45. Academic Medicine to DPC: Dr. Rebecca Berens on Building a Practice Through Pandemic and Pregnancy

Hey doc! In today's episode of ✨Stethoscopes and Strollers✨, I'm joined by Dr. Rebecca Berens, a family Physician who opened her direct primary care practice with a toddler, through a pandemic, while pregnant with her second child.

Dr. Berens shares her journey of:

• Leaving corporate medicine to create a flexible practice
• Navigating breastfeeding challenges that led to becoming an IBCLC
• Building a practice during the pandemic with young children
• Creating a mom-centered medical practice in Sugar Land

Key insights:

• Sometimes the "wrong" timing creates the right opportunity
• Accepting help strengthens both you and your children
• Virtual networking can build powerful connections
• You can create a practice that aligns with motherhood

Doc, if you're considering a major career change while raising little ones, this conversation shows how embracing uncertainty can lead to creating exactly what you need.

Dr. Berens is a family physician and founder of Vida Family Medicine where she provides primary care to individuals and families. Prior to opening her private practice she worked in and led a community health center in Philadelphia, PA and taught medical students and residents in Houston, TX at Baylor College of Medicine. She treats each patient as an individual and tailors prevention and treatment plans to the needs of each patient rather than using a one-size-fits-all approach. Her office is welcoming to all, and her care is trauma-informed and weight-neutral.

For more information about Dr. Rebecca Berens, you can visit her website and connect with her on Instagram, TikTok, and her personal website. 

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Transcript

 Hey doc, I am back with another wonderful guest, my dear friend, who I haven't seen in so long, Dr. Rebecca Berens. want you to tell the listeners who you are, how many kids you have and how old they are. 

Yeah. So, um, I'm Rebecca Behrens. I'm a family physician in private practice in the Houston, Texas area. And, um, I have three kids. My oldest is, um, six. My middle is about to turn four and my youngest is about to turn 10 months. 

So you are in the thick of it. I love it. Oh yeah. So the oldest is six.

So you were you in residency? 

No, I was actually, um, two years out of residency when he was born. Um, and yeah, we actually my husband was still in residency. He, he was actually, no, he just graduated when he was born, but he was in residency for the majority of my pregnancy. Um, and we were in Philadelphia at the time, finishing up his residency.

And then we moved back home for me to Houston six weeks before he was born.  

Oh, so, uh, well, eight weeks.  Yeah. Still  very pregnant. I don't think I knew. I'm like, I've known you for a while. I don't think I knew one, your husband was a physician. Two, that you were in Philly. Like, I don't, do I know you at all?

Oh, so that's so interesting. Okay. How was that move? Um, it was great. So he was coming home for me and he, um, we both went to college together and med school together here in Houston. So sort of home for him now. Um, he's from Nebraska originally, but, um, yeah, so we were coming home and he had basically gotten his, uh,  residency.

And so we're coming back for that. Um, and yeah, but it was, you know, it was, uh, we didn't know what we were getting into. What were you getting into? How was it when you came back? So, you know, when he got this job offer, obviously I, I was working at the time at FQHC in Philly. I was a associate site director for my site and it was great job.

I loved it. Um, so then I was looking for a position down here. Um, Um, and you know, obviously what I was pregnant, I found out I was pregnant actually in the midst of the interviewing process. So, which was always fun  looking for a job while pregnant. and yeah, I think I just didn't have a realistic expectation for what kind of job I would want to and be able to do after my baby was born.

So it was, it 

was 

fun.  

Okay. So we're going to come back to that, but tell me, because I know this is all, this comes up for a lot of people finding out you are pregnant during interviewing or knowing that you're pregnant and going into interviewing. So how soon, if at all, did you tell them while you were in the process?

Yeah, so I had actually completed my first interview, I think a couple weeks before I found out I was pregnant. Maybe not even a couple weeks. It might have been like a week or two. Um, and so, you know, then there's like subsequent discussions and things that happen. So, I basically told them, um, I think I was around nine weeks after I had my OB visit and it was like, this is likely going to continue to be a viable pregnancy.

I just told them, because in my mind, I was like, you know, if this is a problem now, it's going to be a problem then. So, Let's just be open, and if they have a problem with it, then we will look for something else. so that was kind of how I framed it. And, and they were very, they were fine. they were actually great.

I don't think it had any impact on the rest of my interview. Doing process or working process. and yeah, so it was fine. 

Do you think that's because you were family medicine or just because of the type of place it was? I 

think,  I think partially it, so it was an academic institution and yes, it was a family medicine residency.

So I mean,  family friendly ish, we can get into that. But I think also, like, it's just something that they've been through a lot of times. And yeah, in family medicine in particular, there's a lot of women in family medicine. You know, maybe if it was, like, a male dominated surgical subspecialty, it would have been a different situation.

