WEBVTT
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Hi, everyone.
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We are Reena and Dara, and welcome to Fertility Forward.
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We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City.
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Our Fertility Forward podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients, because knowledge is power, and you are your own best advocate.
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I am so excited to welcome back to Fertility Forward today, Dr.
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Katherine Berndorf.
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She is a reproductive psychiatrist, the co-founder, CEO, and medical director of the Motherhood Center of New York, and the founding director of the Payne Whitney Women's Program at Weill Cornell Medicine, New York Presbyterian Hospital.
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In addition, she is a clinical associate professor of psychiatry and obstetrics and gynecology.
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A past postpartum support international board member, Dr.
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Berndorf now serves on the president's advisory council.
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For 10 years, Dr.
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Berndorf was a regular mental health columnist for Self Magazine and has appeared on numerous television programs, including the Today Show, Good Morning America, MSNBC, and CNN.
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Her first book, The Nine Rooms of Happiness, was a New York Times bestseller published in 2010.
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Her most recent book, published by Simon& Schuster in 2019, is entitled What No One Tells You, A Guide to Your Emotions from Pregnancy to Motherhood.
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Oof, what a bio!
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So long.
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I got to shorten that.
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But thank you for reading that.
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And thank you for having me on and back on.
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I think you've done many, many things since I was last here.
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So I'm excited to be back.
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Likewise.
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So excited to have you back and catch up and talk this episode.
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I think we're going to focus on key meds and then we're going to sort of dive into medication and the safety of medication for pregnancy or pre-pregnancy and really just get in there to these super important topics.
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My favorite topics.
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Let's go.
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Let's go.
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So I guess let's first talk about PMADS and what PMADS are, this acronym.
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This acronym.
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It's such a terrible acronym, but on the other hand, I am so happy that it's not just postpartum depression because people can't see themselves in that.
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Neither those who are struggling or those who are treating, they can't always find themselves as having postpartum depression, right?
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So what happens is PMADS, which P-M-A-D has a word mad in it, which we don't love as it pertains to women and illness, but it tries to encompass, it's an umbrella term that encompasses Perinatal, so during and after pregnancy, mood and anxiety disorders.
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Perinatal mood and anxiety disorders.
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That's what the acronym stands for.
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And we will talk also about before pregnancy, trying to conceive.
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And also like many people get to the pregnancy space or trying to conceive space and they are not well.
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They have a history of or kind of baseline anxiety, depression and other things that they've lived with that may not be treated.
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So they're kind of behind the eight ball before they even get into the perinatal.
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perinatal space.
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But for purposes defining PMADS, these are illnesses like depression, anxiety, generalized anxiety disorder, panic disorder, phobias, OCD, PTSD, post-traumatic stress disorder, bipolar disorder, and postpartum depression.
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It's really Anything, that umbrella can't be big enough to hold everything that could happen to somebody psychologically and psychiatrically in this period of their life during this time.
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I just want everybody to be able to find themselves in there because if you think you have something wrong with you, then you have to believe that and get help.
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So it doesn't matter.
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I don't even care what you call it.
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Just know that something's not right and you need help and find somebody who believes you and will talk to you about it so you can get
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diagnosed and treated.
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I think right there, though, sometimes that's the difficult thing, right?
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Asking for help and being...
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able to speak up because i think unfortunately there's still so much shame and stigma and people suffering silence and feel like i shouldn't be feeling this way or i should be better than this or i'm scared to speak up or who do i talk to so what might be some words of advice or guidance there for someone who recognizes themselves in this and doesn't know where to turn
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Well, I think, first of all, if you recognize yourself in here, I'm glad that you can hang your hat on something like you know it.
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So even if you just have an inkling that something could be wrong, it's very hard, to your point, to advocate for yourself and to be able to speak up when you're down, to quote a New Jersey slogan around treatment of postpartum illness, perinatal illness.
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But I think speaking up when you're down is...
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I love it because I think that like...
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You might not be able to do it, but maybe someone around you can.
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Maybe you can talk to someone in your family is noticing, or you can just share with somebody who you confide in or a doctor or anybody.
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And people don't have to know how to treat it or know what to do.
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It's just, I think you have to allow yourself to be seen.
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And if you're around people that know you and love you, hopefully if you can't say something, they'll say to you, Hey, you don't seem like yourself.
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And by the way, that may be the thing you say to them.
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Hey, I don't feel like myself.
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Like I know something's not right.
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And I know it's the hardest thing to do when you're down to be able to say something like that.
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But I always say, even as a physician, I have to advocate for myself medically.
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The system doesn't always work for us in the way that we'd like it to.
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So you really do need advocacy.
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And if you can share and tell someone and get them to help you if you can't do it yourself.
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And you don't have to know what's wrong.
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And they don't have to know either or know how to fix it.
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It's just who can help you get to the next step in the chain of trying to get help.
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And I think sometimes that's what's frustrating, that it is this chain, right?
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And it's one call, it's the next call, and it's the next call.
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Well, I want to jump in part of why, you know, with where I am now, I'm sitting in the motherhood center.
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And part of why we exist is literally to have a single phone number and a website that can get you right there.
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You don't have to know what's going on.
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You just have to know something's not right.
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To me, that was so important because, you you just don't have to know because mostly people don't know.
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And so you just say, I am in this period of time, somewhere between trying to conceive, going through fertility, having had losses, being pregnant, being in the postpartum and up to a year, two years, three years, and just knowing that you are not yourself and that you are not feeling good.
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And then we will help you figure that out.
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So, again, you just don't have to know.
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You just have to know that there's somewhere to turn.
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And again, not everybody has access to us or can come here.
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We do both virtual and in-person, but let's say, hopefully you can get to your own OBGYN or midwife or doula or somebody in the space who will know what to do, right?
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Or a pediatrician or whoever it is, but it can be very hard.
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Yeah, exactly.
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Yeah.
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You know, and so let's talk about, so if you are identifying with this, how might a PMAD be treated?
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Well, the most important thing is that they're really, really, really treatable.
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So like I was just on the phone talking to someone who's going to come in for an evaluation and she feels hopeless and helpless and ashamed.
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She's a very competent, high functioning person who's done well professionally and personally and has a great life and has been miserable due to a million, circumstances, but doesn't have hope.
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So a lot of what we do is say, you know, what I said to her was like, let us hold the hope for you while you are feeling hopeless, which is never normal to really feel like there's nowhere to go and that you feel desperate and despondent.
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And like, you can't really take care of yourself in a way that you know how to.
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And we will hold that hope for you so that you can feel better.
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Because PMADS are super treatable.
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It's just, they have to be identified and you have to have somebody who knows what to do.
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And it's not rocket science.
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It is really, these are super treatable illnesses that if someone knows how to treat anxiety, depression, OCD, PTSD, and then you get into some more difficult stuff to treat, like someone who has a history of bipolar disorder or a history of psychosis or some kind of psychotic disorder, that can be trickier.
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And I'm not saying it's so easy to treat those things I started with.
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But when this happens in the peripartum, it can look a little different, but it is just as treatable.
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You have to find someone who isn't scared and has some experience doing it.
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You may really need an expert to help with the treatment so that you get the right treatment and it gets recognized because, like I said, it can look different.
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Well, and so I know you're a reproductive psychiatrist.
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So if someone is experiencing this, should they specifically look for someone that's a reproductive psychiatrist versus a general
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psychiatrist?
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If you're lucky enough or have access to someone who is a specialist in the field, and we call that reproductive psychiatry.
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So somebody who treats women and birthing people along the reproductive spectrum from menses to menopause, then you're going to find somebody who knows what they're doing in this space, right?
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They're going to know exactly what to do.
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And there are therapists also.
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So, you know, different kinds of therapists, social workers, psychologists who also are in the reproductive or perinatal space, and they also know what to do.
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They can't medicate, but they will know what to do.
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So I do think if you're a generalist, a psychiatrist or therapist doesn't know exactly what to do or what this is called that you're experiencing, then you do want to reach out for consultation.
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And again, at the Motherhood Center, we do a lot of consultations.
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If you work here, you're either an expert or you're training to be an expert.
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So we have trainees and experts, but primarily we are sort of a subspecialty, right?
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If reproductive psychiatry is a subspecialty of psychiatry, we do just the perinatal period.
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So we're pretty expert in a deep way.
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So we love to be able to help people consult with other doctors and medical professionals to talk about it if people can't come in.
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So we do a lot of consultative work as well.
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But we really have an expertise that if you can get to somewhere like us or to someone like us, I would say, you know, you don't go to a general physician clinic.
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to treat a broken bone, right?
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You'd go to an orthopedist or if you've got a cardiac issue, you might start with your internist or primary care doctor, but you end up with, if it's a cardiac issue, with a cardiologist.
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So I do think that we sort of function as the experts in psychiatry around issues related to trying to conceive, being pregnant and postpartum.
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Yeah.
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I mean, the motherhood center is incredible.
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And, you know, I think what you're also touching upon is I see so many people who, you know, they speak to a more general doctor and they're told, oh, you shouldn't think to carry because you have the, you know, preexisting diagnosis and that is not going to be good for you.
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And then someone takes that and says, oh, well, I can't become pregnant.
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I can't become a parent.
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When I think if they were to go to someone who specialized in this and and can really do a deep dive to help support, you know, maybe you need different things than someone that doesn't have a diagnosis of whatever, right?
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But it doesn't mean that you can't.
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And so to take someone's offhand comment and then let that dictate you not family building, I think is horrible.
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And that's why, you know, a specialist like you is, and the Motherhood Center is amazing.
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Thank you.
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I see my job as helping people create options for themselves.
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And I don't, Okay.
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That's not true.
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Once I did say to somebody, I'm not sure it would be a good idea for you to have a kid, but guess what?
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I'm not God.
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That's not my, that's, and that's not my job to tell you not to do this.
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I will give you my professional opinion and I certainly have one, but ultimately we work collaboratively here to help you get where you want to go.
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So we help women make very difficult decisions for themselves when they are not sure what to do, either because a provider or someone has said to them, you can't be on that medication.
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or, oh, sure, who cares?
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Stay on it.
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You'll be fine.
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Everybody's on it, right?
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So you get these two ends of the spectrum, and people really want information.
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They want to be armed with information.
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They want to have the knowledge.
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And I see that as my job to work with someone to have the latest information and, more as importantly, to be able to create the context for given their own life and their own sort of risk aversion or religion or family or the way they think, to understand their own context to decide what to do.
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Yeah.
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I mean, as a clinician, what I see a lot is patients, either if they're trying to conceive or pregnant, being very averse to medication.
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And as you know and I know, sometimes the trying to conceive process can be really stressful, really overwhelming.
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It can be a catalyst to sort of catapult someone into an anxiety or depression or a mental episode that they have not experienced before.
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And sometimes the only way out of that is with the boost of medication.
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And I see so many women suffer because they're afraid to take medication.
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Yeah.
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What do you say about that?
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How much time do you have?
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Although I can say it pretty quickly.
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And I say this to women all the time.
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you are choosing to suffer.
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Why are you choosing to suffer?
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Why must you suffer?
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Because I can't do X, Y, or Z.
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I want to tell you that that is not necessarily true.
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Let's think about it together.
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The way I start a consultation, and again, I don't mean to be blaming when I say you are choosing to suffer.
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I think people often don't know.
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So again, I encourage people to ask to get help.
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So I really want to be careful in how I say that.
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But what I do when I start in a consultation is I let people know that if they have illness, like anxiety or depression, they have risk.
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So you may choose not to be on a medication, but it's a risk-risk analysis.
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You don't get to choose not to have risk.
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Okay, so the person who says, I'd rather suffer or because I can't be on that medication because that's so potentially dangerous, what I would say to them is, okay, then you're choosing the risk of untreated illness, okay?
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So you have risk no matter what.
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And the two choices you get are, again, this is somebody who has illness, are the medication or the untreated illness, the symptom burden that comes with that and what the implications of that are for trying to conceive, being pregnant or postpartum.
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And I want to...
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interject and say too, that there's so much research about medications that are safe to take while trying to conceive and while pregnant.
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Correct.
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And I rarely use the word safe.
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I will always say relatively safe because we can't know everything, everything, but I will tell you that they're in the psychiatric toolbox, the psychotropic toolbox, the medications we use to treat psychiatric illness.
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There is really one exception and that if I can help it, I won't use in pregnancy.
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And that is Depakote or valproic acid, which is a seizure medication primarily and gets used and is an excellent bipolar medication for some people.
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And I don't use it.
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I hope people don't use it in women of reproductive age because 50% at least of pregnancies are unplanned.
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So it is known to be a teratogenic drug, a drug that can cause malformations that we know about.
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And I think that is the one drug to write home about, that there is something to say short of that.
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I essentially don't have an issue with any of the other medications.
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They have been so scrutinized and so marginalized and so considered optional that there's a ton of research out there and good research looking at, do these medications cause miscarriage or malformation?
