Strengths-based, trauma-informed care is key to the clinical approach our team at Phoenix Children’s uses for the unique aspects of care for expectant parents and infants. The April Fetal Conference Series outlined unique aspects of care for the perinatal population, implications for practice and treatment.
Please note: CME credit will only be awarded to participants who attend the live online session in its entirety. Credit is not available for viewing the session in a recorded or on-demand format.
So thank you all for being here. Um, so like Jessica said, my name is Chantelle Hennon and I'm a licensed clinical social worker. Um, and my main role on our team is I am the perinatal mental health therapist. So, um, I meet with families kind of all throughout, like Jessica mentioned, the perinatal period and a primary referral source for me is our fetal care team. So a lot of these folks who are coming in. Um, with a diagnosis of some sort of fetal anomaly, oftentimes that's when they get connected with me. Um, I am, uh, also a certified, uh, perinatal mental health provider. Um, and so first, I'm going to just kind of tell you what we're gonna be talking about today. Um, obviously slides, always wanting those to get working. OK, there we go. Um. Um, so today's agenda, first, I just want to give you a little bit of an overview of what that work flow is like because I know folks on here like we have sent um moms and families to us um and marks that they want maternal mental health and so what does that look like and what do I provide so you can give them a sense of that, um, and how we work together as a team. Then I want to give a brief overview of perinatal mental health and what we mean when we say that kind of um set the stage for why this is important to you all as providers, um, and then some like takeaways, some implications for your practice, how you can better support these families um during this really challenging time in the context of mental health. So kind of to just get started a little bit about what we do. So, um, our goal is to prevent, identify and treat mental health symptoms um and disorders that can impact individuals and their babies during and after pregnancy. So primarily I work with moms, but I do work with dads sometimes as well, or mom and dad together, um, because as we'll talk about in a bit, this impacts not just women but also men. Um, our program focuses on providing the support to families primarily with medically complex pregnancies and infants, um, it's because there's a lot of folks who need our support, um, and so we try to connect folks who maybe have more typical postpartum depression and anxiety symptoms without those medical complications to folks in our community, um, that might be able to serve them, and then we can try to focus on those who maybe have um more specific, specific medical. these, uh, these fetal diagnoses, those sorts of things. Um, and we do this both, um, prenatally, right, in a post, uh, and, and, and postpartum, um, through outpatient and inpatient support that I'm gonna share a little bit more about. So if you send someone over to um our team and they're um they've received a uh a prenatal diagnosis or they're going to be receiving some sort of diagnosis, oftentimes, uh, one of our nurse coordinators will get them connected with me. One of our providers will put in a referral, or maybe you even on the front end, put in a referral um to send them to maternal mental health as well. Um, and we work really collaboratively as a team. These are lots of different folks who are connected to thinking about the mental health of mom and dad as they go through this process, but they, they come to me for an outpatient assessment, um, and then I can see them leading up to hospitalization, helping them prepare for a diagnosis, um, or if they're not going To be maybe in the hospital, but there's more of a palliative kind of um a route that we're going, more comfort care providing support in that regard as well. Um, and then when they do come to our hospital, say they deliver and baby, baby is transferred over to Phoenix Children's and they're on our CVICU or NICU, oftentimes, uh, especially if I already have that relationship, I'm meeting with that mom bedside and I'm going to visit that family and providing that support in real time. Time, you know, when um they're having surgeries this week or or different challenges have shown up medically, that's impacting mom. I'm there to provide that support. Um, and then also ongoing through the postpartum period, up through the first year of life depending on mom's needs. We know that a lot of these, um, babies that come to us, um, are going to be spending a lot of different time with our providers, different specialists. They may have to come back multiple times for even inpatient stays. Um, and we want to, as best as possible, support mom through those, uh, different experiences. Um, and for me, a lot of my referrals end up sticking with me because then they get pregnant again and they have another baby, and then there's new, new challenges there, right? So maybe they had a fetal diagnosis before and they terminated due to medical reasons and that was really challenging and then they get pregnant again and they're like, Chantelle, I'm really struggling, right? We'll talk a bit more about that later and how that can impact folks, but um I kind of can see them as needed kind of throughout that period. Um, and I work collaboratively with our medical providers, our nurse coordinators, um, our palliative team, like I mentioned, we have a CVICU psychologist that's wonderful. Her and I work really collaboratively together, NICU psychology and our floor source social workers. So oftentimes also our floor social workers are the ones that are noticing maybe families that didn't have a prenatal diagnosis, but could really use support and getting those folks connected to me. And so as we're talking about perinatal mental health, I use that language really uh specifically for a reason, because for a long time, uh, we've talked about postpartum depression and that's not bad because that is, that does exist, right? But it's just such a narrow focus and what I think happens when we have narrow language is that we leave folks out that are really struggling, and then they