But, um, in general, I think family medicine is  open enough to those 

sorts of 

things.  

Okay. So yes, tell me about your unrealistic expectations. 

so I, I'm family medicine. We actually, I think you went to Howard, right? For residency. And I was nearby at med school. Oh, for, oh, for med school. Okay. So I trained, um, near Howard in D.

C. at Providence.  We did a lot of OB in my residency and I loved OB and I was like, I'm going to do family medicine with OB. And my first job in Philly, I was not able to do deliveries, but I was doing prenatal care and doing a lot of care coordination with the MFM department at, um, University of Pennsylvania.

So I was still very engaged in OB care. So. When I was looking for a job down here, I wanted to continue that, and this job allowed me to continue doing OB. And I was like, oh yay, I miss OB, I'm so excited. So anyway,  Um, that was not  something that was realistic for me, um, to do, I think. First, I was coming back to deliveries after having not done them for a couple of years, um,  And also just like the sleep deprivation and being on call.

Not great. It's not something you can go back to. No, it really is not. And I think that,  yeah, I think if you continue doing it, you probably are fine, but to not do it for a while and then try to do it again at the same time as you have a baby who, by the way, my first child  was not a sleeper  ever.  Like, like.

People think I'm exaggerating. He, okay, he is now. He is now. Yes. But like, for the first probably two and a half years, not, not a sleeper. Um, and I think people think I'm like exaggerating or something, but no, it was, it was horrific. And I've had two other children now who were not like that. So I know for a fact that I was, it was really special.

So, and, but of course I didn't know that, you know, I I didn't know what to expect. And then I had him and I was like, is this how babies sleep or how do people do this? Like, yeah, it's insane. Um, so yeah, that combination was not great. 

 Tell me a little bit more about this sleep because infant sleep is a big thing for people.

So tell me how, how, how was it from the time that you brought him home? 

So he was a  pretty much from when I brought him home. First of all, I'll say this. He was in the NICU for about 12 hours. 

after he was born, he had meconium aspiration and he had required CPAP and all that. He actually, he did fine, but they did observe him in the NICU for 12 hours.

And then I was discharged about 36 hours after delivery. Which for my first baby, which I was like, eh, seems, seems early. But anyway, um, I had barely But that was not by choice? I had, no.  No. Literally, they, they showed up at 10 AM. You know, my, I, I delivered 11. 52 PM. So you know you get two midnights.  So that was my first midnight.

Wow. Yeah. Second midnight.  Second midnight happens. Lactation consultant is in my room the entire night pretty much. Like, it was going horribly. I had maybe nursed him.  Once successfully and then 10 a. m. they're like you got to go here you go here's your papers so um which I was a little surprised I was like I thought I was gonna get like till the end of the day to make sure I could actually feed this child before I go home but I guess not um  so you know it was stressful um and so he was not feeding well he you know had been in the NICU had been stunned by all of that so that was an issue I didn't know how to breastfeed Obviously, it's my first time.

Um, and then he also had torticollis. Um, so he actually like had a lot of restriction and some and a lot of difficulties with breastfeeding that we later figured out. Um, this is how I ended up becoming an IBCLC was in learning this process. Um, and so anyway, you know, it was a rough start just from a feeding perspective.

And so every time he cried, I was like, not sure if he needed to feed it was happening. Um,  and then, you know, I, uh,  I think I had not a good expectation for, like, how babies will sleep. I thought you put them down and they, you're like, they're sleeping and you put them down and they stay asleep. And that's not what they do.

but I was, like, very ingrained in the safe sleep, right? Because in medicine we're taught, like, you have to, you have to put them alone on their back in a crib. And I'm like, babies don't sleep like that. I don't know whose idea that was. That's not how they sleep. I've never had a child that slept doing that.

Um, so I relaxed a little bit on my sleep practices on my other two, which is how I think those went better. But I was very strict about it with him and, um, it doesn't work. Fun fact. Uh, so, 

 As a quick segue, has it changed how you counsel your patients? Oh, absolutely. Yes. 

So I went down the whole infant sleep rabbit hole, you know, up on Instagram at three in the morning trying to feed him, trying to be like, how do I make this child sleep ever?

I bought the sleep courses. I read all the crazy posts. I went down the whole rabbit hole. And then,  and then I was like, Okay, let me like be a doctor about this and actually look at, you know, evidence based information. Um, and that's how I got to, um, learning the work of James McKenna, which I don't know if you're familiar with, but you know, like, sounds vaguely familiar.

