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Perinatal Mental Health with Dr. Alana Dopp · Mind & Medicine - A Behavioral Health Podcast by Sentara

• 0:00
  Speaker 2: Hello and welcome to Mind and Medicine, the Sentara Podcast.
• 0:03
  Speaker 2: I am Tommy Bateman, your host, and today we'll be talking with Dr.
• 0:06
  Speaker 2: Alana Dobb about treating our pregnant and post pardum individuals .
• 0:13
  Speaker 2: Before we begin, here are a few important CME announcements.
• 0:16
  Speaker 2: This episode is accredited for AMA PRA Category 1 credits for full accreditation, designation, and disclosure information, please refer to the show notes.
• 0:25
  Speaker 2: And now the show.
• 0:26
  Speaker 2: Alright, Dr.
• 0:28
  Speaker 2: Dobb, thank you so much for coming today.
• 0:31
  Speaker: I'm so happy to be here.
• 0:32
  Speaker: Thanks for inviting me.
• 0:33
  Speaker 2: And I'm and I'm really, really excited about this topic.
• 0:36
  Speaker 2: We were talking before this, and and I know I know that people are gonna love it.
• 0:40
  Speaker 2: So uh but before we get into the topic yourself, tell us about yourself.
• 0:43
  Speaker 2: How did you get into this space?
• 0:45
  Speaker: Yeah, so I'm currently an assistant professor in the Department of Psychiatry and Behavioral Sciences at Eastern Virginia Medical School at Old Dominion University.
• 0:54
  Speaker: I graduated from the Medical University of South Carolina a couple years ago now, and there I specialized my training in perinatal mental health conditions, basically meaning focusing psychiatric care for people during pregnancy and postpartum.
• 1:08
  Speaker: I was hired here in August of last year.
• 1:12
  Speaker: I then had my first baby myself, and then started working in the clinic in the fall, winter, and December, where I have been specifically treating people in the OB clinic that have mental health conditions during pregnancy and postpartum.
• 1:28
  Speaker: I also have my own psychiatry clinic where I can I seek people outside of EVMS too.
• 1:34
  Speaker: So really trying to treat people in the Hampton Roads that have these conditions during pregnancy and postpartum.
• 1:41
  Speaker: And I found that there's such a need for this work.
• 1:45
  Speaker 2: There absolutely is.
• 1:46
  Speaker 2: And no, folks, we did not plan this to happen during a certain trial that became famous around perinatal issues.
• 1:54
  Speaker 2: Um, but this is just such a need that I've seen, you know, in my own personal life and professional life.
• 1:59
  Speaker 2: And so I'm really excited to talk more about this.
• 2:02
  Speaker 2: So tell us, you know, perinatal, of course, pregnancy and postpartum.
• 2:07
  Speaker 2: What specific issues are you seeing?
• 2:10
  Speaker 2: What is the need around this?
• 2:11
  Speaker 2: I mean, it may be obvious, of course, but let's let's get specifically here.
• 2:14
  Speaker 2: Yeah, what things are you seeing that uh is is causing such a tremendous need right now?
• 2:21
  Speaker: Well, about one in five um people during pregnancy experience a mental health condition.
• 2:25
  Speaker: So that can be depression, anxiety, obsessive-compulsive disorder, post-traumatic stress disorder, bipolar disorder, substance use disorders, and psychosis.
• 2:35
  Speaker: Some people might have these conditions before they become pregnant and they can receive medications for treatment and they don't really know if they should continue these medications during pregnancy.
• 2:48
  Speaker: A lot of the times they might get the advice to stop these medications.
• 2:51
  Speaker: And what I see is a worsening, oftentimes worsening of mental health conditions when people stop their medication.
• 2:57
  Speaker: And that could be a risk to the pregnancy in itself.
• 3:00
  Speaker: Other times, um, through like stressors of being pregnant, whether that's low social support, financial stressors, housing instability, substance use, people could have new mental health symptoms during pregnancy too.
• 3:13
  Speaker: Um, so either way, whether it's a new onset or chronic condition, um, these symptoms really do need to be treated.
• 3:20
  Speaker: And without treatment, there can be risks to the pregnancy if these symptoms are significant.
• 3:25
  Speaker 2: And so I'm kind of trying to draw parallels.
• 3:28
  Speaker 2: Um, you know, not being a psychiatrist, my counselor, not a psychiatrist, Jim.