think it's a them problem rather than, oh, this is something that other people experience too. Like it adds to the stigma if we focus too much on one thing. And so what we know about this is that it's not just postpartum depression, even depression in this season, about 50% of pregnancies, this depression symptoms actually start earlier on than that postpartum period. Um, and so it's not just postpartum, we're experiencing these things prenatally and postpartum or postpartum, right? One or the other or both, and it's not just depression. Folks experience a lot of different symptoms, including anxiety and panic, especially post-traumatic stress for a lot of the folks that I see. Um, OCD can really show at this time and bipolar disorder as well. Obviously, we, we know too that psychosis is a really scary thing that can happen during this period. It's, while it's not um super common, it's also not uncommon. It happens to 1 to 2 out of every 1000 deliveries, um. will experience postpartum psychosis. Um, and then also grief, right? We work with a lot of folks who end up losing pregnancies, losing babies, um, and they need those that support as well. And so this term perinatal means kind of throughout that perinatal period, um, and it's not just focused on, um, one specific diagnosis. And I also like that it's not gendered language because what we know is that this doesn't just impact women, right? When we say maternal mental. Health, and I say that all the time. I will say because I work primarily with moms, but I also have worked, um, I work with dads too individually, but like I said, the whole family as well. Um, we, we know that this impacts both men and women, and they might experience all of these symptoms during that perinatal period. So we want to be careful about the language that we use so that we're inclusive of maybe all of these different experiences that folks, um, are feeling. Um, and so I want to share a little bit. I'm sure many of you are I'm very aware of these things already, um, but kind of a little bit about these different diagnoses or, or what these different presentations can look like. Oftentimes, um, they're typical, uh, you know, a lot of the typical symptoms that we would see with it outside of the perinatal period with an anxiety or depression diagnosis, right? But there are some things that are kind of more specific to the perinatal period and so I think that can be helpful to understand. So, um, depression, um, those typical depression symptoms obviously of lack of motivation, tearfulness, um, kind of feelings of hopelessness can be present, um, but also anger and irritability or rage is really common. It's so interesting like, uh, with TikTok and and social media these days, I have moms come to me all the time and they're like diagnosing themselves because they found it on the internet, right? Um, I'm sure you all feel that on the medical side of things too. Um, but this term postpartum rage has become really common. So a lot of, uh, moms are coming to me and they're like, oh, I've heard of this, it's postpartum rage. Um, that's a symptom of postpartum depression, right? Um, and so that can be really common, but also if we, we only think of depression as this limited scope. Um, it can, it, we can miss those things, right? Um, oftentimes this looks like lack of interest in baby, um, possible thoughts of harming themselves or harming their baby. That doesn't necessarily mean they have any plan to do that, or we need to kind of be really afraid of that. We just want to get really curious because oftentimes that can be really disturbing for moms to have those thoughts too. Um, and then as you can imagine, a lot of feelings of guilt and shame, uh, oftentimes women are, um, told, you know, this is the happiest period of your life, or there's all this focus on congratulations. I even see this, you know, with our families who are, you know, in the hospital and they're getting ready to leave. Maybe they've had, um, you know, they've they've been in our CBICU and they've had surgeries, um, well-meaning friends and family and providers will be like, aren't you so excited to go home? And moms are. terrified to go home, or they're really sad because actually these nurses and providers have been their main supports and now they're not going to see them anymore, which can be really confusing um when our language is oftentimes focused on a lot of joy and excitement and it's not that moms aren't experiencing that at times, um, but it can add to that guilt and shame when maybe there are moments of really deep sadness or other experiences that they're having. Um, additionally, anxiety shows up a lot in this season. Um, this is true across the board. I see this especially with folks who have a diagnosis of some sort of fetal anomaly, that anxiety can be um really increased during this time, during the hospitalization or especially after returning home after a hospitalization. Um, so this typically looks very similar to anxiety outside of the perinatal period, increase. Worry, feelings that something bad might happen, not being able to stop or control worry, uh, racing thoughts, you know, if you think of feeling anxious, it's usually oftentimes really body focused too, like we have really physical manifestations of this. Um, the thing that's unique is oftentimes the anxiety is specifically about baby or health conditions. Um, so I have a mom, for instance, who has really increased anxiety. There was a termination due to medical reasons, um. And she's pregnant again, getting ready to have her, uh, uh, have a baby, and um she has a lot of health anxiety for herself, and a lot of that is connected to a real fear that like, what if something happens to her, um, and her children that are here and this baby that she's about to have, um, they don't have a mom anymore, and that's really anxiety provoking for her. She also has a ton of medical anxiety, so going to appointments is really, really challenging for this mom. Um, getting ultrasounds doesn't feel exciting. It feels terrifying. Um, she has high blood pressure already and then guess what? At appointments, it's always high because she really is experiencing, um, kind of increased anxiety in these moments. Um, and we also have post-traumatic stress. So again, this is really common for