Yeah. So basically, you know, there's the safe sleep seven and like being, uh, nuanced in your approach to  SIDS risk factors in your individual child and, and what you're doing. And so, and in any case, you know, Um, there were a number of situations in which I fell asleep in unsafe situations, you know, and this I'm sure happens to everyone, um, where you fall asleep and it's unsafe and I mean, it really on multiple occasions could have gone very poorly.

And so  I think now when I'm counseling patients, I will talk to them about expect that this is going to happen and put yourself in a situation for the least risk possible. So. not on a couch, not in a recliner, you know, mattress on the floor without blankets or pillows. That's a great place to feed them.

Because if you fall asleep holding the baby, the risk in that situation is much lower than it is  on a couch in a recliner in your bed full of pillows and high up off the ground and all that. So, um, you know, it's just a lot more nuanced, not like you must do this. This is the only correct way. And if you don't do this, your baby's going to die.

Because I mean, it just creates so much guilt and shame and fear And, um, and I experienced all of that. So now I'm, I quote, like this is what the evidence says. Note, realized that not always can you do things perfectly. So what are the, ways you can reduce risk. 

Yeah, and I think that's really important because so much of how I practice when I was in regular office based practice was influenced by my experiences.

And it's one of those things where you say that you don't have to have the experiences to be a good doctor, but then if you have the experiences, you're a much better doctor.  Right? Because, it is very rigid, you know, like how we are trained and the things that we do on is coming from a place of, well, I don't want your baby to die as crazy as that sounds like that is really where I'm coming from.

But like you said, it's sometimes unrealistic. And the guilt and the shame that we inflict on people is sometimes more damaging. 

And this is what leads people to the alternative practitioners who do not necessarily have the evidence and the best interest in mind. But if people are feeling so guilted and shamed and, and, um, you know, afraid to even tell the truth in visits with us, like I've seen people in comments on social media saying like, Oh, just tell the doctor this, like.

Okay, so now we're having patients lie to us out of fear  for us shaming them or calling CPS on them. You know, like there's so many concerns that people have when they interact with the health care system and I think it, it breaks down a lot of those barriers if you can be real with people. And I'm very real with patients.

Sometimes they ask me for sleep advice and I'm like, listen, I'm not the person. My babies don't sleep.  I hope your baby sleeps. I pray for you.  I didn't, I never figured that out. So what did 

you do during the two 

years though? So did you, is it that you just never slept?  Um, yeah, pretty much. Um, that's pretty much I think what happened.

I, I don't actually know how I survived. I think in like  hour and a half spurts, I would sleep occasionally. But I have, I have vivid memories of this one time when I was on call and I did not sleep one second because he was up and And then I was getting calls about this patient and it was back and forth back and forth and I got and then I had to work the next day because they did not have a post call day for attendings.

Um, and I had to have a full clinic the next day. And that was the day I think I think that day I told him I was like, I can't do this anymore. I can't.  Um, and so it'll be I stopped OB. , and then, I think within a year, I had given notice  that I was leaving. That sounds 

about 

right. So what did you do afterwards? 

So, you know, after that happened, I was like, okay, I'm not going to do OB anymore. There were some other factors about that job that also had revealed themselves that I did not love. Um, and I think a big part of the draw to the job had been, um, That I would get to keep doing OB and since that was no longer there.

I was like, okay  Some of these other parts are no longer. There's the redeeming qualities are not outweighing them.  And also just I think this is everyone in medicine But if you're in a full time clinical position  Especially in a corporate health system or an academic health system.

Mine was in a county health system that's attached to the academic health system and It's very rigid You have to ask off six months in advance if you want a day off. you know, there was all the little like daycare holidays that they tell you about a week in advance. I can't go to that thing. And I was like, the guilt was just piling and piling.

And so I was like, I can't work here and have kids. Like, I just can't do it. Yeah, at least not in the way that I want to have kids. so,  The other thing I realized is that, um, in order to be promoted in this system, you had to attend a certain number of department meetings and do like x, y, z, you know, extra unpaid activities because that's how academics works.

And I was like, you know, I do not want to go to a department meeting at 6 p. m. 

6 p. m. 

Oh, right, right. Yes.  I don't know. This is a, this is maybe, I don't know. None of the other department meetings were at 6 p. m., but the family medicine department meeting is at 6 p. m. And I was like, I am never going to that.

Like, I'm just never going to go. So, my advancement stops here, I guess. 

Right. Um, 

because I'm not going to go to that meeting. Like, I refuse to go to it. and so, you know, just all those little things that you don't really think about or realize if you've never had a position like that before. Um, that I just, it was like, this is not going to work for me.

So, I looked for other options. I start, I was thinking about it. I was thinking about, um, Going back to an FQHC, although I was fairly burned out from that type of work by that point, I Didn't know what to do. And so  I stumbled upon direct primary care again. I had actually heard about it in residency and then stumbled upon it during this time of my, what am I going to do with my life?