• 3:31
  Speaker 2: So, you know, one of the things I'm I'm thinking here is I used to do uh uh evaluations for for individuals that you know may need to be committed um involuntarily, right?
• 3:42
  Speaker 2: And I when I worked, I worked in an area that had a university, a thriving uh graduate program, and I saw more often than not a ton of graduate students uh that that had some sort of break.
• 3:55
  Speaker 2: Um, and I'm kind of liking what you just said there for the ones that had chronic conditions or the the potential for a condition, uh finally have some sort of break during pregnancy or perinatal um that period.
• 4:07
  Speaker 2: Uh very much like my graduate students that, you know, under extreme stress develop something that that was always kind of there.
• 4:14
  Speaker 2: They always had the potential for it, but this kind of made it happen.
• 4:18
  Speaker: Yeah, it definitely can.
• 4:19
  Speaker: Um there can be so many different reasons.
• 4:22
  Speaker: Um, you know, sometimes it's social support, sometimes it's the stress of the pregnancy.
• 4:28
  Speaker: And um the postpartum period can be a very hard time for so many different reasons.
• 4:33
  Speaker: This is a period of like a role transition um to motherhood, like learning how to bond with the baby, take care of the baby at the same time.
• 4:41
  Speaker: There are extreme hormonal changes.
• 4:44
  Speaker: Um, and then having a baby can also cause a lot of changes in people's relationships that can really affect their mood too.
• 4:52
  Speaker: And so, and and in the midst of this, there's very little sleep.
• 4:56
  Speaker 1: Yeah.
• 4:57
  Speaker: Um, so typically when people are sleeping less, everything just kind of gets heightened more.
• 5:02
  Speaker: Um, and it can be a kind of a perfect storm for people to have um some psychiatric decompensation.
• 5:09
  Speaker 2: Absolutely.
• 5:09
  Speaker 2: I'm thinking, yeah, friend groups change because, well, yeah, suddenly I now as a parent, I find myself hanging out more with my friends that have kids, you know, rather than the friends that don't have kids.
• 5:20
  Speaker 2: And of course, I can imagine too that well, I know the whole system changed.
• 5:24
  Speaker 2: Not only was there a change with uh, you know, the mother, of course, um, dramatic changes, but you know, the father, the whole the siblings, the whole system's been affected by this new child.
• 5:34
  Speaker 2: Um, and so yeah, there's uh it's a perfect storm.
• 5:39
  Speaker: Yeah.
• 5:39
  Speaker: So when I'm seeing people, especially during pregnancy and postpartum, I'm always trying to assess their mental health conditions, but I'm also learning about like their social support system, um, their living, um, who they lean on when they need help, how they ask for help, and what additional resources I can offer them.
• 5:58
  Speaker: Um, typically I'm always recommending therapy because having someone to talk through these life stressors with, these role transitions can be so helpful.
• 6:08
  Speaker: But I'm also looking at ways I could help the patient utilize their social support to protect their sleep, to get the help when they need it, to get time to eat a warm meal themselves.
• 6:19
  Speaker: Um, these things are also important when we're talking about mental health.
• 6:23
  Speaker 2: Right.
• 6:23
  Speaker 2: How do how do they even come to see you to begin with?
• 6:26
  Speaker 2: How does how does somebody go, all right, there is a perinatal issue issue here?
• 6:30
  Speaker 2: Um, is is does it already have to be for lack of, I'm gonna I speak crudely, so forgive me.
• 6:35
  Speaker 2: Does it already have to be a problem?
• 6:36
  Speaker 2: Does it already have to be a bad situation before they see you?
• 6:39
  Speaker 2: Or um or is this a common like we need to we have Dr.
• 6:44
  Speaker 2: Dopp over there, we need to refer this person just for check-in.
• 6:48
  Speaker 2: How does that work?
• 6:49
  Speaker: So typically when people are referred to me, there is some sort of like mental health condition that is assessed for psychiatric medication management.
• 6:58
  Speaker: Um I do focus on medication management.
• 7:01
  Speaker: Um, therapy is not something I provide due to limitations in my schedule, even though I would love to provide it to every patient.
• 7:08
  Speaker: Um so typically there's a conversation of is this mental health condition does it warrant treatment with medication?