folks who are spending some time um at our hospital or have babies with these different medical complexities. Or for folks who have maybe had a a traumatic birthing experience. So this looks like flashbacks to the traumatic event, um, a lot of hyperarousal, so, so feeling really on edge, hyper vigilant, difficulty sleeping, um. An exaggerated startle response. This can look like, you know, anything the baby does. There's an immediate kind of like response of a panic almost can come up in these moments. Um, oftentimes it can look, and it usually is typically presents either first. We think it might be depression symptoms or it might be anxiety symptoms, right? Because these are the two kind of stress responses that we have. That hyperarousal is when we have kind of that fight or flight response. Which is typically looks more like anger or anxiety or panic. Um, and then we have more of a hypo arousal, which is like a detached, uh, sometimes it's associated with like dissociation, feelings of unreality, kind of checking out, not being here anymore, um, and that can oftentimes look like depression symptoms, but as we explore, we notice that this is coming from a place of traumatic stress and there's other things going on. It's not uncommon to see Nightmares during this time. Um, and a lot of times avoidance is a key factor here. So that can be avoidance of like thoughts, feelings associated with the event, um, but it also might mean avoidance of aftercare. So maybe like if there's been a birth trauma, not wanting to follow up on that postpartum visit, right? Um, and not doing kind of those follow-up visits even um for baby potentially depending on the level of stress or kind of moving appointments around, um. We also see obsessive compulsive disorders. So folks who've never, never experienced this before or especially never been diagnosed with this before, especially during the perinatal period, they're at a greater risk to develop um symptoms of obsessive compulsive disorder. And what I see a lot of the times is a subclinical manifestation of this, so maybe they're not meeting full criteria for uh a diagnosis of obsessive compulsive disorder, but they're showing a lot of symptoms of it and so we treat the symptoms, right? So oftentimes what this looks like is obsessions or what we call intrusive thoughts. They're persistent, they're repetitive, um, they can be mental images or thoughts. And in this situation, they're oftentimes related to the baby or them as a mom, and these can be really upsetting or even disturbing thoughts. Um, they can have a sense of horror about these thoughts and even fear of being left alone with the baby. So sometimes these Thoughts are about checking, right? So I see this a lot with our families who have babies with medical complexities. Um, they have to check temperature like 10 times a day. Um, there's this really intense obsessive thought about checking the temperature and then the compulsion is to go and do that, right? Um there also though can be things like I've had moms who aren't getting any sleep because they have to check to make sure baby's breathing, right? Um. Additionally, these uh intrusive thoughts can look more like really startling or scary images. So I've had women who have reported like having a a like just a sudden image of of tossing their baby out the window, and that's really, really terrifying for a mom. These are not things that key here is that these are not thoughts of like wanting to do this. Usually, mom is horrified by whatever this thought is, but as you can imagine, this is significantly underreported, um, because no mom wants to go to a healthcare provider. And say I'm having thoughts of hurting my baby, they're terrified that we're going to take their baby away, right? And so if there are situations, I oftentimes will gently kind of, I don't want to ever give people thoughts like, oh, have you had this thought about hurting your baby? But I might say that, you know, it's not uncommon for for moms in this period of time to have increased anxiety and even increased intrusive thoughts and sometimes those can be really upsetting or disturbing, and I just want you to know that if those things are coming up, You can share them with me, um, and that you're not alone in that, and that we can explore them together. Um, I think a real key here is, you know, if that is the thought, if the thought is something about harming baby, usually the compulsion is about avoidance. So usually that terrifies mom and they will actually fear being left alone with their baby or actually avoid touching their baby, interacting with their baby, which we know can be really, um, really harmful as well. And so we want to catch these things. Um, and, and this one is probably One of the ones that is most significantly in my experience, underdiagnosed in the general population, but even especially in this population, it can be harder to spot. It usually presents initially, like I said, as just anxiety, um, but as we explore it a bit more, we notice these things and the reason why that's important is because how I treat this is different. Some of our traditional anxiety treatments can actually increase obsessive compulsive behaviors, and so it's an important thing for me to have that lens and for us to notice those things as they're popping up. Um. Again, I mentioned bipolar disorder and a few other things. The key here is that, uh, oftentimes women are first diagnosed, 50% of women are first diagnosed with bipolar disorders during the postpartum period because they have like an initial experience of mania or a real uh real big depression episode shortly after that and then we kind of uh uncovered that maybe something else is going on. Um, again, I mentioned psychosis is also something that we have to spot and keep an eye out for. And then also, again, I mentioned this, but traumatic grief. I work with a lot of folks who have lost pregnancies, lost babies, or terminated due to medical reasons. Um, and these things kind of all overlap, right? Um, and how they, they manifest. So what about those experiencing a diagnosis of some sort of fetal anomaly or a postpartum complications, right? So, no shock to all of you, but uh it makes it harder, right? This is more prevalent, these perinatal mental health conditions and symptoms