And I decided I would try it. So then I opened my own practice. And then that was about  a little while later. Yeah.  You just 

opened your own practice. So we're going to come back to that. So this, your baby was two at this point. How old was the baby? 

So when I left, when I gave notice, he was  

16 months.  16 months.

Okay. And when in there did you become the IBCLC?  

during that process. So I would say,  I think he was maybe about like  six or seven months old. Okay. When I decided I would start doing it and the start of the process was you know There's on all these all this online education that you can do to get the required education hours to be able to sit for the exam But I think I started it maybe when he was about six or seven months and then I took the exam When he was probably about 20 months And were you interested in that before your experience?

because 

So I was never interested in becoming an IBCLC, but I was always very interested in breastfeeding. And so, like, in med school on our pediatrics rotation, I did an extra, like, I did an elective newborn rotation in addition to regular pediatrics, just because I wanted to take care of babies and moms, and part of that was we got to round with a lactation consultant in the hospital and we're in a more So, like, I'd had some exposure to it.

And then, of course, in residency, we did learn some about breastfeeding and some counseling, but Obviously very limited and not a whole lot of troubleshooting when things are not working as they're supposed to because at that point we would call the lactation consultant. and so, you know, because I struggled with it for various reasons, I wanted to understand, like, how can I help someone who is struggling with this?

you know, doesn't mean I need to always be the lactation consultant, but at least give them a couple more steps between now and then. Um, and so that's why I ended up. And also just having learned from the lactation consultant that worked with my son and just like the reading about what they were telling me, um, it was just interesting to me.

I think it's, I'm also like a doctor addicted to learning things.  We're all like that, I think.  

Yeah, that's how I ended up with a perinatal mental health certification. Yeah, exactly. That sounds about right. Yeah. So what, can you go into more of the issues that you had with the breastfeeding? Because  yes, you were interested in lactation, but I looked at that certification.

It's a lot. So to be inspired that much, it must've been really bad. So what are some of the things that you went through? Cause I'm sure a lot of people can relate. 

Yeah. So, I mean, you know, like I said, he was in the NICU. So when he came to me, I think when he was like, what, 14 hours old or something, he had not nursed at all.

Um, The golden hour had passed, you know, we were all stressed out, so latching just alone was not happening. And then, like I said, he also had torticollis, which we didn't, I didn't really fully understand.  the relationship between those two things until I started doing the lactation consultant training. Um, but, you know, really, there was one side that he just could not latch as well as the other side because of the way, you know, they have to turn their neck and open their mouth and move their tissues.

When he, he had pretty significant restriction on one side and so really struggled with, with that side. And actually to this day,  on my 10 month old, that side has not worked. for like four months. Um, and it's always been like a significant lower producer because he never was really able to like start it working with the first one.

And so it's always been, um, a problem. But anyway, so that was, That piece. And then, you know, then I was pumping a lot to try to build up supply because he wasn't able to latch well and empty well and stimulate well. And so then I had to learn all of the troubleshooting that goes into pumping and fitting the flanges correctly and the frequency and the power pumping to build your supplies, all those things.

Um,  And you know, you would read all these things online and I'm like, is that true? Is there evidence for that? And then I start going down my little rabbit hole. So, yeah. 

Sounds like a lot of rabbit 

holes 

that led you to be 

an IBCLC. 

Yes.  Okay. So, I don't think, I know you as Rebecca Behrens with this amazing DPC practice.

You know, knows everybody in Houston. I didn't realize that you started this practice. When your baby was so young and I absolutely love that because I actually the podcast episode that's coming out next week at the time that we're recording is about making bold moves and huge moves when you have young kids because they won't remember on X, Y, Z.

So tell me about your thinking and like, what was your experience around that time knowing that you had this little baby and then you're going to do this huge undertaking of. Doing something that, first of all, especially in Houston, doing a private practice is like, whoa. And then at that point, DPC was not as popular as it is now.

So that, that's a big deal. So tell me more about that. 

 Yeah. So, um, I think.  Knowing what I know now, I would have been a lot more afraid. I was not appropriately afraid. I don't, I, again, I didn't know what I was getting into, but I was like, oh, that's fine, I can figure that out.  Um, anyway, so,   Yes, it is.

So, I, you know, was just trying to figure out what can I do, and nothing seemed appealing, no employed position seemed appealing, so I was like, okay, how can I work for myself? I'm not dealing with insurance. I refuse to do it.  point blank refuse. So then I was like, what are my options? That's how I found about direct primary care.