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The data supports evidence that It does not increase above baseline in the general population for those who do not have illness and are not on meds.
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So that's why I say these medications are relatively safe for use in pregnancy.
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And if you choose, or conception, if you choose not to be on it, then you are choosing also the risk, and we have lots of data to support this, of having illness and having those symptoms that you are having to manage because they're off the medication and being unwell.
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And what is the effect then on, again, trying to conceive and on the fetus?
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I just think this speaks to so much the larger picture that there's just such a stigma around mental health.
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Yeah.
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And of all things to be scrutinized, why are people picking on this, right?
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Of the new wave of things, you know, no one's reanalyzing all the other medications people are taking or even self-medicating that they're doing.
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Well, by the way, So when people go off medications, what do they do?
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I've had plenty of patients say to me, well, I'm going to just smoke weed because you know what?
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It's natural.
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Oh, okay.
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Well, that also has consequences.
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And some of the supplements people take, they'll go to the drugstore and take all kinds of things over the counter.
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And if you're not well, and by the way, as if those are because they don't have prescriptions and they're not FDA approved or rated that you think that those are safe.
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That's the devil you don't
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know.
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There's no logic in that.
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But that is how we think.
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That is how a great majority of us think about medications, that if it's a prescription medication, it must be bad.
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It's kind of the opposite.
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But these, again, have been so scrutinized.
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We know more about the psychotropic medications than we do about any other category of drug because they have been so scrutinized.
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And so when I started in this field in the late 90s, early 2000s, there was not a lot of literature about these medications in pregnancy.
00:18:40.282 --> 00:18:41.665
There was not as much research.
00:18:42.066 --> 00:18:56.369
It has proliferated the amount of research and wonderful work that's going on to understand both what untreated illness does to the fetus and or can do and to birth and the delivery process and the kid going on.
00:18:56.738 --> 00:19:09.674
In addition to what happens with medications, when people take medications during those same time periods, we are able to really look at those things and compare them and make choices about which risk you want to choose.
00:19:09.795 --> 00:19:17.685
We didn't know as much before, but I guess the scrutiny, there was a silver lining to the scrutiny of it because now we know a lot about these.
00:19:17.865 --> 00:19:27.298
And there really is no good reason not to have a conversation like this that helps you be well, stay well, And that is the best thing you can do both for a fetus and a child.
00:19:27.720 --> 00:19:31.065
And if that includes medication, then that may be the choice.
00:19:31.285 --> 00:19:39.317
And it really requires psychoeducation and often expert consultation so you can feel comfortable with that.
00:19:39.939 --> 00:19:42.683
Well, I would say a mother's mental health is the most important.
00:19:42.703 --> 00:19:49.094
And if you're not healthy mentally, then you're in no position to either carry or take care of a child.
00:19:49.253 --> 00:19:50.957
And so there still seems to be...
00:19:51.842 --> 00:19:52.623
a disconnect.
00:19:52.742 --> 00:20:02.734
And so I would ask you, okay, a mother's mental health is the most important, but from what you kind of just said, does it actually, in addition, transfer to the fetus?
00:20:03.055 --> 00:20:03.375
Yeah.
00:20:04.817 --> 00:20:27.074
You know, there's some very elegant research by a colleague of mine, Catherine Monk up at Columbia, among other people who do this work, but she looks at the fetal environment and, you know, there's some work a while back looking at like stressing fetal the pregnant woman through a math test or through having to say a color when it's read the word, but it's different than the color.
00:20:27.094 --> 00:20:29.457
And it sort of stresses the brain.
00:20:29.497 --> 00:20:33.864
And what you see in women who have an anxious baseline, right?
00:20:33.903 --> 00:20:36.227
So they have historical anxiety.
00:20:36.827 --> 00:20:40.634
When they are stressed, their baby's heart rate can go up.
00:20:41.410 --> 00:20:46.702
So she's looking at the difference in stressing the mom and how it translates through to the baby.
00:20:46.722 --> 00:20:53.660
And we know that there's a protective factor when women are stressed who don't have a baseline of anxiety.
00:20:55.041 --> 00:20:58.384
So the baby is also, so both moms get stressed, right?
00:20:58.404 --> 00:20:59.346
Because you give this test.
00:20:59.705 --> 00:21:05.711
If you have a history of anxiety, it can transmit through, you will see the baby's heart rate go up and it doesn't in the other.
00:21:05.810 --> 00:21:22.125
But what we know from some beautiful work up at Columbia by Catherine Monk and others is when she looks at the stress in moms and then what happens to the fetus, we know that there is a relationship between mothers who are stressed, who have a history of anxiety and what happens to the fetus.
00:21:22.586 --> 00:21:30.453
And it's really important to note that we can tell what is happening to the mother is potentially happening to the fetus.
00:21:30.513 --> 00:21:33.196
And we look at that often by heart rate variability.
00:21:33.237 --> 00:21:35.659
That's probably a better way to say it, right?
00:21:35.699 --> 00:21:39.323
We can see that the babies can get stressed when mothers are stressed.
00:21:39.884 --> 00:21:50.694
And so we know that there's a relationship and she is looking at that in a number of ways to kind of help support understanding about what happens in the fetal environment.
00:21:51.635 --> 00:21:52.897
And that's fascinating.
00:21:53.038 --> 00:21:56.804
And So then how does that translate to implications to the baby?
00:21:56.844 --> 00:22:02.990
Does that mean that they're more at risk of being an anxious person or how does that translate?
00:22:03.201 --> 00:22:17.186
Well, first and foremost, if you have a history of a biological vulnerability to anxiety or depression or any illness, there's the potential to transmit that to the baby biologically in the genetics.
00:22:17.627 --> 00:22:34.855
We also know that the epigenetics are things that happen outside while the baby's in utero or afterwards, that there can be sort of hits on the genome of that could be stressors in the environment, stressors in illness, things like that, that can change genetics.
00:22:35.616 --> 00:22:41.484
But yes, you are prone, you are more likely, if you have your own history, to confer that risk.
00:22:41.766 --> 00:22:59.148
But we also know that with stress and given the fetal environment, that you could also have more risk if there is stress and you're not taking care of it, or illness and you're not taking care of it, both during pregnancy and postpartum, in terms of what you're setting the kid up for going forward.
00:23:00.130 --> 00:23:06.236
I just hope people hear that and really that that grounds them, because I think it's the reverse.
00:23:06.717 --> 00:23:19.430
So many women that I see, they think they're doing what's best for baby by not medicating themselves or not taking care of themselves, when from everything you just said, it's the exact opposite of what you're trying to do.
00:23:19.529 --> 00:23:33.102
If you don't take care of yourself, if you don't take care of your mental health, you're in fact just transferring that passing that along right to your baby which is what you're trying to prevent by not taking medication so you know it's you're doing the opposite action
00:23:33.604 --> 00:23:40.487
it's like almost counterintuitive but like So that's why we boil it down to this idea that like a well mom is a well baby.
00:23:40.507 --> 00:23:50.916
The maternal euthymia, maternal wellness is the goal so that the fetus and the baby and the child can be as well as possible.
00:23:51.137 --> 00:23:52.298
That's the best thing.
00:23:52.778 --> 00:24:04.963
That's why when someone's on a medication and then they find out they're pregnant, you don't stop the medication because now you could be exposed to medication and you were doing well Now you've taken the medication away.
00:24:05.003 --> 00:24:09.672
Now you're going to have symptoms that recur and create distress.
00:24:10.613 --> 00:24:12.135
I mean, I think it's always a conversation.
00:24:12.155 --> 00:24:17.124
If you're someone that's planning a pregnancy and you're on a medication, talk to your physician.
00:24:17.605 --> 00:24:19.488
Have a consult with a reproductive psychiatrist.
00:24:19.508 --> 00:24:20.730
You know, hi, here's the history.
00:24:20.750 --> 00:24:21.210
Go over it.
00:24:21.250 --> 00:24:21.991
This is what I'm taking.
00:24:22.031 --> 00:24:22.692
Is this safe?
00:24:23.233 --> 00:24:23.753
Maybe it is.
00:24:23.834 --> 00:24:26.598
Maybe they say, actually, I think we should tweak it, do something else.
00:24:27.840 --> 00:24:28.362
But always...
00:24:28.961 --> 00:24:34.171
talk to someone and get the information before just saying, oh, I shouldn't be doing this.
00:24:34.791 --> 00:24:36.414
That's typically not what happens.
00:24:36.635 --> 00:24:39.560
Or you go to the pharmacy and you tell them I'm pregnant, can I take this?
00:24:39.641 --> 00:24:41.203
And they're like, oh, I don't think so.
00:24:41.284 --> 00:24:54.883
I mean, again, I don't want to single any discipline out, but I will say that there aren't that many people I think who can talk and knowledgeably and expertly about this, there are a lot more of us.
00:24:54.942 --> 00:24:55.403
Oh, my gosh.
00:24:55.604 --> 00:24:57.247
So many more of us out there now.
00:24:57.686 --> 00:24:59.009
And we train at the Motherhood Center.
00:24:59.029 --> 00:25:02.714
We train people to understand this and to be able to talk about it and to interpret data.
00:25:03.155 --> 00:25:06.221
But generally speaking, everyone's got an opinion.
00:25:06.240 --> 00:25:09.025
And so you ask anyone and they're like, don't take that.
00:25:09.185 --> 00:25:11.528
And it just gets in people's heads.
00:25:12.230 --> 00:25:25.278
And it makes it very hard to feel like you're doing the right thing if you don't or taking medication that somebody has an opinion about that is not what you want to do and know you have to do to stay healthy and well.
00:25:26.039 --> 00:25:26.201
Sure.
00:25:26.221 --> 00:25:32.270
I mean, and I think both you and I are in the New York market and I know that you're branching out the Motherhood Center and we'll certainly talk about that.
00:25:33.172 --> 00:25:43.648
I know in New York, I've been in the field for almost a decade, which is wild, but it's grown so much with reproductive psychiatrists and clinicians that specialize in reproductive mental health.
00:25:44.226 --> 00:25:50.512
The issue I run into here is cost and cost being a barrier to care because people don't take insurance.
00:25:50.613 --> 00:25:51.213
It's super tough.
00:25:51.354 --> 00:26:00.263
And then, you know, patients, they just don't want to pay when really I say, well, what's a better use of your money than to take care of yourself?
00:26:01.045 --> 00:26:03.307
But I think it is a small field.
00:26:03.347 --> 00:26:05.289
You know, I think it's small but mighty.
00:26:05.329 --> 00:26:08.834
And I think certainly the advent of telehealth makes it more accessible to people.
00:26:09.314 --> 00:26:10.777
In other parts of the country.
00:26:10.856 --> 00:26:16.189
But I do think, unfortunately, this is still a niche, small field.
00:26:16.429 --> 00:26:21.640
And you have to be someone who is seeking this out, depending on part of the country you're in.
00:26:21.680 --> 00:26:22.501
For sure.
00:26:22.762 --> 00:26:26.289
Because I don't think it's as talked about, right?
00:26:26.309 --> 00:26:27.853
It's not as given to you.
00:26:28.321 --> 00:26:34.019
Well, one of the things when I was on the board of Postpartum Support International, which is an amazing resource.
00:26:34.039 --> 00:26:38.694
So for anybody listening, PSI, their website is postpartum.net.
00:26:39.076 --> 00:26:41.805
But Postpartum Support International has become the...
00:26:42.145 --> 00:26:44.608
It started very grassroots, and it's now gotten much more.
00:26:44.650 --> 00:26:46.271
It's just enormous.
00:26:46.451 --> 00:26:55.805
And everywhere in the world and in their state chapters, it's really a way to get people to providers and therapists and support groups.
00:26:56.266 --> 00:27:03.635
But I think that one of the things that I was most interested in the second time I was on the board was getting a consultation line going.
00:27:03.675 --> 00:27:07.382
And what I mean by that is so that people could call in.
00:27:07.874 --> 00:27:18.590
other providers from the middle of the country where there might not be anyone who does this in their state and say, hey, I don't know what to do, but you're a specialist.
00:27:18.932 --> 00:27:19.472
What do I do?
00:27:19.512 --> 00:27:20.914
How do I think about this?
00:27:20.974 --> 00:27:22.758
So it's like a curbside consultation.
00:27:22.798 --> 00:27:26.606
And that got going and it's thankfully thriving.
00:27:26.666 --> 00:27:32.731
And there are several other like Project Teach and other operations that are going on on MCPAP for moms.
00:27:32.832 --> 00:27:45.683
And there are different services that really provide information and consultation to providers around the country so that you can really get some help if you don't have access in your area.
00:27:46.243 --> 00:27:48.046
So your doctor can be informed.
00:27:48.105 --> 00:28:01.280
And also true of the OBGYN community that is prescribing or the midwife community or the advanced nurse practitioner who are prescribing, there is so much more education and information out there.