are more prevalent for folks who have um babies with different medical complexities. So what we find is that as the severity of the diagnosis increases, um, and ambiguity, so the unknown around the prognosis, those things are associated with increased psychological distress. Um, and I think this is really helpful for us to understand, obviously, That makes sense, but I think this is why communication, and we're going to talk about this later, but really clear communication is really important, um, so that they have a good sense of like, obviously there is a lot of ambiguity in the work that we do and what the prognosis looks like for a lot of these families and what, what's going on with baby. Um, but where we can give information, it can be really, really helpful for folks to have an understanding. Um, and then also a real understanding of what the severity is, right? And we'll talk. a bit more about that, uh, in a minute. Um, this is some research out of Chop to show some specific rates of this, um, with folks with like a fetal diagnosis. So this was specifically looking at um moms who had had a cardiac diagnosis fatally of some sort of anomaly, and what they found is that um uh that the traumatic stress rates were 39% for this population, anxiety was 31%, and depression symptoms were about 21%. So while depression is Again, like about that 1 in 5, you can tell that those other ones are significantly increased, um, for folks with a diagnosis like this. What's really interesting here is that COP didn't just measure though, uh, looking at the rates of these uh symptoms in these moms, but they also did a measure to look at coping. So how did these moms cope and what did, what was that associated with? And I think this is, this isn't surprising to me at all, but I think it's so helpful to see this in the literature. They found that denial. Um, so families that coped by kind of denying it's, uh, you know, I can't think about it, you know, it's, it's not a big deal. Everything's going to be OK. Whatever that might look like was associated with increased traumatic stress, increased anxiety, and increased depression scores. Uh, whereas the counter, their counterparts that were managing this with more acceptance and positive kind of reinterpretation and growth mindset, um, so being able to really wrap their minds around what's happening and what that could mean, but then also Being able to, um, find some meaning and reinterpret, which we never want to be peddlers of meaning or, or help people find that, because I think in a lot of these situations, it's, it's hard to find and that can be damaging if we as providers are pushing that. But I think having, um, an environment for folks to come to acceptance and come to exploration of these things is really important because that was associated with lower anxiety and depression scores. Um, and we're going to circle back to that in a little bit as well to, to take some takeaways for you all. In regards to that. And then this is focused more on looking at NICU families. So these could be folks who maybe had a fetal diagnosis, maybe they didn't, um, and they just ended up in the NICU in that postpartum period. Um, but what they found, again, this looked at moms and dads and we're gonna see that moms um rates of depression, anxiety and stress are higher, but you'll notice that dads here are also higher than those typical numbers that we see, um, during the, you know, for more of a typical, uh, postpartum or perinatal period. So this I think is really interesting too. So like, again, why, why does this matter to us as medical providers, right? Obviously, this is my focus, this is my lane, but for those of you who are working in more of a thinking through a medical lens, I thought this was really interesting. So this specific study looked at, they wanted to see the relationship between the perceived quality of prenatal care, uh, healthcare specifically, and what that looks like in terms Of examining maternal and infant health outcomes. So this was a sample size of about 2100 women, but they they measured a few different things. So they looked at um asking just in general what their perception and rating of maternity care in the US, what they would say that was, um, the time spent with their provider, which I know is like such a challenge for everyone. Everybody wants more time with their with their patients. I know that's really challenging, but they wanted some like more objective measures, um. Then they looked at the use of medical jargon and how they defined that is if women reported that they, um, that their provider used medical words that they didn't understand, so they walked away being like, what did we just talk about, right? Um, that was marked as use of medical jargon and then the primary thing that they looked at was interaction quality and they measured this by three primary things, looking at whether the prenatal care provider spent enough time. So their perception, I felt like my provider spent enough time with me. Um, whether or not they felt like their provider answered questions to their satisfaction, right? And whether, uh, they were, felt encouraged to ask their provider questions. Um, and what they found is they looked at this and we know that like correlation here doesn't necessarily mean causation. Um, so I'm not suggesting this, but what they found, I do think is pretty astounding. They, they looked at this and they found that the women who perceived a higher quality of prenatal healthcare were significantly less likely to experience preterm birth relative to women who reported lower quality of care. Um, women who reported use of medical jargon during their visits were less likely to have a baby with normal birth weight. Um, and then women who experience kind of all of these things, the medical jargon, this lower perceived quality of interaction with their provider overall, and then just like a lower quality of care, like a, a perception that the US has a lower quality of care in general for maternity, um, they were more likely to display symptoms or be at risk for postpartum depression. So again, I wanna say like correlation doesn't equal causation here, but I just think it is important for us, not just from a mental health side of things, but Even and and we know that like, uh, obviously