• 7:16
  Speaker: Um, and that can be a really heavy decision for people during pregnancy because there are potential risks with medication exposure and pregnancy, and there are, of course, risks of untreated psychiatric illness.
• 7:27
  Speaker: So a big part of appointments with me is me getting a good assessment of the symptoms that are going on, learning about how these symptoms are affecting the patients' lives, and kind of assessing like, is medication needed at that time?
• 7:41
  Speaker: And if so, which medication would be appropriate, in addition to how else can I use like non-pharmacologic interventions to help this patient too?
• 7:50
  Speaker: And that could be like sleek support therapy, utilizing social supports.
• 7:55
  Speaker 2: You said something so interesting there that you know you have the risk of doing something and the risk of doing nothing there.
• 8:00
  Speaker 1: Yeah.
• 8:01
  Speaker 2: Um, and and as a parent, you know, and as someone married to a mother, you know, I could think that I know what my wife went through when she had to make certain decisions about her own health.
• 8:12
  Speaker 2: And so what type of approach do you take when it comes to you know helping the folks make those decisions?
• 8:19
  Speaker 2: Because it's uh, you know, you don't want to take the patient's autonomy away.
• 8:23
  Speaker 2: Um it's certainly they something they have to and and of course we all have our our own internal biases about what should be done.
• 8:31
  Speaker 2: But uh how do you how do you address that?
• 8:33
  Speaker 2: Because that is such a sensitive time, especially during pregnancy.
• 8:36
  Speaker 2: Okay, you want to inject me with something?
• 8:38
  Speaker 2: Well, what does that mean?
• 8:39
  Speaker 2: What's that gonna do?
• 8:40
  Speaker 2: You know, we gonna we want me to take this pill.
• 8:42
  Speaker 2: What's that gonna do?
• 8:43
  Speaker 2: What are the long-term effects?
• 8:44
  Speaker 2: So how how do you go through that um and and not only educate but address the emotional need behind that?
• 8:51
  Speaker: Yeah, so after doing a psychiatric assessment, um, I'll discuss the patient's diagnoses with them.
• 8:56
  Speaker: For example, very common ones would be like major depressive disorder and generalized anxiety disorder.
• 9:04
  Speaker: Um, I'll explain these diagnoses with the patient.
• 9:07
  Speaker: Um, typically, if symptoms are very mild and not necessarily having a significant impact on someone's daily life, medications aren't typically indicated.
• 9:18
  Speaker: When these symptoms become more of the moderate to severe severity, this is when there's a discussion about medication, because these symptoms at that point are having an impact on someone's daily life.
• 9:30
  Speaker: They could be experience significant stress due to the anxiety, um, significant depression that is affecting their ability to do the things that they need to do in their daily life.
• 9:39
  Speaker: And so I discussed this with them.
• 9:41
  Speaker: Um I always let them know, you know, you know, I recommend therapy.
• 9:46
  Speaker: Um, but also like when the symptoms are moderate to severe, uh, medication can be very helpful.
• 9:51
  Speaker: A very common medication that can be prescribed is an antidepressant.
• 9:56
  Speaker: Um, Zoloft is a very common one used in the pregnancy postpartum period, but it's not the only antidepressant that can be used.
• 10:05
  Speaker: I try to learn what has been most helpful for the patient in the past.
• 10:09
  Speaker: And typically, if there's not a contraindication, I'm restarting the medicine that I know that works best for the patient in order to get them stabilized as soon as possible with the least number of medication exposures as possible.
• 10:21
  Speaker: Um, so after introducing that, I walk them through risks of the medication, which are typically for an antidepressant, very low risks of preterm birth, low birth weight, um, a small increased risk of what's called neonatal adaptation syndrome, which is where a baby can be a bit more fussy, harder to sleep, harder to console after they're born.
• 10:41
  Speaker: It goes away in two weeks without any long-lasting effects.
• 10:45
  Speaker: And lastly, there's a very rare increased risk of persistent pulmonary hypertension of the newborn.
• 10:52
  Speaker: This is one in 1000 increased risk compared to someone not taking an antidepressant with serotonin.
• 10:58
  Speaker: Um, and then I let them know that with untreated anxiety and depression, there are more severe risks of preterm birth, low birth weight, and actually the stress that the patient experiences from this can affect um their um the cortisol exposure to the baby during pregnancy.