00:28:01.381 --> 00:28:05.928
So again, that tends to be in cities, but there's now curriculum.
00:28:06.288 --> 00:28:15.061
We're trying to create a board, a subspecialty board for reproductive psychiatry within this, what's called the National Curriculum for Reproductive Psychiatry.
00:28:15.103 --> 00:28:19.169
So there's so much more movement towards having this more places.
00:28:19.209 --> 00:28:23.315
So access remains hard and I agree with you.
00:28:23.494 --> 00:28:25.557
And then the other thing is money, right?
00:28:25.577 --> 00:28:27.460
I mean, there are many things, let me be clear.
00:28:27.579 --> 00:28:34.868
But if you're an insurance company, even though there's supposed to be parity between physical and mental health, there isn't always in terms of reimbursement.
00:28:34.909 --> 00:28:40.115
And I think that just consultations with specialists tend to be more costly.
00:28:40.695 --> 00:28:42.258
So it is problematic.
00:28:42.317 --> 00:28:47.525
I mean, part of what we're trying to do at the Motherhood Center, we have a unique form of treatment.
00:28:47.704 --> 00:28:50.970
In addition to regular consultation and outpatient treatment.
00:28:51.029 --> 00:28:57.038
We have a day hospital or a day program, and we get insurances to pay for that.
00:28:57.640 --> 00:28:59.943
And let me tell you, it is not easy.
00:28:59.983 --> 00:29:03.429
They're sort of like, that's just general health.
00:29:03.670 --> 00:29:04.290
What's the problem?
00:29:04.310 --> 00:29:05.553
Why do you need these specialty?
00:29:05.833 --> 00:29:06.974
Well, we have a nursery on site.
00:29:07.015 --> 00:29:08.958
We are all experts.
00:29:08.998 --> 00:29:19.280
We are doing a very specific thing as we help people transition to motherhood and these are women who are not well and they still look at us like we've got three heads and are like, yeah, we're not paying for that.
00:29:19.320 --> 00:29:20.546
Really?
00:29:20.586 --> 00:29:29.438
What could be more important than helping someone get better faster in an intensive program when they have moderate to severe illness.
00:29:30.078 --> 00:29:36.768
With milder illness, you can get away with not having to have such an expert necessarily.
00:29:36.788 --> 00:29:48.766
But I think once you up the ante and the first medication might not work or the patient really needs to have more expert care, it can be really hard not to have somebody who is well-versed.
00:29:49.153 --> 00:29:49.856
in this field.
00:29:50.018 --> 00:29:51.564
And that goes for therapy too.
00:29:52.126 --> 00:29:58.172
We get lots of people who call and say, you know, my therapist or my psychiatrist just don't know enough about what's happening for me.
00:29:58.554 --> 00:29:59.356
And I'm scared.
00:30:00.034 --> 00:30:02.457
And we really do try to work with everyone to figure out.
00:30:02.477 --> 00:30:10.105
And if we can't do it, we try to help people get to someone who does know there are in-network providers where sometimes there is a specialist.
00:30:10.226 --> 00:30:12.229
And again, that should be the way of the world.
00:30:12.288 --> 00:30:13.529
And we would like to get there.
00:30:14.131 --> 00:30:16.212
But at the moment, that's not always possible.
00:30:16.473 --> 00:30:17.835
But in our day program, it is.
00:30:17.894 --> 00:30:26.645
So we slide on evaluations to get people in if they are really having kind of moderate to severe illness so that we can get them paid for in a higher level of care, as we say.
00:30:27.041 --> 00:30:39.862
which is coming on site or coming here virtually with your baby or with your pregnancy to really figure out how to get well so that you can be the best mom you can be and be well as a person and human who deserves it.
00:30:41.044 --> 00:30:41.263
Yeah.
00:30:41.284 --> 00:30:43.587
Well, I mean, you're such a gift to the world.
00:30:43.607 --> 00:30:46.612
The Motherhood Center is such an incredible place.
00:30:47.012 --> 00:30:49.836
So tell us future, because when we were talking before.
00:30:49.876 --> 00:30:49.958
Yeah.
00:30:50.369 --> 00:30:50.630
I know
00:30:53.055 --> 00:31:03.755
you're expanding, which is funny.
00:31:07.554 --> 00:31:13.221
LMFTs, licensed clinicians of other sorts, and psychiatrists.
00:31:13.361 --> 00:31:15.703
And we do training programs here.
00:31:15.743 --> 00:31:27.720
We have a fellowship in both postdoctoral fellowship for psychologists, and we have fellowship for reproductive psychiatrists so that they can learn more having had a general kind of residency.
00:31:27.740 --> 00:31:37.621
And we've just expanded and want to keep training and treating and know that people deserve this everywhere, not just in New York City.
00:31:37.662 --> 00:31:46.179
So we are planning to open in New Jersey, pending a facility license, which is extremely hard to get.
00:31:46.298 --> 00:31:52.151
We're actually struggling a bit there, but are getting a lot of help from some very high up people.
00:31:52.171 --> 00:31:55.240
We've met with the governor's wife of New Jersey.
00:31:55.279 --> 00:31:56.842
She's really in support.
00:31:56.882 --> 00:31:58.503
It aligns with her agenda.
00:31:58.844 --> 00:32:05.592
We are so grateful and met the governor as well and are really trying to open in New Jersey to be able to provide a service like this.
00:32:05.632 --> 00:32:09.557
We are able to do outpatient treatment in New Jersey and Connecticut.
00:32:09.576 --> 00:32:15.304
We're trying to start by being in the tri-state area, but honestly, there should be a motherhood center.
00:32:15.344 --> 00:32:21.734
Our model could be in every city and in every state because every It's hard to do.
00:32:21.755 --> 00:32:29.625
We have been kind of a pilot program trying to prove proof of concept, which I think we've done certainly in the clinical world.
00:32:29.644 --> 00:32:36.835
And we're trying to, you know, it is a viable business and we are trying to make sure that that is accessible everywhere.
00:32:36.875 --> 00:32:45.865
So our first foray is going to be to hopefully New Jersey by the end of the year, if we're lucky, if not the beginning of next year, and then we'll be Connecticut.
00:32:45.905 --> 00:32:48.529
And we plan to, you know, keep going.
00:32:49.281 --> 00:32:49.883
Amazing.
00:32:49.942 --> 00:32:50.143
Yeah.
00:32:50.182 --> 00:32:53.448
I mean, I think it'd be wonderful if this could exist everywhere.
00:32:53.468 --> 00:33:02.460
You know, I think from trying to conceive through pregnancy, through postpartum, it can be the most beautiful time of someone's life, but also the hardest.
00:33:02.621 --> 00:33:05.084
And it's really navigating the juxtaposition of that.
00:33:05.144 --> 00:33:10.471
And you can have it be both of those things, beautiful and hard, exciting and sad.
00:33:10.491 --> 00:33:10.531
It
00:33:10.932 --> 00:33:12.714
is by definition.
00:33:12.855 --> 00:33:13.095
Right.
00:33:13.115 --> 00:33:14.877
All those things are true.
00:33:15.298 --> 00:33:15.680
Yeah.
00:33:16.202 --> 00:33:22.336
And to have people to support you, you know, I think it really, it takes a village not only to raise a child, but to raise a mother.
00:33:22.849 --> 00:33:23.451
Absolutely.
00:33:23.490 --> 00:33:24.992
You know the word matrescence, right?
00:33:25.032 --> 00:33:26.816
Or if you don't, I'll explain.
00:33:26.855 --> 00:33:29.118
It's like adolescence.
00:33:29.558 --> 00:33:33.345
Matrescence is the becoming of a mother, the journey to motherhood.
00:33:33.384 --> 00:33:39.794
And we sort of think of it as a developmental stage, although I don't know that you can actually say that because it doesn't happen to everybody.
00:33:39.834 --> 00:33:41.695
Not everybody has to go through it.
00:33:41.836 --> 00:33:52.682
But I think it really highlights the fact, given the name, kind of like adolescence, that it is bumpy and it is not just smooth sailing, but there are ups and downs.
00:33:53.282 --> 00:33:56.406
And I always say, you know, ambivalence is synonymous with motherhood.
00:33:56.446 --> 00:34:29.918
And that is so much of what we are dealing with through the challenges and the identity shifts and the happiness and the joy and also the loss that inevitably comes with both fertility, trying to conceive, but also just having a child, the loss, the separation, the changes in phases of life and one's own kind of the loss of who you were as an individual person, as a partner, potentially in a couple or who you were in a family and all of that.
00:34:29.938 --> 00:34:37.373
There's just so many shifts that really have loss within them, even if there is sort of a happy ending so to speak
00:34:37.432 --> 00:35:07.728
yeah oh my gosh you so verbatim almost to what I speak about with clients all the time the idea of who you were before who you are now who you want to be right the importance of taking the time to pause and and whether it's you know to recognize when you get married okay who you are now as a spouse if you become a parent who you are now and I think people often barrel through these life changes, you know, graduating college, getting a degree, like whatever sort of life milestones people kind of barrel through.
00:35:07.748 --> 00:35:12.213
And they don't really stop and pause to think about those things you touched upon, right?
00:35:12.233 --> 00:35:13.396
Okay, who was I before?
00:35:13.436 --> 00:35:14.858
Who am I now?
00:35:14.898 --> 00:35:16.059
And who do I want to be?
00:35:16.079 --> 00:35:20.324
And I think problems arise when people, they don't think about it.
00:35:20.344 --> 00:35:24.773
And then They wake up one day and it's like, whoa, I don't like what's going on.
00:35:25.074 --> 00:35:32.335
And I miss myself or, you know, I haven't showered in days because of this baby or it's like, whoa, you got to take a pause.
00:35:32.396 --> 00:35:33.117
We got to breathe.
00:35:33.820 --> 00:35:37.088
And then, you know, this work that you and I do, I think can be so helpful.
00:35:37.697 --> 00:35:38.780
Yeah, very true.
00:35:38.800 --> 00:35:39.079
And
00:35:39.139 --> 00:35:50.717
I think that it's hard to always be thoughtful, but if you can, like you said, pause and slow down and give yourself the space to think about these transitions, it will serve you so well.
00:35:50.876 --> 00:35:55.344
And it will serve your kid or future kids, family.
00:35:55.364 --> 00:36:03.114
It serves everyone to really consider what's happening during these major transitions, right?
00:36:03.175 --> 00:36:07.378
It's not just like, Right.
00:36:07.760 --> 00:36:08.641
Yeah.
00:36:23.137 --> 00:36:27.043
just because it looks so good in that sort of Instagram way everywhere.
00:36:27.282 --> 00:36:27.422
Right.
00:36:27.463 --> 00:36:28.704
No one's posting that on Instagram.
00:36:28.724 --> 00:36:30.887
They're just posting photos of.
00:36:31.427 --> 00:36:32.429
We are posting that.
00:36:32.528 --> 00:36:32.648
We
00:36:32.668 --> 00:36:33.570
are really posting.
00:36:33.610 --> 00:36:34.851
People are coming out more.
00:36:34.871 --> 00:36:35.913
So much more.
00:36:35.952 --> 00:36:36.313
Right.
00:36:36.554 --> 00:36:37.155
So much
00:36:37.255 --> 00:36:37.454
more.
00:36:37.494 --> 00:36:42.280
You know, and I think it's thanks to people like you and the motherhood center and really talking about it.
00:36:42.681 --> 00:36:45.744
And this is not something to be ashamed of.
00:36:45.764 --> 00:36:46.889
Oh, It's
00:36:46.929 --> 00:36:47.891
not your fault, right?
00:36:47.972 --> 00:36:49.554
These are illnesses.
00:36:49.675 --> 00:36:55.585
I often say to people to help them relieve their guilt about like, how come I have postpartum depression?
00:36:55.625 --> 00:36:58.068
How come I am having anxiety during pregnancy?
00:36:58.108 --> 00:37:01.074
Do you say that when you have diabetes?
00:37:01.554 --> 00:37:03.016
Do you say that when you have asthma?
00:37:03.217 --> 00:37:05.460
I don't think we're talking about it or a seizure disorder.
00:37:05.481 --> 00:37:06.242
We're not saying that.
00:37:06.663 --> 00:37:08.445
Like, what did I do to deserve this?
00:37:08.525 --> 00:37:09.768
What did I do to bring this on?
00:37:10.389 --> 00:37:10.750
Nothing.
00:37:11.202 --> 00:37:13.786
that you don't cause these illnesses.
00:37:14.447 --> 00:37:16.731
There are circumstances that certainly contribute.
00:37:16.751 --> 00:37:21.922
There are lots of ways to think about illness, medical illnesses of which these are.
00:37:21.942 --> 00:37:27.132
But to think that you cause this is just such a...
00:37:27.172 --> 00:37:32.201
It breaks my heart because people feel so ashamed and guilty that they...