mental health stress impacts attachment and attachment we know impacts infants, um, not just emotionally but also physically and, and, and developmentally. And so these things are, uh, you know, I think really important for our medical providers to understand. So what can you all do to help? How can you support? So some considerations for providers. Um, so one of the things that I found interesting in the literature that is that the maternity Internal perception of the severity of a fetal diagnosis was increased with depression and post-traumatic stress symptoms. That's not surprising, right? We already talked about that. If, if, if severity is up and the ambiguity around that prognosis is increased, then that is going to increase that psychological distress, right? But what I found is that that didn't necessarily uh connect or correlate with physician perception of severity. So if a pre uh uh if a medical doctor, if a physician had a perception that the severity wasn't, uh, very high, but mom did perceive that it was really high. It was still gonna increase depressive symptoms, right? But if the physicians didn't, uh, saw it as, um, more severe, that didn't necessarily mean that mom, uh, noticed that, that severity increased her depression or traumatic stress symptoms. Um, so again, I think this is just helpful in terms of communication, and we'll talk more about this, but I think, um, Obviously, our families who are coming to see you all, um, they don't know all of these um medical terms and they're taking in all of this information for the first time. It can be extremely overwhelming, and I know you all know this, um, but really having clear communication so that families walk away understanding um prognosis that they as best as possible, right? There is a lot of ambiguity, a lot of the work I do is helping families manage that ambiguity, but as much as we can give them that information and help them understand Um, rightly, what that severity is, right? Um, it can be really helpful. I mentioned this earlier, but denial, again, was associated with an increase in traumatic stress and anxiety and depression scores. So this is something because we're understanding more about like how um mom's emotions and stress impacts baby. Everybody comes to me and is like, well, I know the baby can feel everything that I feel, right? Um, and this is, this is all over, right? from providers and from friends and the internet, like everywhere is saying that, and we know that like a big part of that is true. But the thing is, is that uh denial is not a solution for that, right? I have folks come to my office all the time and I have moms who are stressed about being stressed. They have anxiety that they're that they're anxious, right? So they get a medical diagnosis. That is really overwhelming and rightly so, are feeling increased anxiety, and then they're stressing themselves out about the fact that they're feeling anxious and that baby can feel all of this. And the problem with denial is that it just doesn't work for our brains, right? So if I tell you right now to close your eyes and picture a pink elephant, you can do that really easily, right? But if I tell you, don't picture a pink elephant, don't picture A pink elephant. Your brain doesn't know how to do that. All you're thinking of is a pink elephant. So, uh, telling moms to, uh, you know, to be careful what, what, you know, baby can feel all the things, um, is well-meaning, but I think what, what folks end up interpreting actually ends up increasing stress, right? And so we, what we really want to do, and what I tell them all the time is that, you know, you need to work through this stress, right? Like if we can help you. Um, manage it, learn how to feel it, move through it, and move towards, again, what this study showed is more acceptance. Um, that's actually going to be associated with lower anxiety and depression scores over time, rather than pretend it's not happening or deny it, or, um, I just can't feel this way, right? That's never helpful for our brains, our brains just don't know how to do that. Um, so I think that can be a really Helpful thing to understand. Um, these are just specifically more in terms of some, some tips for trauma informed practice specifically around imaging. So a couple of things that um I found interesting, um, that I think can be really helpful for providers. So I mentioned a lot of times, um, moms have anxiety around these medical appointments, especially if they have a history. And so really understanding um that Folks might be anxious coming into your office, right? I think again, um, just in general, I'm not saying medical providers, but a lot of folks, uh, assume, uh, somebody's pregnant and assume that's a really exciting period of time. And while that, while that may be true, it also might be a really anxiety provoking time, it might be a really scary time, um, and I think especially imaging, um, these different, you know, uh, Places and spaces and smells can really prompt a lot of memory, right? Um, and anxiety during these experiences. So some of that is just understanding that, um, and, and I think walking in with curiosity, right? Let's not assume anything about how the person in front of me feels about this pregnancy, um, and instead just be really curious and follow their lead in that moment. And specifically, like ways we can do that is like, even asking. During scans or ultrasounds, like if they want to see image images during a scan, right? I have a mom who brings a book to every ultrasound because she cannot watch it. She can't do it. It's too overwhelming for her and she becomes really, really anxious. So she'll tell the sonographer every time, hey, I'm, I'm excited about this pregnancy. I promise you I'm not cold-hearted. I, I can't focus on it right now. I have to distract myself and then I can talk with the provider. Afterward. So I'm just gonna focus on reading my book, right? Um, so asking whether or not they want to engage with the images, um, I think providing an overview of what to expect during imaging, but all the time is really helpful. This is especially true if it's, you know, maybe imaging that isn't something people have experienced before, if they're going to get an MRI, right, those sorts of things. But I think in general, what we