Bereavement Coping and the Need for Specialized Training for Pregnancy and Infant Loss with Dr. Deb Rich

Deb Rich explores with use the gaps in specialized perinatal care for coping with pregnancy and infant loss.  She also walks us through her personal journey in healing from her own still birth and how that brought her to her work with Shoshana Center for Reproductive Health Psychology.  Listen how the field of perinatal mental health has grown, her work with international influence and thoughts on the future. 

Dr. Deb Rich  PhD, Licensed Psychologist, PMH-C, PSYPACT certified
Throughout her 35+ years of practice, Dr. Deb Rich has maintained a vision to engage perinatal professionals in cross-disciplinary collaboration through training and consultation. Since 2013, she has focused her clinical specialties on such challenges of pregnancy as pregnancy loss, infant death, diagnosis of severe fetal abnormality and infertility/family building. She is an expert in LGBTQ+ family building and a champion of reducing health disparities.
In addition to developing her own training model, MommaCareTM which she has taught nationally and internationally, she has served in leadership capacities for the Pregnancy Loss and Newborn Death Alliance, Minnesota Women in Psychology, Pregnancy and Postpartum Support Minnesota, North American Society for Psychosocial OB/Gyn, and is currently the Chair, International Marcé Society Pregnancy and Infant Loss Special Interest Group.

Shoshana Center for Reproductive Health Psychology is named after her daughter, Shoshana, stillborn full-term, August 2, 1985.

https://www.facebook.com/mommacaretm

Shoshana Center for Reproductive Health Psychology 

Transcript

Speaker 1: 0:14

Welcome listeners to baby brain PSMs podcast. I'm Samantha hug, your host. And with me today is the actor Deb rich. She's the founder of Shanna center for reproductive health psychology. She's also a founding member of PSM and internationally recognized for her work in perinatal mental health. Welcome, and thanks for joining us, Deb.

Speaker 2: 0:33

Thank you for inviting me, Samantha.

Speaker 1: 0:36

I'd like to start, but like just getting to know a little bit about your personal connection to the, of perinatal mental health, if you could share that with us.

Speaker 2: 0:44

So I, um, actually originally became a psychologist to support myself as an actor because of the time in the late seventies of the burgeoning of women's mental health and issues related to women's health. That's the field that I went into within community mental health had my first pregnancy, I was married for seven years, had an uneventful pregnancy until the very, very end when I had a full term stillbirth in 1985, I had a daughter named Shanna and that's the name of my practice. I was still in community mental health already, uh, um, a practicing psych college when that happened and was really surprised at the lack of information and support and resources in the Minnesota area. There actually was one of the first, um, pregnancy loss centers in the country, in the United States. And I became involved with them and gradually started doing training of other professionals to prepare them for work with pregnancy losses. I learned about the, um, incidents being as high as it is 20 to 25% of all pregnancies do not end in a healthy life birth. And as I grew in that field became more and more interested in larger picture of perinatal mental health became involved in organizations that were doing the whole umbrella and just slowly morphed into getting additional training. It also in 85 was really new in the United States, the attention to perinatal mental health. So I was on the ground floor all the ways in which it intertwined and grew along with it by meeting colleagues. Um, as I went to trainings, continued to interact. It's important to note that in 1985, we didn't have the internet yet back to graduate school. So I finished my master's degree in, in 1980, continued working in women's mental health and then decided that if I really wanted to enter reproductive health and perinatal mental health, I would be best off getting a doctorate. So went back to graduate school in 95, which was when I had my first computer in the course of doing my doctorate work. My research led me to mental health organizations for colleagueship and publishing and for presenting. And so it just kind of organically grew. I grew hand in hand with, of the field in the United States and it's been an empowering experience professionally and personally.

Speaker 1: 3:25

I think you were also part of developing one of the very first groups here in Minnesota. Can you tell us a little bit more about how you got involved with the hospital based groups that you were leading?

Speaker 2: 3:35

I decided to do as much research as I could about organiz and frankly, I can't even remember how I found this information. I think largely through the Minnesota pregnancy and infant loss center that I learned about resolve through sharing in lacrosse that began establishing, um, hospital based bereavement programming and training. So I went out to California and did a four day training in pregnancy loss, caregiving and hospital coordinating came back and just started contacting hospitals and learned that the children's hospital in St. Paul had a, a pregnancy loss group, um, which they still do in conjunction with, um, a line of hospitals. I began doing work for them. So in 1989, I started leading groups for children's hospital from 89 to 92, started doing that work on my own, started leading enrichment groups for couples. There was a new position at the Fairview health system for a pregnancy loss coordinator, fair was creating its own position, got the position that was in 1999. And I was there until 2013 developing systems change and support groups. And over that period of time, there have been more people that have gotten trained to do grievment groups. And now that we're doing so much, virtually access has really grown. I'm really pleased to see that it's growing, that there's availability for loss group. My first introduction to loss group was 10 days after my stillbirth. I found out about the group at Abbot Northwestern and my husband and I went to that group. And many of the people that I I met in that group continued to be very, very good friends. So I knew for my own experience how important it was to hear other people's stories, to be accepted to no one else blamed me in the same way that I could see them and not blame them for their losses. Uh, it really helped me to get over any feelings that I attributed to myself and to not feel isolated, to, to know that it happened to other people was really an important pool in my healing, but also just strategically in learning what to do. As I went through the process, to see people ahead of me who were living through it, that I could borrow on their faith. And then over time I could mentor the people that joined the group that were earlier in the loss. So I am a strong believer in the healing power of really well led support groups for brief parents.