00:37:32.641 --> 00:37:37.369
could have done something differently or should have done something and it would have changed the outcome, right?
00:37:37.409 --> 00:37:38.931
We don't have that kind of control.
00:37:38.971 --> 00:37:45.880
And I think that the idea that we can't talk about it because we did this to ourselves is just heartbreaking.
00:37:45.900 --> 00:37:45.940
It
00:37:46.541 --> 00:37:46.762
is.
00:37:46.942 --> 00:37:53.490
Well, and I love how you framed it at the beginning, which, you know, might sound a little bit tough love, but why are you choosing to suffer, right?
00:37:53.550 --> 00:37:55.233
You didn't choose to get this illness.
00:37:55.554 --> 00:37:55.773
Yeah.
00:37:55.938 --> 00:37:57.338
But you are choosing to suffer.
00:37:57.739 --> 00:37:57.960
Yeah.
00:37:58.239 --> 00:37:59.961
And that does not have to be your choice.
00:38:00.382 --> 00:38:01.603
It doesn't have to be your choice.
00:38:01.782 --> 00:38:08.469
And if it is your choice, then let's embrace it and say, I am choosing this not to take medications.
00:38:08.530 --> 00:38:10.871
And I know I'm going to be depressed or I know I'm going to be anxious.
00:38:10.972 --> 00:38:15.876
And like, you know, I've had people say, if I have to be hospitalized, I will, but I'm not taking a medication.
00:38:15.936 --> 00:38:16.476
And you know what?
00:38:16.838 --> 00:38:18.579
Okay, that is your choice.
00:38:18.619 --> 00:38:20.760
But make it consciously, right?
00:38:21.121 --> 00:38:25.525
Make an intentional decision as opposed to just let it happen and feel miserable.
00:38:25.922 --> 00:38:26.222
Yeah,
00:38:26.543 --> 00:38:26.963
absolutely.
00:38:26.983 --> 00:38:27.643
That's a great point.
00:38:28.304 --> 00:38:28.565
Yeah.
00:38:29.365 --> 00:38:36.693
Well, thank you so much for coming on and sharing your guidance and wisdom and all the things about the Motherhood Center.
00:38:36.793 --> 00:38:40.717
If anyone is looking to find you, they can just go online.
00:38:41.378 --> 00:38:42.000
Go online.
00:38:42.039 --> 00:38:46.204
The thing you have to know is themotherhoodcenter.com.
00:38:46.244 --> 00:38:48.327
Although, honestly, you will find us anyhow, I hope.
00:38:48.367 --> 00:38:51.851
Or you can call our phone number, which is 212-335-0034.
00:38:54.914 --> 00:38:55.494
Pretty easy.
00:38:55.554 --> 00:39:08.771
We tried to get even easier, but it's like, it's just, we have one number in and you will get a caring, compassionate person on the phone who will ask you some questions that will help you try to identify what may be happening.
00:39:08.851 --> 00:39:10.574
And we'll get you in for an evaluation.
00:39:10.614 --> 00:39:11.996
We're on a mission.
00:39:12.036 --> 00:39:14.920
This is a mission driven center.
00:39:15.119 --> 00:39:17.963
And we are all, we just like, this is what we do.
00:39:18.003 --> 00:39:22.210
And we're all so committed to helping people in this period of time.
00:39:22.978 --> 00:39:23.438
Get better.
00:39:23.978 --> 00:39:24.739
I think you're incredible.
00:39:24.760 --> 00:39:26.322
I think what you've created is incredible.
00:39:26.342 --> 00:39:28.224
And I'm so happy to share this.
00:39:28.304 --> 00:39:33.911
And I know that this episode will help somebody, whether it's for them or sharing it with a friend or family member.
00:39:34.211 --> 00:39:34.371
Yeah,
00:39:34.771 --> 00:39:35.193
for sure.
00:39:35.632 --> 00:39:35.994
For sure.
00:39:36.253 --> 00:39:36.675
Thank you.
00:39:36.715 --> 00:39:37.155
Thank you.
00:39:37.175 --> 00:39:38.056
Yeah.
00:39:38.076 --> 00:39:42.722
So the way we like to wrap our episodes is by saying something that we're grateful for.
00:39:42.742 --> 00:39:44.264
So a gratitude.
00:39:45.284 --> 00:39:46.146
Gratitude that I have.
00:39:46.666 --> 00:39:46.927
I mean, I
00:39:47.487 --> 00:39:49.690
feel so grateful that I get to do this work.
00:39:49.990 --> 00:39:52.253
I feel very privileged and lucky.
00:39:52.865 --> 00:40:00.637
and thus grateful that I have the opportunity to do this, that I can work in the space that is also my passion, right?
00:40:00.697 --> 00:40:03.981
Not many people get to do the work they love to do.
00:40:04.021 --> 00:40:11.652
That doesn't feel like a, I don't remember Mark Twain or whoever said that, if you love what you do, you won't work a day in your life or something like that.
00:40:11.692 --> 00:40:14.034
Now, I feel very lucky.
00:40:14.135 --> 00:40:24.028
I am jazzed about this 30 years later and just feel like, I wish I didn't work so hard or all the time, but I, I really do love what I do.
00:40:24.088 --> 00:40:25.952
And I, for that, I feel very grateful.
00:40:26.012 --> 00:40:27.072
And like, how did that, how
00:40:27.092 --> 00:40:27.813
did I get so lucky?
00:40:28.916 --> 00:40:30.197
So that's amazing.
00:40:30.318 --> 00:40:32.039
And I, I totally feel that from you.
00:40:32.119 --> 00:40:36.226
And I think all of your patients and people that work with you feel that too.
00:40:36.266 --> 00:40:37.007
It's such a gift.
00:40:37.628 --> 00:40:39.010
Feels like it for me.
00:40:39.449 --> 00:40:40.692
The gift is mine, right?
00:40:40.771 --> 00:40:42.074
Like I have the privilege.
00:40:42.735 --> 00:40:42.894
Yeah.
00:40:43.436 --> 00:40:43.516
It's
00:40:44.317 --> 00:40:44.456
a gift.
00:40:44.518 --> 00:40:44.878
Yeah.
00:40:44.898 --> 00:40:45.117
Yeah.
00:40:45.699 --> 00:40:53.262
I would piggyback off that and say, you know, same at the beginning of the episode, we were catching up and he said, Oh, you know, where'd you grow up?
00:40:53.302 --> 00:40:54.163
How'd you end up in New York?
00:40:54.222 --> 00:40:59.572
I said, well, I've always wanted to live in New York and since fifth grade and have a Cavalier King Charles Spaniel.
00:40:59.632 --> 00:41:02.135
And I seem to have manifested those two things.
00:41:02.476 --> 00:41:03.737
I didn't know I'd be doing this.
00:41:04.239 --> 00:41:06.041
And to me, it's such a gift.
00:41:06.222 --> 00:41:12.853
I, you know, I've created this career from my own, you know, journey to have my daughter and I love what I do.
00:41:12.893 --> 00:41:14.074
It's not work.
00:41:14.155 --> 00:41:25.179
It's not, it just is, you know, you kind of keep breathe, live, sleep in and meeting other amazing people like you, you know, it just lifts me up knowing that there are other people out there and it's incredible.
00:41:25.239 --> 00:41:27.543
So I feel super grateful for that also.
00:41:27.563 --> 00:41:27.583
I
00:41:27.822 --> 00:41:29.465
feel, yeah, I think that's great.
00:41:29.686 --> 00:41:31.909
It's really, it feels like a calling, right?
00:41:32.010 --> 00:41:35.675
You know, it feels like, God, how lucky to be able to do
00:41:36.456 --> 00:41:36.496
it.
00:41:36.797 --> 00:41:38.400
Yeah, exactly where we're supposed to be.
00:41:39.621 --> 00:41:41.405
Thank you so much for listening today.
00:41:41.425 --> 00:41:47.411
And always remember, practice gratitude, Give a little love to someone else and yourself.
00:41:47.753 --> 00:41:49.958
And remember, you are not alone.
00:41:50.760 --> 00:41:54.268
Find us on Instagram at fertility underscore forward.
00:41:54.829 --> 00:42:03.909
And if you're looking for more support, visit us at www.rmany.com and tune in next week for more Fertility Forward.
00:00:13.986 --> 00:00:14.647
Hi, everyone.
00:00:14.666 --> 00:00:17.632
We are Reena and Dara, and welcome to Fertility Forward.
00:00:18.213 --> 00:00:24.222
We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City.
00:00:24.923 --> 00:00:35.801
Our Fertility Forward podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients, because knowledge is power, and you are your own best advocate.
00:00:36.898 --> 00:00:40.761
I am so excited to welcome back to Fertility Forward today, Dr.
00:00:41.281 --> 00:00:42.603
Katherine Berndorf.
00:00:43.283 --> 00:00:56.215
She is a reproductive psychiatrist, the co-founder, CEO, and medical director of the Motherhood Center of New York, and the founding director of the Payne Whitney Women's Program at Weill Cornell Medicine, New York Presbyterian Hospital.
00:00:56.255 --> 00:01:01.579
In addition, she is a clinical associate professor of psychiatry and obstetrics and gynecology.
00:01:01.618 --> 00:01:05.563
A past postpartum support international board member, Dr.
00:01:05.602 --> 00:01:08.165
Berndorf now serves on the president's advisory council.
00:01:08.706 --> 00:01:09.846
For 10 years, Dr.
00:01:09.887 --> 00:01:19.575
Berndorf was a regular mental health columnist for Self Magazine and has appeared on numerous television programs, including the Today Show, Good Morning America, MSNBC, and CNN.
00:01:20.135 --> 00:01:24.900
Her first book, The Nine Rooms of Happiness, was a New York Times bestseller published in 2010.
00:01:25.760 --> 00:01:33.707
Her most recent book, published by Simon& Schuster in 2019, is entitled What No One Tells You, A Guide to Your Emotions from Pregnancy to Motherhood.
00:01:34.289 --> 00:01:35.290
Oof, what a bio!
00:01:36.001 --> 00:01:37.524
So long.
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I got to shorten that.
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But thank you for reading that.
00:01:40.388 --> 00:01:43.371
And thank you for having me on and back on.
00:01:43.552 --> 00:01:46.236
I think you've done many, many things since I was last here.
00:01:46.275 --> 00:01:47.597
So I'm excited to be back.
00:01:48.159 --> 00:01:48.539
Likewise.
00:01:48.558 --> 00:01:52.444
So excited to have you back and catch up and talk this episode.
00:01:52.463 --> 00:02:04.960
I think we're going to focus on key meds and then we're going to sort of dive into medication and the safety of medication for pregnancy or pre-pregnancy and really just get in there to these super important topics.
00:02:05.569 --> 00:02:06.490
My favorite topics.
00:02:07.173 --> 00:02:07.632
Let's go.
00:02:07.653 --> 00:02:08.555
Let's go.
00:02:09.096 --> 00:02:13.703
So I guess let's first talk about PMADS and what PMADS are, this acronym.
00:02:14.183 --> 00:02:14.784
This acronym.
00:02:14.884 --> 00:02:24.920
It's such a terrible acronym, but on the other hand, I am so happy that it's not just postpartum depression because people can't see themselves in that.
00:02:25.562 --> 00:02:32.670
Neither those who are struggling or those who are treating, they can't always find themselves as having postpartum depression, right?
00:02:32.711 --> 00:02:53.008
So what happens is PMADS, which P-M-A-D has a word mad in it, which we don't love as it pertains to women and illness, but it tries to encompass, it's an umbrella term that encompasses Perinatal, so during and after pregnancy, mood and anxiety disorders.
00:02:53.127 --> 00:02:54.748
Perinatal mood and anxiety disorders.
00:02:54.788 --> 00:02:56.290
That's what the acronym stands for.
00:02:56.330 --> 00:03:00.655
And we will talk also about before pregnancy, trying to conceive.
00:03:00.715 --> 00:03:06.979
And also like many people get to the pregnancy space or trying to conceive space and they are not well.
00:03:07.460 --> 00:03:13.004
They have a history of or kind of baseline anxiety, depression and other things that they've lived with that may not be treated.
00:03:13.445 --> 00:03:16.207
So they're kind of behind the eight ball before they even get into the perinatal.
00:03:16.207 --> 00:03:17.270
perinatal space.
00:03:17.971 --> 00:03:36.123
But for purposes defining PMADS, these are illnesses like depression, anxiety, generalized anxiety disorder, panic disorder, phobias, OCD, PTSD, post-traumatic stress disorder, bipolar disorder, and postpartum depression.
00:03:36.163 --> 00:03:48.229
It's really Anything, that umbrella can't be big enough to hold everything that could happen to somebody psychologically and psychiatrically in this period of their life during this time.