know about trauma informed care is that um being able to anticipate what's Coming, especially in these moments where there's so many things that they can't anticipate. There's so much ambiguity in any moments that we can help provide clarity or, uh, what to anticipate, that's really gonna help families feel a little bit more secure, um, and decrease some of that distress. Um, and then offering distractions. So if you can in your practice, having ways, you know, thinking about, I think in our practices, uh, what What is there for, for folks to do while they're waiting, right? Um, and can we offer things that, you know, this suggests music, but there's different ways of distraction and sometimes that is just having a conversation and maybe it's not about what's happening in the scan in that moment, um, but maybe it's talking about other things that might be, um, kind of a distraction for, for the family. But again, just following their lead and getting a sense of, of really what the needs of the family are in that moment. And then some additional real practical um takeaway. So first on here is screening, so. I will be the first to admit we're still growing in this area, and this is an area where our fetal care team, I really want us to continue to, to think about how we screen families for these perinatal mental health diagnoses and things like that. Um, but screening is really, really important and I think we've grown so much in this. Like, I, especially in the postpartum period, we're doing so well in so many spaces at screening, um, moms. Or postpartum depression and anxiety, um, whether that's in an OB visit, postpartum or even a lot of the pediatricians are screening, uh, the caregiver for depression and anxiety, which is really, really wonderful, um, but I think us continuing to grow in screening on the front end, right, during that prenatal period is really, really vital. So there's different tools to do this. I'm sure you guys are, um, um. Familiar with the Edinburgh um postnatal depression scale. There's obviously more of our uh typical PHQ-9 or GAT7 to measure just anxiety and depression symptoms. Those can be really helpful. And then obviously, we need a place to, what to do with them if they do screen, right? So connecting them to resources, um, referring them to support, and we'll talk a little bit about some of those resources in just a moment. Um, but yeah, increasing screening, so looking at your Process, is there a way that, or is there a space where we could be doing better at screening folks who maybe um we're not catching that are experiencing some of these symptoms. The earlier we can screen, the earlier we can get folks connected to care, um, and help reduce some of those symptoms. Um, and then this is an acronym, this came from a systematic review. It's so interesting. I'm, I'm preparing for this and I'm thinking about my experience with clients, um, and thinking about what, what do I really wanna communicate to. medical providers about how they can support. And so I jotted some things down of just off the top of my mind and then I went to the literature and I'm exploring and I found this systematic review and it has like um what there's 6 points on here and I think I had like 4 of these on my list. So it's really, really great that the literature supported what I was finding in my practice as well. So they came up with this acronym, they looked at 43 different um research articles focused specifically on, um, Medical providers communicating around, um, pregnancy complications. And that could have been, um, early on in the pregnancy or, or late in the pregnancy, but them communicating about different medical complications for baby. And this is what they found were themes in the literature of what can be really, really helpful for providers to, to think about and to be practicing. So the first thing is preparation, um, and I'm sure you All know this and hear this in other spaces as well, but being prepared for the consultation, understanding the medical history, preparing uh the parents for the possible outcomes of screenings and tests, you know, um, the preparation here that I think is something that I see a lot that can be really helpful is, is really looking at the chart and knowing ahead of time if there is a history of, um, you know, loss in the prenatal period or a history of. Challenges in pregnancy or high-risk pregnancy because that can alert you when you're walking through the door, just to be sensitive so that this might be a high anxiety situation for these folks and having an understanding of that. We don't want to assume, but I think knowing that ahead of time and being careful about our language in those moments can be really, really helpful. Um, and then referral, so minimizing wait times for referral and diagnosis, referring to specialists as appropriate. I know a lot of you are doing this. Because we're getting so many referrals, um, but oftentimes I do hear from families and I think this is just the nature of a lot of the work we do is we're trying to navigate diagnosis and get folks to the right imaging, especially for this, uh, you know, prenatal period for fetal anomalies, is that, you know, families will have been to see a lot of different providers before they make it to us, right? Um, and how that's not necessarily bad. That's just part of the process, but I think um their anticipation of what that time is going to be, uh, you know, it's really challenging, and we'll talk about this more with clarity, but, um, when folks, uh, hear over and over again, oh, baby's just not moving or I just can't get a good picture, um, and then it ends up being a really devastating diagnosis. So I think just kind of keeping that in mind as well. So, um, Connected to that, I mentioned clarity. I'll come back to individualized care, but yeah, having clear communication that's honest, direct, um, we don't wanna, uh, you know, give false reassurance. We also don't want to overwhelm folks. I've had both happen where I have families who came to me and, you know, the initial diagnosis they received was significantly um more devastating than what is actually going on, which is always like a relief when they find out better information, right? But that stress that they experience in the moment was very real. Um, or oftentimes