Speaker 1: 6:22

Over the course of time, there has gotta be a number of things that have changed and even surprises that have come both for you professionally and personally in perinatal mental health. What are some of the biggest things that you've noticed that are different?

Speaker 2: 6:34

Probably 20 years ago, the, uh, medical field was changing in terms of developing electronic mental health records and developing templates for treatment, new attention to categorization of perinatal mental health, and how would it be flagged and what patients were at risk. And how would that be in incorporated into the flagging that was happen for happening for other kinds of diagnoses and flagging physicians about what symptoms to watch for what treatments were common treatments, et cetera. It continued to astound me that perinatal mental health was overlooked. There was guidance in terms of depression or anxiety within pregnancy streamlined into the templates that were being used for mental health throughout. And I would say that that really continues till today. I think it's somewhat better, but still it remains a carve out in terms of training. So if we think about childbirth professionals who are gonna be the first contact for women who are pregnant, they can complete their training without any exposure to the mental health considerations of managing a pregnant and postpartum patient. And we are still fighting that fight to integrate mental health into medical diagnoses and treatment. Looking at the holistic patient, especially in perinatal mental health. We have learned that there is an increased risk of depression, anxiety because of the biochemistry, whether traumatic or simply life changing one can, would call it traumatic. And then it's out of their regular experience. And anytime anyone has an experience out of normal experience, we attend to that. We anticipate that. So I often liken it to if you're in a car accident, even if it's a fender bender, you immediately have a response where you're trying to understand what happened and you're trying to undo what happened. And no one pathologizes that we expect that that's going to happen. So people know what to say, but pregnancy loss and perinatal mental health as the larger umbrella, both of those continue to be taboo. People continue to have no socialization and professionals do not have professional training in what, and you expect the tools to use what are the treatment guidelines and decision trees that you should automatically go to for every single person. It should be on your radar in the same way that if you treat a cut, you look for infection or fever. If you give, uh, in a inoculation, there are things you watch for. So I would say that that is probably the biggest thing for me that when I get frustrated, that's what I get frustrated about is why is it that this isn't common knowledge, that this is part and parcel of pregnancy and partum and all childbirth professionals and all mental health professionals that work with people in childbearing age need to understand that this goes with the territory. If you do this work as a mental health professional, and you work with people who are in childbearing in the course of your career, you're going to have people with perinatal mental health issues during pregnancy or postpartum, it's going to affect men and women. It's going to affect parenting. And if there's pregnancy loss, then you need to be prepared to know what to do. And we don't do a good job of, of making that standard training.

Speaker 1: 10:40

I think that most people who work outside of the mental health field really don't understand that postpartum depression, postpartum psychosis, postpartum anxiety, they aren't even real diagnostic codes. They're not billable by insurance companies. That's how little impact perinatal mental health has on a ripple effect of insurance in the rest of the world.

Speaker 2: 11:00

Exactly. I think also there, there's the complexity of, at what point do you diagnose somebody with anxiety or depression is that really what's captured? So there is the aspect of trauma and of acute stress response and is under anxiety. And in my experience most often, what you're seeing first is some element of acute response to a change in life and emotional reaction to a medical situation that anyone who's going through a pregnancy or a postpartum is having a major change in life. And pregnancy is a my experience.

Speaker 1: 11:40

Can you now tell us about your life's work in the Shanna center?

Speaker 2: 11:44

So I began doing, uh, private practice and as I really identified that as a passion, I decided at the point that I would start graduate school, that I wanted to name my practice as my living daughter, my subsequent child was growing and I would be launching her at some time that I could birth Shanna center and grow Shanna center. It has been my private practice initially doing professional and largely, uh, individual and couple psychotherapy. It's really grown into doing consultation. I do evaluations for reproductive health. I do all sorts of triage intervention for early intervention. When diagnoses first happen and birth is yet to happen or miscarriages yet to happen. I work with parents in subsequent pregnancies, after loss or after traumatic birth. I have taken leadership in other professional organizations most recently in the international Marai society, special interest group for pregnancy and newborn loss. And it's incredibly exciting to see I of international influence and that our group, my goal in the next chapter of my professional career is really to empty my brain into the next generation of leaders, but also to feel like I'm doing something in the world. So I see lots of exciting development, and I am doing this as a volunteer as a member of the international Marsai and as the owner director of Swana center. So she continues to live in my work.