00:03:48.250 --> 00:03:56.609
I just want everybody to be able to find themselves in there because if you think you have something wrong with you, then you have to believe that and get help.
00:03:57.217 --> 00:03:58.120
So it doesn't matter.
00:03:58.240 --> 00:03:59.544
I don't even care what you call it.
00:03:59.663 --> 00:04:06.741
Just know that something's not right and you need help and find somebody who believes you and will talk to you about it so you can get
00:04:06.800 --> 00:04:07.782
diagnosed and treated.
00:04:07.802 --> 00:04:11.992
I think right there, though, sometimes that's the difficult thing, right?
00:04:12.173 --> 00:04:14.078
Asking for help and being...
00:04:14.337 --> 00:04:35.245
able to speak up because i think unfortunately there's still so much shame and stigma and people suffering silence and feel like i shouldn't be feeling this way or i should be better than this or i'm scared to speak up or who do i talk to so what might be some words of advice or guidance there for someone who recognizes themselves in this and doesn't know where to turn
00:04:36.161 --> 00:04:43.572
Well, I think, first of all, if you recognize yourself in here, I'm glad that you can hang your hat on something like you know it.
00:04:44.112 --> 00:04:57.672
So even if you just have an inkling that something could be wrong, it's very hard, to your point, to advocate for yourself and to be able to speak up when you're down, to quote a New Jersey slogan around treatment of postpartum illness, perinatal illness.
00:04:58.132 --> 00:04:59.834
But I think speaking up when you're down is...
00:04:59.954 --> 00:05:01.677
I love it because I think that like...
00:05:02.209 --> 00:05:05.132
You might not be able to do it, but maybe someone around you can.
00:05:05.192 --> 00:05:15.663
Maybe you can talk to someone in your family is noticing, or you can just share with somebody who you confide in or a doctor or anybody.
00:05:15.682 --> 00:05:18.386
And people don't have to know how to treat it or know what to do.
00:05:18.406 --> 00:05:22.949
It's just, I think you have to allow yourself to be seen.
00:05:22.970 --> 00:05:33.394
And if you're around people that know you and love you, hopefully if you can't say something, they'll say to you, Hey, you don't seem like yourself.
00:05:34.276 --> 00:05:36.218
And by the way, that may be the thing you say to them.
00:05:36.238 --> 00:05:38.122
Hey, I don't feel like myself.
00:05:38.242 --> 00:05:40.105
Like I know something's not right.
00:05:40.788 --> 00:05:45.235
And I know it's the hardest thing to do when you're down to be able to say something like that.
00:05:45.637 --> 00:05:50.386
But I always say, even as a physician, I have to advocate for myself medically.
00:05:50.754 --> 00:05:55.298
The system doesn't always work for us in the way that we'd like it to.
00:05:55.759 --> 00:05:57.721
So you really do need advocacy.
00:05:57.922 --> 00:06:02.807
And if you can share and tell someone and get them to help you if you can't do it yourself.
00:06:03.468 --> 00:06:04.769
And you don't have to know what's wrong.
00:06:04.990 --> 00:06:07.954
And they don't have to know either or know how to fix it.
00:06:08.714 --> 00:06:14.401
It's just who can help you get to the next step in the chain of trying to get help.
00:06:15.302 --> 00:06:19.007
And I think sometimes that's what's frustrating, that it is this chain, right?
00:06:19.047 --> 00:06:21.973
And it's one call, it's the next call, and it's the next call.
00:06:22.473 --> 00:06:28.004
Well, I want to jump in part of why, you know, with where I am now, I'm sitting in the motherhood center.
00:06:28.483 --> 00:06:35.656
And part of why we exist is literally to have a single phone number and a website that can get you right there.
00:06:35.697 --> 00:06:37.521
You don't have to know what's going on.
00:06:37.841 --> 00:06:40.286
You just have to know something's not right.
00:06:40.425 --> 00:06:45.021
To me, that was so important because, you you just don't have to know because mostly people don't know.
00:06:45.040 --> 00:07:02.449
And so you just say, I am in this period of time, somewhere between trying to conceive, going through fertility, having had losses, being pregnant, being in the postpartum and up to a year, two years, three years, and just knowing that you are not yourself and that you are not feeling good.
00:07:02.908 --> 00:07:05.112
And then we will help you figure that out.
00:07:05.353 --> 00:07:07.244
So, again, you just don't have to know.
00:07:07.264 --> 00:07:09.247
You just have to know that there's somewhere to turn.
00:07:09.266 --> 00:07:13.353
And again, not everybody has access to us or can come here.
00:07:13.413 --> 00:07:25.773
We do both virtual and in-person, but let's say, hopefully you can get to your own OBGYN or midwife or doula or somebody in the space who will know what to do, right?
00:07:25.793 --> 00:07:29.798
Or a pediatrician or whoever it is, but it can be very hard.
00:07:30.480 --> 00:07:31.341
Yeah, exactly.
00:07:31.362 --> 00:07:31.581
Yeah.
00:07:31.810 --> 00:07:37.579
You know, and so let's talk about, so if you are identifying with this, how might a PMAD be treated?
00:07:37.619 --> 00:07:42.386
Well, the most important thing is that they're really, really, really treatable.
00:07:42.966 --> 00:07:50.819
So like I was just on the phone talking to someone who's going to come in for an evaluation and she feels hopeless and helpless and ashamed.
00:07:51.278 --> 00:08:04.709
She's a very competent, high functioning person who's done well professionally and personally and has a great life and has been miserable due to a million, circumstances, but doesn't have hope.
00:08:05.310 --> 00:08:18.367
So a lot of what we do is say, you know, what I said to her was like, let us hold the hope for you while you are feeling hopeless, which is never normal to really feel like there's nowhere to go and that you feel desperate and despondent.
00:08:19.007 --> 00:08:23.151
And like, you can't really take care of yourself in a way that you know how to.
00:08:23.192 --> 00:08:27.317
And we will hold that hope for you so that you can feel better.
00:08:27.377 --> 00:08:29.723
Because PMADS are super treatable.
00:08:30.004 --> 00:08:34.071
It's just, they have to be identified and you have to have somebody who knows what to do.
00:08:34.230 --> 00:08:35.552
And it's not rocket science.
00:08:36.094 --> 00:08:54.302
It is really, these are super treatable illnesses that if someone knows how to treat anxiety, depression, OCD, PTSD, and then you get into some more difficult stuff to treat, like someone who has a history of bipolar disorder or a history of psychosis or some kind of psychotic disorder, that can be trickier.
00:08:54.322 --> 00:08:58.591
And I'm not saying it's so easy to treat those things I started with.
00:08:59.032 --> 00:09:05.883
But when this happens in the peripartum, it can look a little different, but it is just as treatable.
00:09:05.923 --> 00:09:11.552
You have to find someone who isn't scared and has some experience doing it.
00:09:11.773 --> 00:09:20.046
You may really need an expert to help with the treatment so that you get the right treatment and it gets recognized because, like I said, it can look different.
00:09:20.514 --> 00:09:23.860
Well, and so I know you're a reproductive psychiatrist.
00:09:23.879 --> 00:09:31.193
So if someone is experiencing this, should they specifically look for someone that's a reproductive psychiatrist versus a general
00:09:31.413 --> 00:09:32.034
psychiatrist?
00:09:32.416 --> 00:09:40.610
If you're lucky enough or have access to someone who is a specialist in the field, and we call that reproductive psychiatry.
00:09:40.650 --> 00:09:50.865
So somebody who treats women and birthing people along the reproductive spectrum from menses to menopause, then you're going to find somebody who knows what they're doing in this space, right?
00:09:50.946 --> 00:09:52.668
They're going to know exactly what to do.
00:09:53.089 --> 00:09:54.490
And there are therapists also.
00:09:54.610 --> 00:10:02.822
So, you know, different kinds of therapists, social workers, psychologists who also are in the reproductive or perinatal space, and they also know what to do.
00:10:02.903 --> 00:10:05.706
They can't medicate, but they will know what to do.
00:10:05.826 --> 00:10:17.681
So I do think if you're a generalist, a psychiatrist or therapist doesn't know exactly what to do or what this is called that you're experiencing, then you do want to reach out for consultation.
00:10:17.761 --> 00:10:20.804
And again, at the Motherhood Center, we do a lot of consultations.
00:10:20.904 --> 00:10:24.669
If you work here, you're either an expert or you're training to be an expert.
00:10:24.710 --> 00:10:29.215
So we have trainees and experts, but primarily we are sort of a subspecialty, right?
00:10:29.635 --> 00:10:34.841
If reproductive psychiatry is a subspecialty of psychiatry, we do just the perinatal period.
00:10:34.881 --> 00:10:37.924
So we're pretty expert in a deep way.
00:10:38.466 --> 00:10:47.577
So we love to be able to help people consult with other doctors and medical professionals to talk about it if people can't come in.
00:10:47.618 --> 00:10:49.841
So we do a lot of consultative work as well.
00:10:49.900 --> 00:10:59.614
But we really have an expertise that if you can get to somewhere like us or to someone like us, I would say, you know, you don't go to a general physician clinic.
00:10:59.714 --> 00:11:01.376
to treat a broken bone, right?
00:11:01.397 --> 00:11:12.754
You'd go to an orthopedist or if you've got a cardiac issue, you might start with your internist or primary care doctor, but you end up with, if it's a cardiac issue, with a cardiologist.
00:11:13.294 --> 00:11:22.909
So I do think that we sort of function as the experts in psychiatry around issues related to trying to conceive, being pregnant and postpartum.
00:11:23.426 --> 00:11:23.826
Yeah.
00:11:24.006 --> 00:11:25.990
I mean, the motherhood center is incredible.
00:11:26.029 --> 00:11:42.433
And, you know, I think what you're also touching upon is I see so many people who, you know, they speak to a more general doctor and they're told, oh, you shouldn't think to carry because you have the, you know, preexisting diagnosis and that is not going to be good for you.
00:11:42.474 --> 00:11:45.739
And then someone takes that and says, oh, well, I can't become pregnant.
00:11:45.778 --> 00:11:46.919
I can't become a parent.
00:11:47.541 --> 00:11:59.115
When I think if they were to go to someone who specialized in this and and can really do a deep dive to help support, you know, maybe you need different things than someone that doesn't have a diagnosis of whatever, right?
00:11:59.134 --> 00:12:00.616
But it doesn't mean that you can't.
00:12:00.677 --> 00:12:08.149
And so to take someone's offhand comment and then let that dictate you not family building, I think is horrible.
00:12:08.269 --> 00:12:12.937
And that's why, you know, a specialist like you is, and the Motherhood Center is amazing.
00:12:12.976 --> 00:12:14.259
Thank you.
00:12:14.399 --> 00:12:17.504
I see my job as helping people create options for themselves.
00:12:18.164 --> 00:12:20.807
And I don't, Okay.
00:12:20.847 --> 00:12:22.229
That's not true.
00:12:22.249 --> 00:12:26.152
Once I did say to somebody, I'm not sure it would be a good idea for you to have a kid, but guess what?
00:12:26.471 --> 00:12:27.072
I'm not God.
00:12:27.113 --> 00:12:31.196
That's not my, that's, and that's not my job to tell you not to do this.
00:12:31.336 --> 00:12:39.543
I will give you my professional opinion and I certainly have one, but ultimately we work collaboratively here to help you get where you want to go.
00:12:39.604 --> 00:12:49.072
So we help women make very difficult decisions for themselves when they are not sure what to do, either because a provider or someone has said to them, you can't be on that medication.
00:12:49.072 --> 00:12:51.696
or, oh, sure, who cares?
00:12:51.956 --> 00:12:52.817
Stay on it.
00:12:52.857 --> 00:12:53.500
You'll be fine.
00:12:53.600 --> 00:12:54.600
Everybody's on it, right?
00:12:54.640 --> 00:12:58.668
So you get these two ends of the spectrum, and people really want information.
00:12:58.707 --> 00:13:00.631
They want to be armed with information.
00:13:00.652 --> 00:13:02.094
They want to have the knowledge.
00:13:02.534 --> 00:13:23.485
And I see that as my job to work with someone to have the latest information and, more as importantly, to be able to create the context for given their own life and their own sort of risk aversion or religion or family or the way they think, to understand their own context to decide what to do.
00:13:25.226 --> 00:13:25.768
Yeah.
00:13:25.788 --> 00:13:33.857
I mean, as a clinician, what I see a lot is patients, either if they're trying to conceive or pregnant, being very averse to medication.
00:13:33.898 --> 00:13:41.984
And as you know and I know, sometimes the trying to conceive process can be really stressful, really overwhelming.
00:13:42.043 --> 00:13:49.831
It can be a catalyst to sort of catapult someone into an anxiety or depression or a mental episode that they have not experienced before.
00:13:49.870 --> 00:13:54.336
And sometimes the only way out of that is with the boost of medication.
00:13:54.355 --> 00:13:59.561
And I see so many women suffer because they're afraid to take medication.
