, which like that's a who knows what's going on there, but it professionally too, you know, like our um in terms of uh holding journal clubs or lectures about I getting a lot of questions from medical students, from residents. So I think it is an opportunity to make to really dig our feet in and make, you know, have some roots in terms of progress forward. But I mean, that's my hope. Um who knows? I I I'm probably a little bit too cynical to be just completely optimistic, but that would be, I think the opportunity certainly is there.

SPEAKER_01 35:18

Because I'm my fear was this is, you know, because a lot of people have been on trial and professions that treat moms, right? Is that what they have been crucified? Some rightfully, in my opinion, some not. And um I do think it it could put us push us back where people are like, oh, we're not gonna touch them again, right? We're vote-that's a vulnerable population. Um, if they don't have access to mentorship like you or training from you or like experience. So, but one last thing. Um, so listeners, if you don't know, Claire's mom. And um let's say your daughter fast forward, she's fixing to become pregnant. What would you tell her about pregnancy and postpartum that you think would really help her? Goodness.

SPEAKER_02 36:00

I could even longer than talking about readiness for partners, I could talk about this if she decides to do so. Um she's probably gonna be so annoyed with me and and all the things I'm going to say. I mean, I not even just for my own daughter, but I do feel like a sense of duty to like I said, there's a middle ground. I'm not trying to scare people. Lots of people have a lovely perinatal experience, but just the realities of of some things about it, I would tell there's so much. I don't even I couldn't even pinpoint a few things, but I think the overarching theme that that I have realized in pregnancy is, and I think I've said this before, maybe on one of our other episodes, is that it seems like kind of um going back to what I said at the beginning, this is a really routine experience and why people should know how to treat it and why people should know what to do in case somebody gets pregnant or has an issue while pregnant. But in in that, you you sort of think that it's a kind of mundane experience or just like this run-of-the-mill. In reality, it's one of the more profound, for better or for worse, like profound, surreal, strange experiences you found yourself in, both pregnancy and growing a human, loss, miscarriage, stillbirth, and delivery and raising a kid, and the everything that comes along with labor and delivery in the postpartum period, all of that is so individual and so unique and so surreal. And I I wish that was talked about more.

SPEAKER_01 37:38

Yeah. No. Well, I know she will be very lucky if that's a choice, if she chooses to go that to have you. And I will try my best to convince you to do a whole episode of uh to my daughter. And if she gets annoyed, you can just be like, listen to the podcast episode.

SPEAKER_02 37:52

Oh my gosh, that would be hilarious. Yeah.

SPEAKER_01 37:55

So that because I think honestly, I think the best thing I've seen in this experience, and you probably too, is just openness of sharing. And like if you share and I share, um, that's that's an effort that maybe a listener's maybe never heard before. And so that she would ask for help or she'd feel not alone. And there's so much micro movement that eventually goes to macro movement when you share.

SPEAKER_02 38:19

I no, I agree. I I think that vulnerability always begets more vulnerability. And we it doesn't matter if you are enjoying it and having a nice time, you need support. You need help. If you're having the picture perfect pregnancy and postpartum, you still need help. You still need compassion. And not just that, but we deserve all of those things. You know, everybody does experience. Um, and I'd say that's my biggest takeaway.

SPEAKER_01 38:45

Well, Claire, you're always, I wish I could, you know, replicate a zillion Claire zebras and release them into our healthcare system. And I think that would be the best that we could ever do. But um until AI figures out how to do that, then we're just going to continue to um be thankful for your voice and what you are doing at your institution and how we're trying to just spread the word for more trade. So, Claire, as always, we appreciate you so much.

Final Takeaways And Closing

SPEAKER_01 39:13

Thank you. All right, listeners, I'll be back next week.

SPEAKER_00 39:19

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 Parkers, 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.