Speaker 1: 13:29

So what's your vision for PMA, perinatal mood and anxiety disorder, treatment yourself, professionally policy, you personally, and globally

Speaker 2: 13:39

I've found the pandemic as challenging as everyone else. Of course, for all sorts of reasons. I, I resist saying the gift in it because it's been really challenging, problematic. A lot of people have died. It's been distressing. I, and there have been all sorts of other political upheaval in this time, period. However, and I say that with a big sigh, it has opened up the world. The fact that people are using, uh, zoom and technology to actually communicate around the world, I think is going to be the power. A full tool will help us come to some solutions that we haven't thus far because dissemination of innovation is very choppy. Areas of expertise are siloed, but not a lot of interwoven interaction. So the ability to actually meet and get to know people and then working together and really getting acquainted, I'm not just reading someone's research and sending an email. I actually know them, see them, know their life and learn from their experience. And there's so much that is yet to be shared that is already known. And I look forward to seeing that, and I think it's going to explode in the next few years where our learning is gonna grow exponentially. And our dissemination of innovation is going to have, and much more quickly, we really are going to be able to serve all of the areas of economics and population and cultural differences that we don't right now because of silos. So that's my dream.

Speaker 1: 15:26

I think that there's probably not a single PSM member that doesn't know you personally or heard of you ORs taken one of your classes or read some of your articles. Tell us a little bit about your journey through P PSM, because there's been a lot of change. You were one of the roots to the grassroot effort.

Speaker 2: 15:42

It's been really quite an experience, a lovely experience. And it really is. I about relationship, I adore that about P PSM. Um, so Suzanne Swanson who most PPS members either know or know of, and I graduated from the same graduate program. Uh, she was ahead of me and I didn't know her at the time, but I knew her by name and every so often she would send me an email and not an email. She would send me a note or she would call me and then emails happen and we would connect with each other and then Facebook happened and we would connect that way. And so one day she just asked me to coffee and said, so this is what I'm thinking about. I think I should put together this organization. Would you be on the board? Sure. So for a number of, and possibly longer than that, she gathered people that were doing this work. And so there's several that continue to be, um, very involved in P PSM, who she just gathered momentum of us getting together and talking and brainstorming and challenging each other and getting a sense of how we might start and figuring out the name and the mission and just all of the things that one does to start an organization. But she really was the motor behind that. I just kept bringing my best thinking and challenging. And I had been already working within a large medical. So I had a lot of understanding about how one does implementation of program and what kinds of structure you need in order to build upon it. But then we had some really great visionaries, like still Clancy, who just one day announced that she was going to start a Daisy day Ash. And we were like, what, how in the world are you going to do that? And bless her heart. She nearly single handedly got that thing to go the first time. And she didn't require anyone else go along as long as no one stopped her. And it just kept going like that. Or camp stepped in Krista post stepped in, and there were many others that joined along the way to develop volunteer training. And then one of my contributions that I was secure a grant from the university of Minnesota, the rural grant for developing programming, outstate, um, and all of those things together, just mobilized. And then I think we're already in another generation of leadership within P P S M and also the relationship between P PSM and P S I postpartum support international as it has grown.

Speaker 1: 18:35

I too, I'm really excited to see what the future brings. I think that the telemedicine factor in being able to reach patients who would not have otherwise been able to access specialized care, and then to be able to share like us today, we aren't sitting in the same room making this recording. You're at I'm at home. Being able to have meetings with people and sharing research and information. I just think is going to make us a fast track and disseminate that information to be able to be put into clinical practice more quickly.

Speaker 2: 19:03

Absolutely. And I love that the recent, uh, news from P PSM about adjusting what the focus is going to be in offloading parts of the program that can be better done by other programs that PSM has notified, which is really just essential to the growth of an organization really looks at what are we good at? What are things that others can do better? How can we best serve women in men? And so for PSM members that are listening to this or people who are interested in PSM, I just wanna endorse the health of the organization and welcome people to join and find your place that calls to you in the organization. I'm not paid to say that I really feel like you can contribute as much or as little as you want that the organization is really human about the different challenges we all have and really, uh, welcoming the gifts that anyone brings. So I look forward to seeing the development over time of this organization that I love.

Speaker 1: 20:11

Thank you for joining us tonight. For more information regarding Deb, her work and the shun center, please visit the podcast description below.