• 11:16
  Speaker: And there have been some links to when babies are exposed to severe anxiety and depression during pregnancy, that they might be at increased risk of developing like anxiety or ADHD during that baby's childhood.
• 11:28
  Speaker: Um so a I really try to learn, you know, explain this, leave room for questions, and then um allow the patient to make the decision that they feel more comfortable with.
• 11:39
  Speaker: If they don't want to start medication or need more time to think about it, they absolutely can take that time.
• 11:45
  Speaker: I just try to make sure they know the risks of untreated anxiety and depression, which of course, in the worst case, um, could be suicidal thoughts, um, that can be self-harm, and that can be very serious.
• 11:57
  Speaker: So I let people know, yeah, if you don't want to take this, this is fine.
• 12:00
  Speaker: This is information you can have, but please um schedule an appointment with me sooner if you know this is something worsening and we can rediscuss this and reassess.
• 12:08
  Speaker: I see.
• 12:09
  Speaker 2: So um, so and what I'm hearing here is if you do meet resistance to anything, uh, when it comes to taking medications, you go now totally your choice, you know.
• 12:19
  Speaker 2: And and there's not not really any like you really need to take this type attitude.
• 12:23
  Speaker: Oh yeah.
• 12:24
  Speaker: It's always it's always the patient's choice.
• 12:26
  Speaker: Um, I'm an outpatient provider.
• 12:28
  Speaker: So um I try to, you know, just give patients the information I have and always make a treatment plan they're comfortable with.
• 12:36
  Speaker: Whether I prescribe something or not, it's always the patient's choice at the end of the day, the actions they take to promote healthy changes in their mental health.
• 12:47
  Speaker: Um, I only see, you know, patients for an intake, uh follow-up, you know, varies between a very close follow-up could be a couple weeks, sometimes it can be up to a couple months.
• 12:58
  Speaker: And so I only get a very small snapshot into the patient's life.
• 13:02
  Speaker: And being an outpatient provider, the responsibility for the patient to take care of their mental health is really on them.
• 13:10
  Speaker: And I'm just there to, you know, guide them, um, order a prescription when appropriate, and um try to make sure that they have the resources they need to be healthy.
• 13:21
  Speaker: So that's my approach.
• 13:22
  Speaker 2: Yeah.
• 13:23
  Speaker 2: You mentioned some of them elsewhere, uh briefly, but uh you you mentioned um for lack of a better way of putting it, prescribing other types of um interventions here.
• 13:33
  Speaker 2: Uh you know, of course, talk therapy, like what I do, sleep therapy.
• 13:38
  Speaker 2: Um what is your relationship with the patient when you start uh pushing them, not pushing them, excuse me, guiding them into that direction of um let's do some non-pharmacological interventions here and uh um um and see what happens.
• 13:53
  Speaker: Yeah, so um it can really look a couple ways.
• 13:56
  Speaker: If you know, it doesn't seem like medications are indicated and therapy is really the treatment the patient should be pursuing.
• 14:03
  Speaker: Um the patient can call me back if they want to follow up.
• 14:06
  Speaker: But if it's this question of, oh, is therapy going to be effective or not in managing um the condition, then I usually have follow-up with the patient to reassess symptoms after they at least they start therapy to see if therapy was really effective enough in their treatment.
• 14:27
  Speaker 2: So shifting gears a little bit, um you're in this field, and I'm sure y'all stay pretty busy because I I you know I refer to psychiatrists all the time or I used to, and I don't see this niche quite as much, you know.
• 14:41
  Speaker 2: Usually what I've seen is uh OBGYNs prescribing Zoloft and things like that, but no, none specifically, no psychiatrist specific for this population.
• 14:51
  Speaker 2: Um, so I I do want to get your insight onto this.
• 14:54
  Speaker 2: Like what what barriers or what not barriers, what holes are we seeing or that are left unchecked?
• 15:02
  Speaker 2: You know, what are we not what are we missing as a system when it comes to this population?
• 15:07
  Speaker: I think that there is a huge need for a psychiatrist to treat this population.
• 15:12
  Speaker: And unfortunately, not all psychiatrists are comfortable treating people who are pregnant in postpartum.
• 15:17
  Speaker: Why is that?
• 15:18
  Speaker: Um there is I think it's like maybe like the having the knowledge needed to give thorough counseling on the potential risks of the medication versus the risks of untreated illness, because that's a very like nuanced discussion.