And I had heard about it, like I said, in residency, but it was even more in its infancy then. So just connecting with people got acquainted with the model and, and the very basic steps to get started. Um, so yeah, he was about,  so my son was born August of 2018 and I opened my practice in January of 2020, which also is relevant.

Um, I spent the year between sort of December 20, yeah, I think December of  2018 was when I had that call that was terrible. He was four months old and I was stopped doing obesity. I spent the rest of the year figuring out, like, what am I going to do? And researching and learning and preparing.  And, um, and then I was ready with the basics in January of 2020.

Um, and  I, my plan was that I was going to work, continue working part time on a PRN basis for the county clinic, um, to fund the practice as I was building it and then, and then build a practice. And it would allow me to set my hours and be more flexible and be around for him. You know, he was still in daycare, so I still had childcare covered.

And then of course, March, 2020. Like, this was all chugging along just fine. March 2020, daycare shuts down because they have a COVID case.  PRN shifts are all cancelled from this county clinic because they don't need any outpatient PRN shifts anymore.  And now I was, like, literally home with an almost two year old and pregnant, I found out, that same week.

, and it was just a crazy month. so yeah, and then we just kind of figured it out from there. Stumbled our way through. Oh, you can't skip over the good stuff. Come 

on.  When you found out you were pregnant with all of these things going on what was going on in your mind 

so  It was so I wanted to have my second child Two years later.

It was always my plan. My family always makes fun of me I have a spreadsheet of like my life of how I want things to go and in my spreadsheet That was I was gonna have my first two two years apart  So you,  I love it. It's terrible. Um, so anyway, it was on time for that, but I was not anticipating that I would have  a brand new practice and a pandemic happening.

So it was a little bit of like, I don't know, I don't know. I think I'm allowed to swear on this, but, 

oh, yes you are. 

Oh, okay. Well, I was like, it was an oh, it was an oh shit. It was an oh shit. Um, and.  I like told my husband, I think his face was very like, what? Um, but yeah, so, you know, I think at that point I was just like, what else can happen?

You know, it's already the end of days pandemics here. Like,  it's fine. We'll figure it out. Um, and so, yeah, I just, you know, did what I could do. I think I had three months that he wasn't in any child care. So I would just get some work done while he was napping. You know, I only had a few patients at that point because I'd only been open a couple months and everything was going virtual anyway.

So I would just do virtual visits with my patients during his naps. I would do virtual networking during that time. I would do, you know, whatever I could. I remember every morning I would get up and we would go for a walk around the neighborhood. I would push him in his little trike thing and I would take calls with people for networking or whatever during that time when we were walking.

Um, and we, you know, I built up my network of people. I  established patients. I think November of 2020 was when my daughter was born. And I think I had 55 patients by then, um, that I just sort of like gradually built up, um, over the time. And then I think around, I think in the summer, my mom works for a school district or did at the time.

And so by the summertime, she was able to help me with child care. And so by June, I had child care again, and, I was able to work more long hours during the day. Um, and then by the time my daughter was born, we got a nanny, and then I was able to, to kick back into gear again and do, do more work. Right. 

And what was, what's your husband's specialty? He is internal medicine and pediatrics. 

Okay, so what was his schedule like 

during the pandemic? Right. Um, So he is fully outpatient. Um, and he is in a specialized clinic. Um, so it's primary care for a specialized population. So that he has 60 percent clinical 40 percent research.

And what they ended up doing was during the pandemic, um, shifting around their admin slash research time so that each person had one full day that they didn't have to be in the office and they could work from home. So he would work from home on those days. Um, But the rest of the time he was like normal, 8 to 5.

He was on the full time hours and there was a period of time where he was on the draft list for, you know, if we need to call in reinforcements to the hospital. So that was scary. Um, never happened, thankfully. But, um, but yeah, he was working his regular full time hours this whole time.  Gotcha. 

Wow. And I just want to  commend you because with your virtual networking, that is something that has always impressed me about you. 

Everybody. Anytime somebody asks a question about, Hey, do you know, like a super specialized doctor that I've never heard of Rebecca's like, Oh yeah, this person in this health system,  but in your research about DPC, did you really, like, was that a thing that it was very obvious that networking in this way was very important and that you continue to  do it during the pandemic, or is that naturally your personality? 

I think.  . I mean, I learned so much about how to open the DPC practice in that year, leading up 2019  from people in honestly, Facebook groups, you know, so like Facebook groups of DPC doctors. So I was networking amongst that group.  Just to learn from them and, you know, learn from their experience. And everyone in that group is so generous with their time and their resources and sharing their own experience, um, and their own struggles to help other people learn and start their own practice.