it's more often that it's the other, that they didn't think it was very bad. Um, and then they get a really devastating diagnosis. And I know that, um, you all, you all are doing what you can with the, the resources you have. And so I'm not, uh, expecting you to, to be able to, you know, read the tea leaves and know what's going on, but as much as you can with kindness, provide as much clarity as possible, that can help reduce, um, some of these moments, or if you are concerned. That something is going on. I think it's really important for families to have a sense of that on the front end. Additionally, here, um, which is really hard is when you receive a devastating, uh, diagnosis, um, what happens, what we know about our nervous systems is when we're receiving uh really hard news that is really emotionally intense and maybe flooding to our system, and we're going into one of those like, uh, usually survival responses of fight or Flight or freeze internally, um, our prefrontal cortex goes offline. So we're learning all this new information about this diagnosis in a moment where the part of our brain that is most necessary to capture that information and recall it and you know it is offline, right? And so I think it's really, really important that as you, you still provide that verbal communication, but that folks can reference written materials, um, afterwards. Because if not, and they're probably going to do this either way, but when they do walk away from your visit, and they're like, oh, they, they said this diagnosis, they're gonna go straight to Google and that can be really overwhelming and cause significantly increased anxiety. And again, they might do that anyway, but I think having um written communication around some information uh about what the diagnosis is can be really, really helpful for them to reference, oh, this is what the doctor said, oh yeah. I forgot about this part, right? Or I didn't even hear this part. I have family all the time who tell me like, oh, we got home and my husband said the doctor said this, and I have no recollection of that, right? Because it's so overwhelming and our whole brain isn't working in that moment. And so we want to give them the opportunity to be able to circle back to that information, to ask questions. I think one of the ways that our team, um, just to to tout our own horn a little bit, does this really well as our nurse coordinators are amazing because they do a lot of follow up with. Families, they're checking in about like, uh, you know, if they're understanding, if they have follow-up questions, and that makes such a difference to these families. I hear rave reviews about our nurse coordinators all the time from the families that are sent my way. Um, and then individualized care, right? So not adopting a one size fits all approach, but offering information and care that's tailored to patients. So this is again back to that, uh, posture of curiosity, right? Um, while we want to have, um, You know, have a lens where we're aware of, you know, um, that anxiety might be present, that a trauma response might be present in the history. We also just want to look at the person in front of us and pay attention to how they're presenting and meet them where they're at, right? Um. So I think that's really important and then empowerment, um, in a moment where oftentimes a lot of choice is taken and a lot of security, um, is, is taken from folks because of a diagnosis and, and, and in comes this flood of ambiguity and unknown of what the future holds, offering empowerment to uh families and their uh women and their partners to make decisions where they can, to have choice where they can. Um, and let their voices and their priorities and concerns be heard, um, not making assumptions about their wishes, right, and really kind of focusing on empowering that choice. Um, I see this a lot. One of the, the teams that I see that do this really, really well is our palliative care team. They're really focused on this, um, because they're really focused on helping families, right, like identify what their wishes are and how do we help. You practice those things, but oftentimes families don't know what they're allowed to ask for or allowed to um what even, what even their options are. So a lot of this comes with like education I think like education is empowerment in a lot of ways. So really that education so that they understand their options, um, and that they feel informed to make the decisions that are going to be best for their baby, their family, Selves is really important. And then of course sensitivity, right? So as we're disclosing information, I'm doing it with a lot of empathy and sensitivity, um, I think it is really helpful to consider if, if, if somebody I loved or if I was getting a diagnosis like this, how would I want the person across from me to communicate this? Um, and, and not everybody's the same is gonna want that information like you do, but I think really knowing. Um, and thinking through that lens can be really helpful. Um, and, and sometimes it can be helpful to understand again, that individualized care, right? Like what's going to be best for the family. So this is something that I know our palliative care team does really well. They even ask those questions on the front end, right, when they're meeting with family, how do you want information, right? And so I'll see in charts direct clear communication or um, you know, give us time to process, right? Those sorts of things can be really helpful. Um, and I know that our providers in the community don't always have that luxury of being able to give folks time or or those different accommodations, but just kind of leading with empathy, um, and sensitivity and not, um, and not fear, right? These are really scary conversations, um, for the families and uh you being able to lead with that empathy, I think is really um vital and important. And then I want to provide just um oh this is really helpful to you. I want to circle back to this. So that same study that the prices came out of, um, they, um, I'm not gonna read all of this to you, but they actually uh drew out some practical points specifically for communication style and uh correlated it with different complications or when that complication was happening. Um, I found some really