• 15:33
  Speaker: Um also, you know, like there are potentially more like legal risks for providers if something were to happen, um, like a negative outcome for the baby.
• 15:43
  Speaker: Um so that can be um a difficult place for providers to be in.
• 15:48
  Speaker: Um and if they're not well versed in these medications and prescribing them during pregnancy, it can be a very uncomfortable space.
• 15:57
  Speaker 2: What makes what makes it it seems obvious, but on its face, but what makes it nuanced?
• 16:02
  Speaker 2: You know, what what makes this a little different from me, Joe Blow, I'm depressed, a psychiatrist, I got my lexapro, see you later, right?
• 16:10
  Speaker 2: Right.
• 16:10
  Speaker 2: What makes this a little bit more nuanced when you're dealing with uh pregnant or just perinatal issues in general?
• 16:16
  Speaker: So when you're prescribing a medication to anyone pregnant or not, you need to know um the indication, risks, benefits of these medications, be able to have those conversations with people.
• 16:25
  Speaker: When it comes to pregnancy, you're also having conversations about how that medication might affect the pregnancy, um whether that's associated with preterm birth or low birth weight or um gestational hypertension.
• 16:39
  Speaker: And what's really hard about this is there's not a lot of good research there.
• 16:44
  Speaker: All the studies that we have to go off of are observational studies.
• 16:49
  Speaker: There's no like randomized control trials that specifically prove that this medication causes this pregnancy outcome.
• 16:56
  Speaker: Um, we have observational studies, which are impacted by a lot of confounding variables that lead us with that this medication maybe has this potential risk.
• 17:06
  Speaker: Um, so it can be it can take a lot of time to like go through the literature and feel comfortable having these discussions.
• 17:14
  Speaker: And also you're in a field where there's new information coming out all the time, too.
• 17:19
  Speaker: So staying on top of that in order to provide the most up-to-date uh evidence-based counseling um can be challenging to keep up with, but it's very important.
• 17:29
  Speaker 2: So in that that I interrupted to thought about uh barriers and gaps and and what we're dealing with in this field or in this particular niche, but you you said something interesting that there's only well, either is there is data, there is research, but there's only so much.
• 17:43
  Speaker 2: And and that's kind of surprising to me that there's still data to be needed when it comes to um psychotropics in pregnancy.
• 17:52
  Speaker: Definitely.
• 17:52
  Speaker: And typically the newer the medication is, the less data that's available too.
• 17:59
  Speaker: So there are these really great new medications that come out, but is the newer something is, the less I have to tell somebody how that can potentially could affect their pregnancy.
• 18:11
  Speaker 2: Very interesting.
• 18:11
  Speaker 2: What other gaps are we missing here?
• 18:13
  Speaker 2: Of course, when it comes to psychiatrists in general, by the way, I mean, I used to have to find find kids, psychiatrists, pediatric, and I that was just almost an impossibility half the time without a gigantic waist list.
• 18:23
  Speaker 2: So but what but what other gaps are we missing when it comes to this specific population?
• 18:28
  Speaker 2: You know, pregnant and parenting and dealing with a substance use or or excuse me, a mental health condition.
• 18:34
  Speaker: I think that there can be a lot of stigma when people have mental health conditions during pregnancy and substance use disorders.
• 18:41
  Speaker: I think um, I think it's getting a little better, but I think there's like this myth that pregnancy is like this really happy time where people are supposed to be doing really well and are just like super excited to grow their family and everything's okay.
• 18:54
  Speaker: Um, in reality, um that's not the case for a lot of people.
• 18:58
  Speaker: Um, and a lot of people do really need help.
• 19:01
  Speaker: And I think that people can experience shame um to need help.
• 19:06
  Speaker: Um, but I think that people shouldn't because these conditions are so common.
• 19:12
  Speaker: Um, there's nothing someone did that is doing wrong that has a condition.
• 19:16
  Speaker: Having postpartum depression does not make someone a bad mother.
• 19:20
  Speaker: Um, you just have a mental health condition that needs treatment and luckily treatment's available.
• 19:25
  Speaker: Um, so I think that's one.
• 19:27
  Speaker: I think another thing is which it's a mixed bag, is that there's so much um so much of a push to increase screening for postpartum depression and anxiety, but there's not a lot of resources for like you know, primary care OB doctors that do these screenings to be able to get people the treatment they need.