And so I just, I met a lot of people through that. And then when I needed help, I would say like, Hey, how do I do this? And they would introduce me to someone. And so for me. I feel like the more people I know, the more people I can help, and we can help each other, and I just pay it forward, you know? So like, I've accumulated people over this time that have helped me, and now I can  share with other people.

Um, it is,  I'm like a very introverted, quiet person normally.  which is not my personality at all to do this, but it was sort of by necessity.  Because I was in this insane situation and I was like, How can I do this from my house during nap time?  And the only way was to meet as many people as possible and like, talk to as many people as possible and meet people and that's, that's what I did. 

Kind of how the practice was built. And yeah, just didn't have a choice.  

, I think that is really amazing that you were able to continue to build during COVID. So when did you join EBS? Because FYI. Yeah. This is how I know Dr. Barron. She is another wonderful member of the Andre M. D. Business School. Again, Dr. Barron does not pay me. But when did you join?  

I joined, um, June of 2021.

So my daughter was, what, seven months? Oh, we're in the same court. 

Yeah.  Okay. Gotcha. All right. So, She was  born in November, you said, right?  How was the difference? I know you said she slept more, but did you notice a very big difference between the two of them? And did it affect you in any way negatively, positively having the comparison? 

Um, I think she did definitely sleep better, but I think that was because I had engaged in the safe co sleeping at that point. Yeah, um.  So it was easier. Um, I think breastfeeding was also easier, but I think also just because like, I knew more, um, she, it was not like the, there was no issues, but it wasn't anything like what I experienced the first time around.

Cause I mean, she wasn't in the NICU, like it just wasn't. Um, my labor was worse cause I ended up having to be induced with Pitocin. Um, and so my recovery was a little harder. Um, because I had to, you know, have an epidural and I didn't have to do any of that the first time around. So it was just, it was just a lot more, um, of a recovery process.

but I had help with her cause I had the nanny already. So, um, you know, when she came home, um, we had family around to help and then  after they left, the nanny was there cause she was watching my son. And so I always had help. I was able to rest every day. Like, like every day I was able to take a nap.  Um, which with my son, I did not take one nap my entire maternity leave.

and so, like, because the only way I could get him to sleep was to like drive him around or push him around or walk him around or whatever. So, like, I never napped. But, so yeah, I was able to just rest more. And I think the other thing that I learned from one to two was that, you have to accept help.

So, I'm not really a person who asks for or accepts help very well. Um, but I was more willing and able to do that the second time around just out of necessity. One, but also just like learning that, hey, this is  a wise thing to do. 

Yeah. And I was just about to ask you because during the no sleep of the two years of your son's life, I didn't realize that you had no help.

Was that a choice? 

It's not that I had no help. I had plenty of help, but I would not accept it. Um, so during my maternity leave with him, um, one again, unrealistic expectations. I was thinking maternity leave, Oh, you know, I'll like meet some other moms who have babies and we'll go out on like little walks together or go get coffee or whatever. 

Insane. No. I was not prepared. realizing the need to prioritize my rest and like people were offering to help like my in laws were offering to help my mom was around and offering to help but like i would be like oh no it's okay i'm i don't need it you know um and i was alone a lot of the time but it was not because i had to be it was because i thought that was what i would should be doing or was it supposed to be doing  

when did those ideas leave your mind  

I mean, I think as my son grew,  part of it, I think, was also just like the anxiety of new mom, breastfeeding's hard.

And I think this was the thing too, like, because breastfeeding was so hard, I was like, I need to be with him all the time so that I can like, feed, like, learn the cues and learn how to breastfeed and make sure I don't miss a feed. And there was a lot of like anxiety around that. And so I didn't want other people to hold him or go away for a nap because I was like, oh, they're not going to wake me up in time and he's going to miss a feed or we're going to be late for a feed and then my milk's going to tank, you know, that kind of thing.

Yeah. 

Um,  so that was feeding into a lot of my not accepting help. But I think after that was more well established, breastfeeding was going okay, I was gradually able to accept more help with him. And then so then when my daughter was born, I was like, you know what? It's not the end of the world. If you go take a nap and someone else holds her, you can still figure out the breastfeeding will be fine.

Yeah. 

Yeah. Okay. And tell me with that level of anxiety, was that a level where you felt like you probably should have had intervention or did you? 

I was seeing, um, I actually preemptively scheduled an, uh, an appointment during my pregnancy with the, um, perinatal psychiatry group at the hospital where I delivered.

Um, because I had a history of. depression and other issues. And I was like, I'm the person that's going to have a problem. So, um, so I scheduled an appointment with her and I did see her for several sessions, in the postpartum period. And then she referred me to a therapist after that, who I actually still see like six years later.