interesting things here, um, you know, Words to avoid that are helpful, avoiding that, you know, over, you know, medicalized language that folks don't understand, um, or at least defining that for folks, right? Um, and then, um, another thing that really stuck out to me here and we just talked about this, but really is, um, you know, making sure you're providing information in a way that they can reference, right? So involving resources for folks that they can Review um what you just shared, providing written information for them, individualized care, those sorts of things, and I'm happy to share these slides so you can reference back to them. Um, but I also wanted to provide a few specific resources. Um, so one that is really, really, uh, wonderful is the Arizona Perinatal Psychiatric Access line. So this is something I'm really hopeful that it sticks around. There's some Um, potential budget funding cuts that are happening that might impact this, but this is a really wonderful resource because what we know, I am not a physician, I do not, uh, prescribe any medications uh for psychiatric, um, diagnosis or anything like that. However, I work with a lot of folks who do need medication, right? And our understanding of perinatal mental health disorders and the um Psychiatric medications that can be safe during the, during pregnancy and the postpartum period of breastfeeding, that is evolving so rapidly and we have so much more information and data points um in the literature to show what is safe and effective, um, and, and what is really not safe and effective to do. So I'll have, um, I, I'll have folks that are connected to a psychiatrist that have been on medication, and out of nowhere, they, they hear they're pregnant and they take them off all the medication. Um, and that can be really, really dangerous, right? Uh, for some of our folks, especially if there are things like bipolar disorder happening or even severe anxiety that can be really debilitating. And so the, the challenge is that like, uh, a lot of folks um don't have specific training in this. And so, um, in the, in the um options of folks who do are really limited. So there are very few psychiatric providers that we can connect folks to that have specific training and parent. Mental health, um, and so this is a wonderful resource for those of you who aren't psychiatrists but can prescribe medication and are willing to, you know, help your, um, your patients in that way. Um, you don't have to go in and, and always be updating on all of the information. This is a resource where you can call during business hours or schedule an appointment to contact um a perinatal psychiatrist for free and get consultation in real time about what medications um might be. Helpful for this client and um especially if there is um uh substance abuse going on, what that might look like and what might be needed in terms of um medication for that, especially for like opioid withdrawal, those sorts of things. Um, so that's a resource, you can call that number. This is also a link where you can go to that website. Um, it's through the UFA um and it's really a wonderful resource that we have here in Arizona. Um, and then another wonderful resource that I send a lot of folks to that I think can be really, really Helpful as postpartum Support International. So the first thing that they had are flyers, which are really educational. So again, I mentioning, um, uh, knowledge is power, right? Empowerment looks like empowering these families to have information. So not every family who's receiving these diagnoses is going to have a perinatal mental health condition, right? Not all of them need to come and see me probably either. But what they do need to know and what can be helpful for them is what to look at. for and how to know if they do need to talk to somebody, right? They can be really beneficial for them, but maybe that's not the right next step. Maybe the right next step is something more like a support group. Um, this is something that Postpartum Support International offers as well. So you can go on here, you can download and print their flyers that are really wonderful educational resources to provide to your patients, um, and that will also get them connected to different resources. So when they go on to Postpartum Support International's website, they're going to get a lot of. Information about uh different mental health conditions and what to expect. They have online support groups that are completely free with folks who have been trained facilitators and there's for all different categories. So they have specific groups for NICU families. They have groups for folks who have terminated due to medical reasons, um, folks who have terminated due to medical reasons and are trying to get pregnant again, uh, families with medically complex babies, right? So they have all of these different resources that are free of Charge for families, and that can be a really helpful resource for a family who maybe has a lot of um a lot of resources and a lot of coping skills of their own and maybe don't need necessarily to see a mental health provider like myself or a psychiatrist, but they still need some support, right? Um, and they also have a provider directory, so they have a directory of folks who are trained in perinatal mental health like myself, so that's including therapists, there's doctors and physicians on there, there's also um psychiatrists on there. Birth workers, doulas, midwives, if they're interested in that sort of support as well. And Postpartum Support International also has a helpline available for families. So this is something that folks can call. It's a warm line, so usually they answer, but if somebody can't answer, they'll give a call back within I think 24 hours, and they are able to, um, they have specialists, they can connect folks to that are specialists in their area to connect them to the resources they need and they're also there to just provide support in the moment as well. Um, and then I'm a resource, feel free if you have questions, if I can be supportive, um, you can reach out to me directly and obviously, you can send families our way who are, um, needing support. Um, and I am happy to answer if there are any questions. Um, I would love to, to answer any of those, so thank you all.