• 19:48
  Speaker: Um I am a perinatal psychiatrist, obviously practicing through EBMS, and then there's one other perinatal psychiatrist uh psychiatrist, um Christina Truman in the Hampton Roads area.
• 20:00
  Speaker: We're two psychiatrists, and obviously this is like a huge population.
• 20:04
  Speaker: Um so we can't unfortunately see everybody that needs us.
• 20:08
  Speaker: Um there is something called the Virginia Mental Health Access Program, which is evaluated um abbreviated as VMAP for moms.
• 20:16
  Speaker: And it's actually a really cool tool where anybody that is treating a pregnant postpartum patient can call and talk to a perinatal psychiatrist.
• 20:24
  Speaker: I think it's within 20 to 30 minutes for recommendations on medication management.
• 20:29
  Speaker: Um I also use VMAP to connect patients with therapy appointments because a lot of times when people are experiencing significant depression or anxiety, their executive defunct functioning is impacted.
• 20:43
  Speaker: And so they might need help making a therapy appointment.
• 20:45
  Speaker: And luckily, this is something that VMAP program that is helping bridge the gap because there are care coordinators and perennial psychiatrists out there through this service that can be very helpful with that.
• 20:59
  Speaker 2: So, first off, hey, entrepreneurial mind that psychiatrist, you know, there's in market, you know.
• 21:05
  Speaker 2: Yeah, even your comp your potential competitor, Dr.
• 21:09
  Speaker 2: Dobbs saying, nah, we y'all, y'all need to come over here, get in here.
• 21:13
  Speaker 2: So excellent, excellent.
• 21:15
  Speaker 2: Um so uh throughout treatment, um, you know, you focus on this specific population, but there's a time when somebody's no longer postpartum, right?
• 21:27
  Speaker 2: Yeah, the the kid's 18, I don't know, you know.
• 21:31
  Speaker 2: What what how do you transit?
• 21:34
  Speaker 2: Do you transition to longer-term care and go or or or just a different type of psychiatrist?
• 21:40
  Speaker 2: Or do you say we can actually wind down this particular treatment?
• 21:44
  Speaker 2: Um, what's your approach to that?
• 21:46
  Speaker 2: As the person's leaving that.
• 21:47
  Speaker 2: Well, first off, when do you say somebody's left that postpartum phase?
• 21:51
  Speaker 2: And then what's your your approach to discharge or treatment to that?
• 21:56
  Speaker: Yeah, so that is a very good question.
• 21:58
  Speaker: It's something that I have been Working on and thinking a lot about.
• 22:02
  Speaker: With me being the only provider here and like through the OB clinic, I've had to make the one-year postpartum as the time that I help transition people's care, whether that means continuing with the psychiatrist or maybe if it's a more simple medication regimen that the patient's been stabilized on, going back to their primary care doctor to prescribe it.
• 22:25
  Speaker: I don't think that there's any perfect cutoff when the postpartum period ends.
• 22:31
  Speaker: I think some people might be feeling well from a mental health perspective in a couple months, but other people it could take several years.
• 22:57
  Speaker 2: But yeah, the most crucial time is that pregnancy and just after birth, you know, time period.
• 23:04
  Speaker 2: That that is when the I I guess for lack of the most dangerous experience, yeah.
• 23:10
  Speaker: Yeah, the um peak rates for suicide postpartum are actually six to nine months, which I think some people are surprised about.
• 23:19
  Speaker: Um, but during this time period, it's really where a lot of people like fall off care because um, you know, during pregnancy, there's so many visits.
• 23:29
  Speaker: The mom's really being looked out for um postpartum.
• 23:33
  Speaker: There's that six weeks postpartum check.
• 23:34
  Speaker: And ideally, the pediatrician would keep an eye on mom during the well child visits.
• 23:39
  Speaker: Yeah.
• 23:39
  Speaker: But it just seems like the six to nine months, that can be a period where somebody's falls through the gaps, things can get a lot worse.
• 23:46
  Speaker 2: Um I can imagine, like, you know, some of these mothers are going back to work after their their leave, and then things just get a little crazy.
• 23:55
  Speaker: Yeah.
• 23:56
  Speaker 2: Yeah.
• 23:57
  Speaker: That's another thing that I me becoming a mom myself, I am much more intentional about asking about.
• 24:04
  Speaker: Um, like, you know, what does return to work look like for you?