Um, nice. And so, um, so I was seeing someone, and I, I do think it was, A pathologic level of anxiety. but it was,  I think it was, it's one of those things where it's like, I, I have enough presence of mind to know it's happening, but I'm also like trying to educate myself out of it.  It's a very doctor thing to do.

Yes.  What did you, what did you do? Like, what do you mean by that?  

Um, so, um,  A lot of my, my anxiety was very focused around the breastfeeding issue because that was the, the present issue and the sleep issue. So I was like, Oh, I'll just learn everything I need to know about sleep and learn everything I need to know about breastfeeding.

And then I won't be anxious about it anymore.  Um, did that work?  I mean, eventually,  I mean, no, I did. I think it,  it,  it was okay. Um, you know, I think. I recognized what I was doing while I was doing it. Um, and it ended up being okay. But I was not, I at least did not experience like the,  I was, I was more worried about like postpartum depression and that sort of thing.

And I didn't really experience anything like that. I just had sort of the more like the anxiety obviously around feeding and sleep. And then the, um, just kind of like intrusive, scary thoughts that a lot of people will get. Um, but it, nothing that required Medication or more serious intervention. I was seeing the therapist and the psychiatrist.

Yeah, whichever one I was seeing at the time fairly regularly, so 

So I think that's really important to just like sit on a little bit  because a lot of people worry about depression. So did I. But I feel like, especially in physician mom circles, it's the anxiety. And you can see it sometimes in the posts in our Facebook groups.

Like the anxiety is screaming at you.  And I just, I don't even, it's not like if I have a solution, I just want people to be away. Hey, whoever's listening, depression is one thing and it's serious. But I feel like we are more likely to have postpartum anxiety and for it to be ignored and especially by our family because they're just like, it's easy to say it's your first baby.

That's why she's like that. You know, it's this is how she is. She always is. Because I felt this is something that happened to me and it was with my second. Um, and I wasn't that was no way on my radar. Like there was, it was not there at all. 

Yeah. And I think I do feel like there's at least more discussion now about postpartum anxiety.

But  even back then, I don't think it was as commonly discussed. but  yeah, I mean, it's, it's one of those things where like, you know, Especially when there's a breastfeeding issue, I see, I think, every single patient I've ever seen who's had difficulty with breastfeeding has had some degree of anxiety.

and you know, I think, like you said, physicians in general, we're a little bit more of a high strung group of people, a little more type A. We like things to go a certain way, and that's just not how babies work. So,  we are definitely at risk. Um, and and it's easy to not recognize it, like you said, because it's like sort of our personality to start with, 

right?

And it's things that are lauded, like, you know, my ability to think about every single situation when I'm on call, and somebody is hemorrhaging and literally dying in front of me is the same thing that kept me up and I couldn't sleep, you know, because I'm like,  all of these things. And I like that you said about the intrusive thoughts, because everybody gets them.

But it's when it's affecting your ability to live your life and take care of your baby, then it's like, okay, well, do I need some kind of help?  So thank you for sharing that. So you had the second baby. You had, you accepted the help, which was wonderful. Tell me a little bit more about the nanny, because that's also a huge hurdle for people.

Just the idea of having somebody else in your space. Yeah. And all of that. Like, what were your feelings around, um, having a nanny? 

Yeah, I, I did not like the idea. But, and I don't think we would have done it if it wasn't for COVID, but it was one of those situations where it was like,  you know, being out with, from daycare with an illness every other week for a week or two weeks at a time, like it's not feasible.

Um, so there wasn't really a way around it. Um, and, , it was one of those situations where I was like, I don't have a choice. I just need to do it. And it was expensive. And it was stressful to find a nanny. And there was a couple times where I, you know, I interviewed several people.

We had someone come for a trial one day who was like, Horrible. And I was like, oh my God, how am I going to find a person? And then I got so lucky. I found this amazing nanny and she was with us for almost two years. Um, and she was wonderful. Um, she was actually had previously been with a physician family who had, she'd been with their youngest child for, from birth till age five and that child was starting school and that's how, so yeah, it was, it was a great fit, but yeah, it was definitely a struggle to get there.

Um, and it was expensive.   And that was hard because I wasn't making any money,  but I was also like if I don't have the child care, I can't build a practice to make the money. So I have to do it. so that was a hurdle. But yeah, it was one of those things where it's just like, this is just the investment you have to make to be able to keep going.

Um, and it was great. She.  My kids loved her. You know, we still talk about her, still share birthday photos and things. And, um, yeah, yeah.  

Yeah. So why did you part ways?  

Um, when we moved, so we lived, used to live in the city and then we moved out to the suburbs. Um, both of my kids were going to start at a Montessori school.

my son was, um, You know, he was like the typical COVID kid who like never really got much interaction. And I was like, it was starting to become a problem. And I was like, we need to get you into school. Um, and I really could not afford to pay for school for one and the nanny. That was absolutely not going to happen. 