00:13:59.581 --> 00:13:59.660
Yeah.
00:14:00.341 --> 00:14:02.923
What do you say about that?
00:14:03.745 --> 00:14:05.285
How much time do you have?
00:14:05.326 --> 00:14:07.288
Although I can say it pretty quickly.
00:14:07.307 --> 00:14:09.169
And I say this to women all the time.
00:14:10.145 --> 00:14:11.548
you are choosing to suffer.
00:14:11.929 --> 00:14:13.352
Why are you choosing to suffer?
00:14:14.434 --> 00:14:15.476
Why must you suffer?
00:14:15.517 --> 00:14:17.721
Because I can't do X, Y, or Z.
00:14:18.563 --> 00:14:21.389
I want to tell you that that is not necessarily true.
00:14:21.429 --> 00:14:23.234
Let's think about it together.
00:14:23.274 --> 00:14:30.226
The way I start a consultation, and again, I don't mean to be blaming when I say you are choosing to suffer.
00:14:30.307 --> 00:14:31.808
I think people often don't know.
00:14:31.828 --> 00:14:35.533
So again, I encourage people to ask to get help.
00:14:35.573 --> 00:14:37.557
So I really want to be careful in how I say that.
00:14:37.976 --> 00:14:45.527
But what I do when I start in a consultation is I let people know that if they have illness, like anxiety or depression, they have risk.
00:14:46.267 --> 00:14:50.812
So you may choose not to be on a medication, but it's a risk-risk analysis.
00:14:51.514 --> 00:14:53.576
You don't get to choose not to have risk.
00:14:54.298 --> 00:15:09.653
Okay, so the person who says, I'd rather suffer or because I can't be on that medication because that's so potentially dangerous, what I would say to them is, okay, then you're choosing the risk of untreated illness, okay?
00:15:10.033 --> 00:15:11.294
So you have risk no matter what.
00:15:11.754 --> 00:15:25.011
And the two choices you get are, again, this is somebody who has illness, are the medication or the untreated illness, the symptom burden that comes with that and what the implications of that are for trying to conceive, being pregnant or postpartum.
00:15:26.013 --> 00:15:26.653
And I want to...
00:15:26.754 --> 00:15:34.666
interject and say too, that there's so much research about medications that are safe to take while trying to conceive and while pregnant.
00:15:35.126 --> 00:15:35.506
Correct.
00:15:35.768 --> 00:15:37.470
And I rarely use the word safe.
00:15:37.529 --> 00:15:50.309
I will always say relatively safe because we can't know everything, everything, but I will tell you that they're in the psychiatric toolbox, the psychotropic toolbox, the medications we use to treat psychiatric illness.
00:15:50.850 --> 00:15:55.903
There is really one exception and that if I can help it, I won't use in pregnancy.
00:15:56.062 --> 00:16:06.179
And that is Depakote or valproic acid, which is a seizure medication primarily and gets used and is an excellent bipolar medication for some people.
00:16:06.220 --> 00:16:07.643
And I don't use it.
00:16:07.682 --> 00:16:13.251
I hope people don't use it in women of reproductive age because 50% at least of pregnancies are unplanned.
00:16:13.692 --> 00:16:20.924
So it is known to be a teratogenic drug, a drug that can cause malformations that we know about.
00:16:21.044 --> 00:16:26.572
And I think that is the one drug to write home about, that there is something to say short of that.
00:16:26.613 --> 00:16:30.298
I essentially don't have an issue with any of the other medications.
00:16:30.719 --> 00:16:44.837
They have been so scrutinized and so marginalized and so considered optional that there's a ton of research out there and good research looking at, do these medications cause miscarriage or malformation?
00:16:44.878 --> 00:16:54.241
The data supports evidence that It does not increase above baseline in the general population for those who do not have illness and are not on meds.
00:16:54.761 --> 00:17:00.068
So that's why I say these medications are relatively safe for use in pregnancy.
00:17:00.328 --> 00:17:17.493
And if you choose, or conception, if you choose not to be on it, then you are choosing also the risk, and we have lots of data to support this, of having illness and having those symptoms that you are having to manage because they're off the medication and being unwell.
00:17:17.814 --> 00:17:22.160
And what is the effect then on, again, trying to conceive and on the fetus?
00:17:23.381 --> 00:17:29.288
I just think this speaks to so much the larger picture that there's just such a stigma around mental health.
00:17:29.910 --> 00:17:29.990
Yeah.
00:17:30.009 --> 00:17:33.835
And of all things to be scrutinized, why are people picking on this, right?
00:17:33.875 --> 00:17:41.023
Of the new wave of things, you know, no one's reanalyzing all the other medications people are taking or even self-medicating that they're doing.
00:17:41.104 --> 00:17:45.561
Well, by the way, So when people go off medications, what do they do?
00:17:45.643 --> 00:17:49.689
I've had plenty of patients say to me, well, I'm going to just smoke weed because you know what?
00:17:50.190 --> 00:17:51.010
It's natural.
00:17:51.692 --> 00:17:52.093
Oh, okay.
00:17:52.532 --> 00:17:54.476
Well, that also has consequences.
00:17:54.556 --> 00:17:59.304
And some of the supplements people take, they'll go to the drugstore and take all kinds of things over the counter.
00:17:59.324 --> 00:18:08.258
And if you're not well, and by the way, as if those are because they don't have prescriptions and they're not FDA approved or rated that you think that those are safe.
00:18:08.698 --> 00:18:09.660
That's the devil you don't
00:18:09.839 --> 00:18:09.920
know.
00:18:10.019 --> 00:18:11.001
There's no logic in that.
00:18:11.617 --> 00:18:12.839
But that is how we think.
00:18:13.319 --> 00:18:19.648
That is how a great majority of us think about medications, that if it's a prescription medication, it must be bad.
00:18:19.689 --> 00:18:21.471
It's kind of the opposite.
00:18:21.551 --> 00:18:23.615
But these, again, have been so scrutinized.
00:18:23.654 --> 00:18:31.486
We know more about the psychotropic medications than we do about any other category of drug because they have been so scrutinized.
00:18:32.130 --> 00:18:40.022
And so when I started in this field in the late 90s, early 2000s, there was not a lot of literature about these medications in pregnancy.
00:18:40.282 --> 00:18:41.665
There was not as much research.
00:18:42.066 --> 00:18:56.369
It has proliferated the amount of research and wonderful work that's going on to understand both what untreated illness does to the fetus and or can do and to birth and the delivery process and the kid going on.
00:18:56.738 --> 00:19:09.674
In addition to what happens with medications, when people take medications during those same time periods, we are able to really look at those things and compare them and make choices about which risk you want to choose.
00:19:09.795 --> 00:19:17.685
We didn't know as much before, but I guess the scrutiny, there was a silver lining to the scrutiny of it because now we know a lot about these.
00:19:17.865 --> 00:19:27.298
And there really is no good reason not to have a conversation like this that helps you be well, stay well, And that is the best thing you can do both for a fetus and a child.
00:19:27.720 --> 00:19:31.065
And if that includes medication, then that may be the choice.
00:19:31.285 --> 00:19:39.317
And it really requires psychoeducation and often expert consultation so you can feel comfortable with that.
00:19:39.939 --> 00:19:42.683
Well, I would say a mother's mental health is the most important.
00:19:42.703 --> 00:19:49.094
And if you're not healthy mentally, then you're in no position to either carry or take care of a child.
00:19:49.253 --> 00:19:50.957
And so there still seems to be...
00:19:51.842 --> 00:19:52.623
a disconnect.
00:19:52.742 --> 00:20:02.734
And so I would ask you, okay, a mother's mental health is the most important, but from what you kind of just said, does it actually, in addition, transfer to the fetus?
00:20:03.055 --> 00:20:03.375
Yeah.
00:20:04.817 --> 00:20:27.074
You know, there's some very elegant research by a colleague of mine, Catherine Monk up at Columbia, among other people who do this work, but she looks at the fetal environment and, you know, there's some work a while back looking at like stressing fetal the pregnant woman through a math test or through having to say a color when it's read the word, but it's different than the color.
00:20:27.094 --> 00:20:29.457
And it sort of stresses the brain.
00:20:29.497 --> 00:20:33.864
And what you see in women who have an anxious baseline, right?
00:20:33.903 --> 00:20:36.227
So they have historical anxiety.
00:20:36.827 --> 00:20:40.634
When they are stressed, their baby's heart rate can go up.
00:20:41.410 --> 00:20:46.702
So she's looking at the difference in stressing the mom and how it translates through to the baby.
00:20:46.722 --> 00:20:53.660
And we know that there's a protective factor when women are stressed who don't have a baseline of anxiety.
00:20:55.041 --> 00:20:58.384
So the baby is also, so both moms get stressed, right?
00:20:58.404 --> 00:20:59.346
Because you give this test.
00:20:59.705 --> 00:21:05.711
If you have a history of anxiety, it can transmit through, you will see the baby's heart rate go up and it doesn't in the other.
00:21:05.810 --> 00:21:22.125
But what we know from some beautiful work up at Columbia by Catherine Monk and others is when she looks at the stress in moms and then what happens to the fetus, we know that there is a relationship between mothers who are stressed, who have a history of anxiety and what happens to the fetus.
00:21:22.586 --> 00:21:30.453
And it's really important to note that we can tell what is happening to the mother is potentially happening to the fetus.
00:21:30.513 --> 00:21:33.196
And we look at that often by heart rate variability.
00:21:33.237 --> 00:21:35.659
That's probably a better way to say it, right?
00:21:35.699 --> 00:21:39.323
We can see that the babies can get stressed when mothers are stressed.
00:21:39.884 --> 00:21:50.694
And so we know that there's a relationship and she is looking at that in a number of ways to kind of help support understanding about what happens in the fetal environment.
00:21:51.635 --> 00:21:52.897
And that's fascinating.
00:21:53.038 --> 00:21:56.804
And So then how does that translate to implications to the baby?
00:21:56.844 --> 00:22:02.990
Does that mean that they're more at risk of being an anxious person or how does that translate?
00:22:03.201 --> 00:22:17.186
Well, first and foremost, if you have a history of a biological vulnerability to anxiety or depression or any illness, there's the potential to transmit that to the baby biologically in the genetics.
00:22:17.627 --> 00:22:34.855
We also know that the epigenetics are things that happen outside while the baby's in utero or afterwards, that there can be sort of hits on the genome of that could be stressors in the environment, stressors in illness, things like that, that can change genetics.
00:22:35.616 --> 00:22:41.484
But yes, you are prone, you are more likely, if you have your own history, to confer that risk.
00:22:41.766 --> 00:22:59.148
But we also know that with stress and given the fetal environment, that you could also have more risk if there is stress and you're not taking care of it, or illness and you're not taking care of it, both during pregnancy and postpartum, in terms of what you're setting the kid up for going forward.
00:23:00.130 --> 00:23:06.236
I just hope people hear that and really that that grounds them, because I think it's the reverse.
00:23:06.717 --> 00:23:19.430
So many women that I see, they think they're doing what's best for baby by not medicating themselves or not taking care of themselves, when from everything you just said, it's the exact opposite of what you're trying to do.
00:23:19.529 --> 00:23:33.102
If you don't take care of yourself, if you don't take care of your mental health, you're in fact just transferring that passing that along right to your baby which is what you're trying to prevent by not taking medication so you know it's you're doing the opposite action
00:23:33.604 --> 00:23:40.487
it's like almost counterintuitive but like So that's why we boil it down to this idea that like a well mom is a well baby.
00:23:40.507 --> 00:23:50.916
The maternal euthymia, maternal wellness is the goal so that the fetus and the baby and the child can be as well as possible.
00:23:51.137 --> 00:23:52.298
That's the best thing.
00:23:52.778 --> 00:24:04.963
That's why when someone's on a medication and then they find out they're pregnant, you don't stop the medication because now you could be exposed to medication and you were doing well Now you've taken the medication away.
00:24:05.003 --> 00:24:09.672
Now you're going to have symptoms that recur and create distress.
00:24:10.613 --> 00:24:12.135
I mean, I think it's always a conversation.
00:24:12.155 --> 00:24:17.124
If you're someone that's planning a pregnancy and you're on a medication, talk to your physician.
00:24:17.605 --> 00:24:19.488
Have a consult with a reproductive psychiatrist.
00:24:19.508 --> 00:24:20.730
You know, hi, here's the history.
00:24:20.750 --> 00:24:21.210
Go over it.
00:24:21.250 --> 00:24:21.991
This is what I'm taking.
00:24:22.031 --> 00:24:22.692
Is this safe?
00:24:23.233 --> 00:24:23.753
Maybe it is.
00:24:23.834 --> 00:24:26.598
Maybe they say, actually, I think we should tweak it, do something else.
00:24:27.840 --> 00:24:28.362
But always...