• 24:08
  Speaker: Um, what is your if if there's child care plans, how do you feel about that?
• 24:14
  Speaker: Because the transition back to work can bring about so many different feelings.
• 24:18
  Speaker: Because, you know, a lot of people, the only way that they know how to be a mom is when they're at home with their baby and now they have to learn how to be a mom while they're also working.
• 24:27
  Speaker: And with um, if they're nursing or pumping, that can be a whole nother challenge to figure out at work that can come with a lot of stress too.
• 24:37
  Speaker 2: Yeah, that's that's um that's really, really tough.
• 24:41
  Speaker 2: Um I'm I can't imagine.
• 24:44
  Speaker 2: Well, I can't imagine.
• 24:46
  Speaker 2: I watched it, didn't experience it myself, but I went, ah, that's that's uh that's tough.
• 24:50
  Speaker 2: Um so what what what can you tell?
• 24:53
  Speaker 2: Speaking in my position, I'm I'm more, you know, of course, a father and you know, I'm involved with the child, but in a husband, and I definitely want to support my wife.
• 25:01
  Speaker 2: But in general, I would like what what do you want um the support systems around these folks to know?
• 25:08
  Speaker 2: Uh what would be most helpful to the people surrounding your patients?
• 25:13
  Speaker: Great.
• 25:14
  Speaker: Um, so I think like on the most basic level is learning how to be on the same team, uh, like for like mom and dad to be on the same team, or mom with their partner, or mom and the support system, whatever that looks like, and learning how to support each other, uh, because the family unit does better when everybody is doing better and um people are getting along.
• 25:36
  Speaker: I think something very practical is learning how to protect sleep.
• 25:42
  Speaker: So if mom is having a hard time wanting to introduce bottles and is only breastfeeding, um, that mom is probably not getting more than two to three hours of sleep.
• 25:55
  Speaker: So sometimes I have conversations of how can can you introduce a bottle?
• 26:00
  Speaker: Can your partner take a feed overnight so you could get maybe five to six hours?
• 26:05
  Speaker: What does this look like for you?
• 26:07
  Speaker: Um also just having the ability for both parents to have their like basic needs met.
• 26:13
  Speaker: So like showering, eating, um maybe you know, something that makes them feel a little bit like themselves can go a long way.
• 26:22
  Speaker: Um it's really ideal when you know people have like a bigger family system in town, um, whether that's like grandparents, sisters, or you know, close friends that can come by and help.
• 26:35
  Speaker: Um, but unfortunately, I think something unique in like this Hampton Roads area is there's so many like military families.
• 26:43
  Speaker: Um, so that's something that can be really hard because if um like mom's partner is deployed and they just moved here because their partners in the military, they often don't have someone else they can really lean on, which makes things hard.
• 27:02
  Speaker 2: You know, a lot of in a lot of what you said, I would apply to you know, families with mothers that have not exhibited any, you know, necessarily diagnosable mental health conditions.
• 27:14
  Speaker 2: Certainly surround them with love, you know, support, be their same team, and all these things.
• 27:19
  Speaker 2: I it that's so truly there is no secret sauce.
• 27:24
  Speaker 2: It really is let's show up for our folks.
• 27:27
  Speaker 2: Yeah.
• 27:27
  Speaker 2: You know, no, I love it.
• 27:29
  Speaker 2: Uh now you did say I I do want to take a quite quick diversion down the military route because I think this is very interesting.
• 27:35
  Speaker 2: Um, what typical issues are you seeing?
• 27:37
  Speaker 2: I mean, or challenges are you having to overcome with these this particular subset?
• 27:43
  Speaker: Well, when there's a new mom with maybe one, two, three kids at home and their partner is deployed.
• 27:50
  Speaker: Yeah, that's hard.
• 27:52
  Speaker 2: Yeah, well, it's just good lord.
• 27:54
  Speaker: Yeah, that's hard whether you have a mental health condition or not.
• 27:58
  Speaker: And so this is where it's like, okay, how can I like increase your access to resources so that maybe you have like home visiting or um maybe like can get like a discounted child care or you know, things like that.
• 28:13
  Speaker: Because it's like, are you do you have severe depression from like anything else besides needing a break from caring for your children?
• 28:22
  Speaker: Um so that can be really hard.
• 28:25
  Speaker: And of course, um, I think when people imagine having a family, they imagine someone that they're co-parenting with and sharing those responsibilities with.