So, so we had to, we had to part ways then. But, um, but she did go, I think, to another physician family. So,  

and so I want to highlight two things that you said that you eventually found somebody that was,  I'm assuming it was a referral. 

It was actually from a Facebook group. yeah, there's we have like a nanny Facebook group.

Mm hmm  

Perfect. Yes, because 

a lot of people like oh, how do I find them? Like the referrals are the best other physicians like posting those Facebook groups I talk about Facebook groups a lot, but there's so much value there in our circles. So it's just a good resource and also That you had to have the help so that you can grow your practice because it's like, yeah, I, I don't have the money to,  I don't have the money to pay, but I can't make the money without like having the help.

And that can be expanded to other things in general,  having the help allows you to do all the things that you want to do so that you could eventually. Create your schedule however you want so you can spend all the time with your kids or do whatever it is you want But it's just you just have to have the help.

There's no way around it Even if it is expensive, which is why I have an au pair. Yeah  Like yeah full time nannies in California. Oh, yeah.  Yeah. So what made you say? You know what? I want another baby  So 

I always wanted three babies  Spreadsheet. It's on my spreadsheet. Yes. This one is a year late, but I was not ready. 

It wasn't going to be 222. Like that wasn't going to work. So, um, I was not ready for that. So we had to postpone a year. Um, so he's three years apart from my daughter. but yeah, I just, I always wanted three. And I remember,  like my spreadsheet alarm was going off. It's like, you need to have this baby cause you're going to be old soon and you can't have any more babies.

And I was like, okay. Um, and I, I remember having this thought, like, uh, do I really want to do this again? Like I really don't, but I also still want the baby. So anyway, we had the baby. Um, and he is like a trick baby because he's so good and he wants me to have another baby. And my husband is like, 

So that's a problem, we shall see, we shall, um, but yeah, he's been like such a chill baby. I think, but I think it is partially, I am more chill.  Because I've done this enough times now,  and therefore he is more chill.  

Yes, chill mommy, chill baby. That's my new phrase. Not healthy mommy, healthy baby. Um, okay, so we'll see.

Maybe there'll be a number four on the way.  So you have a six year old and a ten month old. What would you have told your prior self six years, five and a half years ago, that you wish you knew from all of your experience over the last six years?

 I think that the help piece is the biggest part, is accepting the help, but not just that you need the help for yourself, but also your kids need the influences of other people.  , and I think there's still this very pervasive  feeling or thought in society that like, moms are supposed to do XYZ thing and the mom is responsible for all these things, but like, in reality, evolutionarily even, that's not true.

 And Children benefit from having multiple different caregivers who can bring them even the theme. We're in different things from different people. Um, and it's actually important for them to have other people in their lives. It can't just be you. And if it is just you, you know,  that's  down the line, not as helpful to them as having the experience of interacting with multiple people.

Um, and so I think just, you know, It's accepting the help for yourself, but also for your kid's sake to have  the other positive influences in their life. 

And I love that perspective. You are the second person to say that, uh, during one of my interviews and I hadn't heard it before she said it and I just, it's so true and it's so obvious and I love that you are saying it as well.

So, hey, you, you hear, you heard her, she does a lot of research. So, it's true. So listen. Alright, so as we wrap up, we've talked a lot about your practice, kind of tangentially, but tell the listeners about your practice and everything that you're doing now. 

Oh yeah, so my practice is,  a direct primary care practice in Sugar Land, which is a suburb of Houston. 

 We do direct primary care. I, um, just have a, had a new physician join me this year a couple months ago, so she's building up her panel as well now. Um, she's also a mom, so it's, we have an entirely mom run practice.  The doctors are moms. My VA is a mom, my in person assistant's a mom, we're all moms.

Um, which is chaotic at times because everyone has kid things come up at various times, but, uh, but it works cause we're flexible. Um, and yeah, so we see, you know, I see all ages. My partner is an internist, but I see a lot of patients who are in recovery from disordered eating. That's sort of my area of interest.

And then my partner does a lot of perimenopause care.  Oh, nice.  So where can they find you?  So my practice is Vita Family Med. com the Vita family medicine in Sugarland and I'm on Instagram and TikTok at Rebecca Barron's MD.  

All right, great, and she is wonderful. Go follow her look up her practice if you are in Sugarland if you want beautiful direct care outside of your lame ass insurance  It's so much better. 

All right, Rebecca. Thank you so much for coming on and sharing your story and all of your wisdom. It was an absolute pleasure. 

Thanks so much for having me.  

Yes. All right, doc. I will see you next time on another episode of Stethoscopes and Strollers. Bye.