00:24:28.961 --> 00:24:34.171
talk to someone and get the information before just saying, oh, I shouldn't be doing this.
00:24:34.791 --> 00:24:36.414
That's typically not what happens.
00:24:36.635 --> 00:24:39.560
Or you go to the pharmacy and you tell them I'm pregnant, can I take this?
00:24:39.641 --> 00:24:41.203
And they're like, oh, I don't think so.
00:24:41.284 --> 00:24:54.883
I mean, again, I don't want to single any discipline out, but I will say that there aren't that many people I think who can talk and knowledgeably and expertly about this, there are a lot more of us.
00:24:54.942 --> 00:24:55.403
Oh, my gosh.
00:24:55.604 --> 00:24:57.247
So many more of us out there now.
00:24:57.686 --> 00:24:59.009
And we train at the Motherhood Center.
00:24:59.029 --> 00:25:02.714
We train people to understand this and to be able to talk about it and to interpret data.
00:25:03.155 --> 00:25:06.221
But generally speaking, everyone's got an opinion.
00:25:06.240 --> 00:25:09.025
And so you ask anyone and they're like, don't take that.
00:25:09.185 --> 00:25:11.528
And it just gets in people's heads.
00:25:12.230 --> 00:25:25.278
And it makes it very hard to feel like you're doing the right thing if you don't or taking medication that somebody has an opinion about that is not what you want to do and know you have to do to stay healthy and well.
00:25:26.039 --> 00:25:26.201
Sure.
00:25:26.221 --> 00:25:32.270
I mean, and I think both you and I are in the New York market and I know that you're branching out the Motherhood Center and we'll certainly talk about that.
00:25:33.172 --> 00:25:43.648
I know in New York, I've been in the field for almost a decade, which is wild, but it's grown so much with reproductive psychiatrists and clinicians that specialize in reproductive mental health.
00:25:44.226 --> 00:25:50.512
The issue I run into here is cost and cost being a barrier to care because people don't take insurance.
00:25:50.613 --> 00:25:51.213
It's super tough.
00:25:51.354 --> 00:26:00.263
And then, you know, patients, they just don't want to pay when really I say, well, what's a better use of your money than to take care of yourself?
00:26:01.045 --> 00:26:03.307
But I think it is a small field.
00:26:03.347 --> 00:26:05.289
You know, I think it's small but mighty.
00:26:05.329 --> 00:26:08.834
And I think certainly the advent of telehealth makes it more accessible to people.
00:26:09.314 --> 00:26:10.777
In other parts of the country.
00:26:10.856 --> 00:26:16.189
But I do think, unfortunately, this is still a niche, small field.
00:26:16.429 --> 00:26:21.640
And you have to be someone who is seeking this out, depending on part of the country you're in.
00:26:21.680 --> 00:26:22.501
For sure.
00:26:22.762 --> 00:26:26.289
Because I don't think it's as talked about, right?
00:26:26.309 --> 00:26:27.853
It's not as given to you.
00:26:28.321 --> 00:26:34.019
Well, one of the things when I was on the board of Postpartum Support International, which is an amazing resource.
00:26:34.039 --> 00:26:38.694
So for anybody listening, PSI, their website is postpartum.net.
00:26:39.076 --> 00:26:41.805
But Postpartum Support International has become the...
00:26:42.145 --> 00:26:44.608
It started very grassroots, and it's now gotten much more.
00:26:44.650 --> 00:26:46.271
It's just enormous.
00:26:46.451 --> 00:26:55.805
And everywhere in the world and in their state chapters, it's really a way to get people to providers and therapists and support groups.
00:26:56.266 --> 00:27:03.635
But I think that one of the things that I was most interested in the second time I was on the board was getting a consultation line going.
00:27:03.675 --> 00:27:07.382
And what I mean by that is so that people could call in.
00:27:07.874 --> 00:27:18.590
other providers from the middle of the country where there might not be anyone who does this in their state and say, hey, I don't know what to do, but you're a specialist.
00:27:18.932 --> 00:27:19.472
What do I do?
00:27:19.512 --> 00:27:20.914
How do I think about this?
00:27:20.974 --> 00:27:22.758
So it's like a curbside consultation.
00:27:22.798 --> 00:27:26.606
And that got going and it's thankfully thriving.
00:27:26.666 --> 00:27:32.731
And there are several other like Project Teach and other operations that are going on on MCPAP for moms.
00:27:32.832 --> 00:27:45.683
And there are different services that really provide information and consultation to providers around the country so that you can really get some help if you don't have access in your area.
00:27:46.243 --> 00:27:48.046
So your doctor can be informed.
00:27:48.105 --> 00:28:01.280
And also true of the OBGYN community that is prescribing or the midwife community or the advanced nurse practitioner who are prescribing, there is so much more education and information out there.
00:28:01.381 --> 00:28:05.928
So again, that tends to be in cities, but there's now curriculum.
00:28:06.288 --> 00:28:15.061
We're trying to create a board, a subspecialty board for reproductive psychiatry within this, what's called the National Curriculum for Reproductive Psychiatry.
00:28:15.103 --> 00:28:19.169
So there's so much more movement towards having this more places.
00:28:19.209 --> 00:28:23.315
So access remains hard and I agree with you.
00:28:23.494 --> 00:28:25.557
And then the other thing is money, right?
00:28:25.577 --> 00:28:27.460
I mean, there are many things, let me be clear.
00:28:27.579 --> 00:28:34.868
But if you're an insurance company, even though there's supposed to be parity between physical and mental health, there isn't always in terms of reimbursement.
00:28:34.909 --> 00:28:40.115
And I think that just consultations with specialists tend to be more costly.
00:28:40.695 --> 00:28:42.258
So it is problematic.
00:28:42.317 --> 00:28:47.525
I mean, part of what we're trying to do at the Motherhood Center, we have a unique form of treatment.
00:28:47.704 --> 00:28:50.970
In addition to regular consultation and outpatient treatment.
00:28:51.029 --> 00:28:57.038
We have a day hospital or a day program, and we get insurances to pay for that.
00:28:57.640 --> 00:28:59.943
And let me tell you, it is not easy.
00:28:59.983 --> 00:29:03.429
They're sort of like, that's just general health.
00:29:03.670 --> 00:29:04.290
What's the problem?
00:29:04.310 --> 00:29:05.553
Why do you need these specialty?
00:29:05.833 --> 00:29:06.974
Well, we have a nursery on site.
00:29:07.015 --> 00:29:08.958
We are all experts.
00:29:08.998 --> 00:29:19.280
We are doing a very specific thing as we help people transition to motherhood and these are women who are not well and they still look at us like we've got three heads and are like, yeah, we're not paying for that.
00:29:19.320 --> 00:29:20.546
Really?
00:29:20.586 --> 00:29:29.438
What could be more important than helping someone get better faster in an intensive program when they have moderate to severe illness.
00:29:30.078 --> 00:29:36.768
With milder illness, you can get away with not having to have such an expert necessarily.
00:29:36.788 --> 00:29:48.766
But I think once you up the ante and the first medication might not work or the patient really needs to have more expert care, it can be really hard not to have somebody who is well-versed.
00:29:49.153 --> 00:29:49.856
in this field.
00:29:50.018 --> 00:29:51.564
And that goes for therapy too.
00:29:52.126 --> 00:29:58.172
We get lots of people who call and say, you know, my therapist or my psychiatrist just don't know enough about what's happening for me.
00:29:58.554 --> 00:29:59.356
And I'm scared.
00:30:00.034 --> 00:30:02.457
And we really do try to work with everyone to figure out.
00:30:02.477 --> 00:30:10.105
And if we can't do it, we try to help people get to someone who does know there are in-network providers where sometimes there is a specialist.
00:30:10.226 --> 00:30:12.229
And again, that should be the way of the world.
00:30:12.288 --> 00:30:13.529
And we would like to get there.
00:30:14.131 --> 00:30:16.212
But at the moment, that's not always possible.
00:30:16.473 --> 00:30:17.835
But in our day program, it is.
00:30:17.894 --> 00:30:26.645
So we slide on evaluations to get people in if they are really having kind of moderate to severe illness so that we can get them paid for in a higher level of care, as we say.
00:30:27.041 --> 00:30:39.862
which is coming on site or coming here virtually with your baby or with your pregnancy to really figure out how to get well so that you can be the best mom you can be and be well as a person and human who deserves it.
00:30:41.044 --> 00:30:41.263
Yeah.
00:30:41.284 --> 00:30:43.587
Well, I mean, you're such a gift to the world.
00:30:43.607 --> 00:30:46.612
The Motherhood Center is such an incredible place.
00:30:47.012 --> 00:30:49.836
So tell us future, because when we were talking before.
00:30:49.876 --> 00:30:49.958
Yeah.
00:30:50.369 --> 00:30:50.630
I know
00:30:53.055 --> 00:31:03.755
you're expanding, which is funny.
00:31:07.554 --> 00:31:13.221
LMFTs, licensed clinicians of other sorts, and psychiatrists.
00:31:13.361 --> 00:31:15.703
And we do training programs here.
00:31:15.743 --> 00:31:27.720
We have a fellowship in both postdoctoral fellowship for psychologists, and we have fellowship for reproductive psychiatrists so that they can learn more having had a general kind of residency.
00:31:27.740 --> 00:31:37.621
And we've just expanded and want to keep training and treating and know that people deserve this everywhere, not just in New York City.
00:31:37.662 --> 00:31:46.179
So we are planning to open in New Jersey, pending a facility license, which is extremely hard to get.
00:31:46.298 --> 00:31:52.151
We're actually struggling a bit there, but are getting a lot of help from some very high up people.
00:31:52.171 --> 00:31:55.240
We've met with the governor's wife of New Jersey.
00:31:55.279 --> 00:31:56.842
She's really in support.
00:31:56.882 --> 00:31:58.503
It aligns with her agenda.
00:31:58.844 --> 00:32:05.592
We are so grateful and met the governor as well and are really trying to open in New Jersey to be able to provide a service like this.
00:32:05.632 --> 00:32:09.557
We are able to do outpatient treatment in New Jersey and Connecticut.
00:32:09.576 --> 00:32:15.304
We're trying to start by being in the tri-state area, but honestly, there should be a motherhood center.
00:32:15.344 --> 00:32:21.734
Our model could be in every city and in every state because every It's hard to do.
00:32:21.755 --> 00:32:29.625
We have been kind of a pilot program trying to prove proof of concept, which I think we've done certainly in the clinical world.
00:32:29.644 --> 00:32:36.835
And we're trying to, you know, it is a viable business and we are trying to make sure that that is accessible everywhere.
00:32:36.875 --> 00:32:45.865
So our first foray is going to be to hopefully New Jersey by the end of the year, if we're lucky, if not the beginning of next year, and then we'll be Connecticut.
00:32:45.905 --> 00:32:48.529
And we plan to, you know, keep going.
00:32:49.281 --> 00:32:49.883
Amazing.
00:32:49.942 --> 00:32:50.143
Yeah.
00:32:50.182 --> 00:32:53.448
I mean, I think it'd be wonderful if this could exist everywhere.
00:32:53.468 --> 00:33:02.460
You know, I think from trying to conceive through pregnancy, through postpartum, it can be the most beautiful time of someone's life, but also the hardest.
00:33:02.621 --> 00:33:05.084
And it's really navigating the juxtaposition of that.
00:33:05.144 --> 00:33:10.471
And you can have it be both of those things, beautiful and hard, exciting and sad.
00:33:10.491 --> 00:33:10.531
It
00:33:10.932 --> 00:33:12.714
is by definition.
00:33:12.855 --> 00:33:13.095
Right.
00:33:13.115 --> 00:33:14.877
All those things are true.
00:33:15.298 --> 00:33:15.680
Yeah.
00:33:16.202 --> 00:33:22.336
And to have people to support you, you know, I think it really, it takes a village not only to raise a child, but to raise a mother.
00:33:22.849 --> 00:33:23.451
Absolutely.
00:33:23.490 --> 00:33:24.992
You know the word matrescence, right?
00:33:25.032 --> 00:33:26.816
Or if you don't, I'll explain.
00:33:26.855 --> 00:33:29.118
It's like adolescence.
00:33:29.558 --> 00:33:33.345
Matrescence is the becoming of a mother, the journey to motherhood.
00:33:33.384 --> 00:33:39.794
And we sort of think of it as a developmental stage, although I don't know that you can actually say that because it doesn't happen to everybody.
00:33:39.834 --> 00:33:41.695
Not everybody has to go through it.
00:33:41.836 --> 00:33:52.682
But I think it really highlights the fact, given the name, kind of like adolescence, that it is bumpy and it is not just smooth sailing, but there are ups and downs.
00:33:53.282 --> 00:33:56.406
And I always say, you know, ambivalence is synonymous with motherhood.