• 28:34
  Speaker: And so when someone's single parenting, even if they support their partner's work in the military, like they just feel like they need more that their partner's not able to give.
• 28:46
  Speaker: And that's just like a hard feeling for a lot of people, I think.
• 28:50
  Speaker 2: That's really tough.
• 28:51
  Speaker 2: It's really tough.
• 28:52
  Speaker 2: And I'm sure even you know the partners are like, I wish I could be there, I would be there, but yeah, that's oof.
• 28:57
  Speaker 2: Yeah, that's um again, thank you to our troops, because good lord, that that's that's a lot.
• 29:03
  Speaker 2: So I I figured if there's anybody here that's listening, and and of course, Sintera is located in the mostly in the Tidewater area, so I'm sure there's a lot of families affected by that particular message.
• 29:13
  Speaker 2: So I wanted to go down it real quick.
• 29:15
  Speaker 2: But you know, in these last few minutes, I did want to ask you, what do you see um when it comes to you know the future for your particular field?
• 29:24
  Speaker 2: Of course, psychiatry in general, I think is never going to go away.
• 29:27
  Speaker 2: It's always gonna be important.
• 29:28
  Speaker 2: But when it comes to the treatment of this particular um this particular niche, what um what do you think the future is and what do you what would you like to see um uh happen?
• 29:40
  Speaker: Yeah, so as I said, I started this clinic um last December.
• 29:45
  Speaker: Um, and I think it's been a success in the way that you know I'm I'm very busy.
• 29:50
  Speaker: I think that I've been able to help a lot of people, but at the end of the day, it's just me here at UVMS.
• 29:55
  Speaker: Um and I would love to work with another um provider to be able to serve more patients.
• 30:02
  Speaker: And I think what's really needed is um fast time to care.
• 30:08
  Speaker: When the OB puts that referral in, like, how can we quickly see that patient?
• 30:13
  Speaker: Because this is very urgent, people having postpartum depression, depression anxiety during pregnancy.
• 30:20
  Speaker: Like, people need treatment quickly, but when it's just one provider in a clinic, oftentimes that uh first time to intake gets pushed longer and longer out as my schedule gets busier.
• 30:32
  Speaker: And I would love to be able to seek patients as soon as they as soon as they need it.
• 30:36
  Speaker: Um I would also love to increase access to therapy so that um that's less of a barrier if I have a therapist working with me in the same clinic that could be easier for patients to get into.
• 30:48
  Speaker: Um, and if I was practicing in my most ideal clinic, it would be great to have a care coordinator that could help patients get um treatment for like substance use disorders or help with like housing instability or like you know, help with like resources for financial stressors because these are very real stressors for patients.
• 31:09
  Speaker: But as a psychiatrist, I am limited to what I can do to help with those types of things.
• 31:16
  Speaker 2: Yeah, I'm hearing like a lot of collaborative care model going into this.
• 31:19
  Speaker 2: So that that would be really important.
• 31:21
  Speaker 2: So excellent.
• 31:22
  Speaker 2: Um well, Dr.
• 31:23
  Speaker 2: Dupp, uh, do you have anything you would like to leave with the audience?
• 31:28
  Speaker: Yeah, um, well, definitely think the most important thing is um, I guess for people like listening that may be affected by perinatal mental health conditions, is like you are not alone in this.
• 31:38
  Speaker: Help is out there.
• 31:40
  Speaker: Um, and it's so important that you get it and you shouldn't be ashamed by it.
• 31:44
  Speaker: Um, you are the best parent for your baby, um, and you might feel a lot better if you get the help you need.
• 31:51
  Speaker: Um, for providers practicing at Sentera, I hope you know about my services after listening to this.
• 31:57
  Speaker: And I'm happy to see um patients that you think would be appropriate to be seen by me.
• 32:02
  Speaker: Um, and I just want to do what I can to help this population feel better.
• 32:08
  Speaker 2: You've been listening to Mind and Medicine, a Sentera podcast.
• 32:11
  Speaker 2: As a reminder, please check the show notes for details on how to claim your continuing education credits, as well as any resources mentioned in the episode.
• 32:18
  Speaker 2: That's it for now, but keep an eye out for another episode and more evidence-based education for healthcare providers on the go.
• 32:24
  Speaker 2: Be well.