00:33:56.446 --> 00:34:29.918
And that is so much of what we are dealing with through the challenges and the identity shifts and the happiness and the joy and also the loss that inevitably comes with both fertility, trying to conceive, but also just having a child, the loss, the separation, the changes in phases of life and one's own kind of the loss of who you were as an individual person, as a partner, potentially in a couple or who you were in a family and all of that.
00:34:29.938 --> 00:34:37.373
There's just so many shifts that really have loss within them, even if there is sort of a happy ending so to speak
00:34:37.432 --> 00:35:07.728
yeah oh my gosh you so verbatim almost to what I speak about with clients all the time the idea of who you were before who you are now who you want to be right the importance of taking the time to pause and and whether it's you know to recognize when you get married okay who you are now as a spouse if you become a parent who you are now and I think people often barrel through these life changes, you know, graduating college, getting a degree, like whatever sort of life milestones people kind of barrel through.
00:35:07.748 --> 00:35:12.213
And they don't really stop and pause to think about those things you touched upon, right?
00:35:12.233 --> 00:35:13.396
Okay, who was I before?
00:35:13.436 --> 00:35:14.858
Who am I now?
00:35:14.898 --> 00:35:16.059
And who do I want to be?
00:35:16.079 --> 00:35:20.324
And I think problems arise when people, they don't think about it.
00:35:20.344 --> 00:35:24.773
And then They wake up one day and it's like, whoa, I don't like what's going on.
00:35:25.074 --> 00:35:32.335
And I miss myself or, you know, I haven't showered in days because of this baby or it's like, whoa, you got to take a pause.
00:35:32.396 --> 00:35:33.117
We got to breathe.
00:35:33.820 --> 00:35:37.088
And then, you know, this work that you and I do, I think can be so helpful.
00:35:37.697 --> 00:35:38.780
Yeah, very true.
00:35:38.800 --> 00:35:39.079
And
00:35:39.139 --> 00:35:50.717
I think that it's hard to always be thoughtful, but if you can, like you said, pause and slow down and give yourself the space to think about these transitions, it will serve you so well.
00:35:50.876 --> 00:35:55.344
And it will serve your kid or future kids, family.
00:35:55.364 --> 00:36:03.114
It serves everyone to really consider what's happening during these major transitions, right?
00:36:03.175 --> 00:36:07.378
It's not just like, Right.
00:36:07.760 --> 00:36:08.641
Yeah.
00:36:23.137 --> 00:36:27.043
just because it looks so good in that sort of Instagram way everywhere.
00:36:27.282 --> 00:36:27.422
Right.
00:36:27.463 --> 00:36:28.704
No one's posting that on Instagram.
00:36:28.724 --> 00:36:30.887
They're just posting photos of.
00:36:31.427 --> 00:36:32.429
We are posting that.
00:36:32.528 --> 00:36:32.648
We
00:36:32.668 --> 00:36:33.570
are really posting.
00:36:33.610 --> 00:36:34.851
People are coming out more.
00:36:34.871 --> 00:36:35.913
So much more.
00:36:35.952 --> 00:36:36.313
Right.
00:36:36.554 --> 00:36:37.155
So much
00:36:37.255 --> 00:36:37.454
more.
00:36:37.494 --> 00:36:42.280
You know, and I think it's thanks to people like you and the motherhood center and really talking about it.
00:36:42.681 --> 00:36:45.744
And this is not something to be ashamed of.
00:36:45.764 --> 00:36:46.889
Oh, It's
00:36:46.929 --> 00:36:47.891
not your fault, right?
00:36:47.972 --> 00:36:49.554
These are illnesses.
00:36:49.675 --> 00:36:55.585
I often say to people to help them relieve their guilt about like, how come I have postpartum depression?
00:36:55.625 --> 00:36:58.068
How come I am having anxiety during pregnancy?
00:36:58.108 --> 00:37:01.074
Do you say that when you have diabetes?
00:37:01.554 --> 00:37:03.016
Do you say that when you have asthma?
00:37:03.217 --> 00:37:05.460
I don't think we're talking about it or a seizure disorder.
00:37:05.481 --> 00:37:06.242
We're not saying that.
00:37:06.663 --> 00:37:08.445
Like, what did I do to deserve this?
00:37:08.525 --> 00:37:09.768
What did I do to bring this on?
00:37:10.389 --> 00:37:10.750
Nothing.
00:37:11.202 --> 00:37:13.786
that you don't cause these illnesses.
00:37:14.447 --> 00:37:16.731
There are circumstances that certainly contribute.
00:37:16.751 --> 00:37:21.922
There are lots of ways to think about illness, medical illnesses of which these are.
00:37:21.942 --> 00:37:27.132
But to think that you cause this is just such a...
00:37:27.172 --> 00:37:32.201
It breaks my heart because people feel so ashamed and guilty that they...
00:37:32.641 --> 00:37:37.369
could have done something differently or should have done something and it would have changed the outcome, right?
00:37:37.409 --> 00:37:38.931
We don't have that kind of control.
00:37:38.971 --> 00:37:45.880
And I think that the idea that we can't talk about it because we did this to ourselves is just heartbreaking.
00:37:45.900 --> 00:37:45.940
It
00:37:46.541 --> 00:37:46.762
is.
00:37:46.942 --> 00:37:53.490
Well, and I love how you framed it at the beginning, which, you know, might sound a little bit tough love, but why are you choosing to suffer, right?
00:37:53.550 --> 00:37:55.233
You didn't choose to get this illness.
00:37:55.554 --> 00:37:55.773
Yeah.
00:37:55.938 --> 00:37:57.338
But you are choosing to suffer.
00:37:57.739 --> 00:37:57.960
Yeah.
00:37:58.239 --> 00:37:59.961
And that does not have to be your choice.
00:38:00.382 --> 00:38:01.603
It doesn't have to be your choice.
00:38:01.782 --> 00:38:08.469
And if it is your choice, then let's embrace it and say, I am choosing this not to take medications.
00:38:08.530 --> 00:38:10.871
And I know I'm going to be depressed or I know I'm going to be anxious.
00:38:10.972 --> 00:38:15.876
And like, you know, I've had people say, if I have to be hospitalized, I will, but I'm not taking a medication.
00:38:15.936 --> 00:38:16.476
And you know what?
00:38:16.838 --> 00:38:18.579
Okay, that is your choice.
00:38:18.619 --> 00:38:20.760
But make it consciously, right?
00:38:21.121 --> 00:38:25.525
Make an intentional decision as opposed to just let it happen and feel miserable.
00:38:25.922 --> 00:38:26.222
Yeah,
00:38:26.543 --> 00:38:26.963
absolutely.
00:38:26.983 --> 00:38:27.643
That's a great point.
00:38:28.304 --> 00:38:28.565
Yeah.
00:38:29.365 --> 00:38:36.693
Well, thank you so much for coming on and sharing your guidance and wisdom and all the things about the Motherhood Center.
00:38:36.793 --> 00:38:40.717
If anyone is looking to find you, they can just go online.
00:38:41.378 --> 00:38:42.000
Go online.
00:38:42.039 --> 00:38:46.204
The thing you have to know is themotherhoodcenter.com.
00:38:46.244 --> 00:38:48.327
Although, honestly, you will find us anyhow, I hope.
00:38:48.367 --> 00:38:51.851
Or you can call our phone number, which is 212-335-0034.
00:38:54.914 --> 00:38:55.494
Pretty easy.
00:38:55.554 --> 00:39:08.771
We tried to get even easier, but it's like, it's just, we have one number in and you will get a caring, compassionate person on the phone who will ask you some questions that will help you try to identify what may be happening.
00:39:08.851 --> 00:39:10.574
And we'll get you in for an evaluation.
00:39:10.614 --> 00:39:11.996
We're on a mission.
00:39:12.036 --> 00:39:14.920
This is a mission driven center.
00:39:15.119 --> 00:39:17.963
And we are all, we just like, this is what we do.
00:39:18.003 --> 00:39:22.210
And we're all so committed to helping people in this period of time.
00:39:22.978 --> 00:39:23.438
Get better.
00:39:23.978 --> 00:39:24.739
I think you're incredible.
00:39:24.760 --> 00:39:26.322
I think what you've created is incredible.
00:39:26.342 --> 00:39:28.224
And I'm so happy to share this.
00:39:28.304 --> 00:39:33.911
And I know that this episode will help somebody, whether it's for them or sharing it with a friend or family member.
00:39:34.211 --> 00:39:34.371
Yeah,
00:39:34.771 --> 00:39:35.193
for sure.
00:39:35.632 --> 00:39:35.994
For sure.
00:39:36.253 --> 00:39:36.675
Thank you.
00:39:36.715 --> 00:39:37.155
Thank you.
00:39:37.175 --> 00:39:38.056
Yeah.
00:39:38.076 --> 00:39:42.722
So the way we like to wrap our episodes is by saying something that we're grateful for.
00:39:42.742 --> 00:39:44.264
So a gratitude.
00:39:45.284 --> 00:39:46.146
Gratitude that I have.
00:39:46.666 --> 00:39:46.927
I mean, I
00:39:47.487 --> 00:39:49.690
feel so grateful that I get to do this work.
00:39:49.990 --> 00:39:52.253
I feel very privileged and lucky.
00:39:52.865 --> 00:40:00.637
and thus grateful that I have the opportunity to do this, that I can work in the space that is also my passion, right?
00:40:00.697 --> 00:40:03.981
Not many people get to do the work they love to do.
00:40:04.021 --> 00:40:11.652
That doesn't feel like a, I don't remember Mark Twain or whoever said that, if you love what you do, you won't work a day in your life or something like that.
00:40:11.692 --> 00:40:14.034
Now, I feel very lucky.
00:40:14.135 --> 00:40:24.028
I am jazzed about this 30 years later and just feel like, I wish I didn't work so hard or all the time, but I, I really do love what I do.
00:40:24.088 --> 00:40:25.952
And I, for that, I feel very grateful.
00:40:26.012 --> 00:40:27.072
And like, how did that, how
00:40:27.092 --> 00:40:27.813
did I get so lucky?
00:40:28.916 --> 00:40:30.197
So that's amazing.
00:40:30.318 --> 00:40:32.039
And I, I totally feel that from you.
00:40:32.119 --> 00:40:36.226
And I think all of your patients and people that work with you feel that too.
00:40:36.266 --> 00:40:37.007
It's such a gift.
00:40:37.628 --> 00:40:39.010
Feels like it for me.
00:40:39.449 --> 00:40:40.692
The gift is mine, right?
00:40:40.771 --> 00:40:42.074
Like I have the privilege.
00:40:42.735 --> 00:40:42.894
Yeah.
00:40:43.436 --> 00:40:43.516
It's
00:40:44.317 --> 00:40:44.456
a gift.
00:40:44.518 --> 00:40:44.878
Yeah.
00:40:44.898 --> 00:40:45.117
Yeah.
00:40:45.699 --> 00:40:53.262
I would piggyback off that and say, you know, same at the beginning of the episode, we were catching up and he said, Oh, you know, where'd you grow up?
00:40:53.302 --> 00:40:54.163
How'd you end up in New York?
00:40:54.222 --> 00:40:59.572
I said, well, I've always wanted to live in New York and since fifth grade and have a Cavalier King Charles Spaniel.
00:40:59.632 --> 00:41:02.135
And I seem to have manifested those two things.
00:41:02.476 --> 00:41:03.737
I didn't know I'd be doing this.
00:41:04.239 --> 00:41:06.041
And to me, it's such a gift.
00:41:06.222 --> 00:41:12.853
I, you know, I've created this career from my own, you know, journey to have my daughter and I love what I do.
00:41:12.893 --> 00:41:14.074
It's not work.
00:41:14.155 --> 00:41:25.179
It's not, it just is, you know, you kind of keep breathe, live, sleep in and meeting other amazing people like you, you know, it just lifts me up knowing that there are other people out there and it's incredible.
00:41:25.239 --> 00:41:27.543
So I feel super grateful for that also.
00:41:27.563 --> 00:41:27.583
I
00:41:27.822 --> 00:41:29.465
feel, yeah, I think that's great.
00:41:29.686 --> 00:41:31.909
It's really, it feels like a calling, right?
00:41:32.010 --> 00:41:35.675
You know, it feels like, God, how lucky to be able to do
00:41:36.456 --> 00:41:36.496
it.
00:41:36.797 --> 00:41:38.400
Yeah, exactly where we're supposed to be.
00:41:39.621 --> 00:41:41.405
Thank you so much for listening today.
00:41:41.425 --> 00:41:47.411
And always remember, practice gratitude, Give a little love to someone else and yourself.
00:41:47.753 --> 00:41:49.958
And remember, you are not alone.
00:41:50.760 --> 00:41:54.268
Find us on Instagram at fertility underscore forward.
00:41:54.829 --> 00:42:03.909
And if you're looking for more support, visit us at www.rmany.com and tune in next week for more Fertility Forward.
