Postpartum Psychosis: Recognition, Treatment, and Advocacy with Dr. Susan Feingold

Postpartum psychosis is a rare but severe psychiatric emergency that requires rapid recognition, coordinated care, and clear clinical protocols. In this episode, we are joined by Dr. Susan Feingold for an in-depth discussion on the presentation, risk factors, and evidence-based management of postpartum psychosis.

Dr. Feingold examines how postpartum psychosis differs from other perinatal mood disorders, why early symptoms are often missed, and the consequences of delayed intervention. The conversation also explores gaps in screening, challenges at the intersection of obstetrics and psychiatry, and the role of health systems in preventing adverse maternal and infant outcomes.

This episode is designed for clinicians, policymakers, and maternal health advocates seeking a deeper understanding of postpartum psychosis and the structural changes needed to improve identification, treatment, and continuity of care in the postpartum period.

Transcript

Susan Feingold: 0:00

Probably the most misunderstood, called postpartum psychosis. And that is really a loss of touch with reality. It's it comes on often, very quickly. It's very severe. It's considered a clinical emergency, a psychiatric emergency, so women need to get to the hospital. It needs to be diagnosed properly, and they respond really well with treatment.

Unknown: 0:37

Welcome to perinatal and reproductive perspectives. This is a podcast where we empower birthing individuals, partners and health professionals with evidence based insights, holistic strategies and relatable stories. Hosted by a healthcare expert. This podcast fosters understanding equity and growth in perinatal and reproductive health. Here's your host, Becky Morrison gleed.

Rebecca Gleed: 1:09

Welcome everyone to another episode of perinatal and reproductive perspectives. Today, we are so fortunate to have Dr Susan Feingold. She is coming to us all the way from Chicago area and speaking on postpartum psychosis. Susan is an author, a clinical psychologist, an advocate and a mother and a grandmother. Welcome to the show.

Susan Feingold: 1:34

Thank you so much, and thank you for mentioning my kids and granddaughter. You know, of

Rebecca Gleed: 1:40

course, they're the best. That might be a nice segue to tell folks who you are, what brought you into this space of you know, perinatal advocacy, specifically postpartum psychosis.

Susan Feingold: 1:56

Well, it kind of dates back to the 1990s I hate to give my age away, but with my second child, I was, at that point, doctoral level and clinical psychologist working in a Naval Hospital and a VA Medical Center in about an Hour from where I live now, in the city of Chicago, and with my second child, I had a very severe depression, really an anxious depression, with put which postpartum depression can and Often is so a lot of symptoms of anxiety and fear, and in fact, I went on leave from my job. And that experience really changed me, because many of my colleagues who were they were a big group of psychiatrists, psychologists and social workers, nurses, psychiatric nurses, many of my colleagues didn't believe this disorder existed and weren't taking it seriously. And I would sort of talk to them about how I just didn't feel right. I didn't feel like myself, which I always listen to with my patients now. But anyway, I ended up, once I got well and went back to work for a while, I decided this was the work I needed to do, is make people more aware. And even at that point, my colleagues, many of them said there's just not enough women with this to make a full time practice with. And I've been in practice now over 30 years. I'm been very busy, and now we know that in the US, there's something like 800,000 women a year with this disorder, 15 to 20% of women surrounding childbirth, or, you know, one in seven. And now we even know there's one in 10 men that can get these disorders that we now call perinatal mood and anxiety disorders because they not only come during following birth, but oftentimes they begin during pregnancy, and those women are at very high risk in the postpartum period, so we definitely want them to get treated

Rebecca Gleed: 4:43

absolutely and you and I share that in common. When I went into this niche, I was told maybe that'll be 10% of your practice. And not only is it the entire population that I serve, but we have an entire team now, and we still get daily referral. Models for you know, birthing individuals, their partners, who are suffering. So first and foremost, thank you for doing this work and going a step beyond and doing the advocacy piece. We will give space to that today because, because when you are making waves and making real impact legally through legislation like I said, we'll revisit that later, but let's open it up specifically for postpartum psychosis. What is it? And also, can you speak to how this is often more of a specifier versus a standalone diagnosis?

Susan Feingold: 5:37

Yes, great questions when we're talking about perinatal mood and anxiety disorders, we're talking about a group of disorders or psychiatric illnesses surrounding childbirth. But along a spectrum, there's a level of more and less severe, and even within each disorder, like postpartum depression, there's women who are more moderate and there's women who are more moderate severe, there's women who are more severe. There's quite a spectrum. And each of these disorders you mentioned, including postpartum psychosis, the most severe, a very distinct disorder. You know, each of these disorders have different symptoms, different risk factors, different levels of of incidence. That means how many women are affected by these disorders, and there's differences. They're not the same, but they're under sort of this umbrella of perinatal so when we're talking about postpartum psychosis, it's different than postpartum depression. Like I had stated, 15 to 20% of women have postpartum depression or anxiety disorders, because, remember, there's a lot of it can be just depression, it can be just anxiety, and then we'll call, you know, perinatal anxiety disorders or panic disorder or obsessive compulsive disorder, those are all sort of one group of disorders, or it can be symptoms of all the all of those. But in addition, there's another disorder on the the most severe and probably the most misunderstood, called postpartum psychosis. And that is really a loss of touch with reality. It's it comes on often, very quickly. It's very severe. It's considered a clinical emergency, a psychiatric emergency, so women need to get to the hospital. It needs to be diagnosed properly, and they respond really well with treatment and when it's correctly identified. Unfortunately, sometimes it is not identified, or people don't realize the sign. So I think, you know, I want to go over what those signs are, besides loss of touch with reality. In fact, perfect timing. There was a really good piece in The New York Times that I was sent from several people, in fact, and I have been looking at my New York Times for a couple of weeks, or whatever, I've been ill. So it states in the article, and I would certainly concur with this postpartum psychosis often strikes women with no history of mental illness. In fact, we know that about half the women that get this or more have no mental health history. Many of them have never been in therapy before or had depression or anything so to continue, who in the weeks after giving birth are seized by paranoia or delusions or can be hallucinations. Vision, I'm just going to add into the definition here a little bit visual. You know, hearing voices auditory or hear smelling things that aren't there, seeing things that aren't there. We're talking about so a pretty scary state, sort of losing touch with the rare reality, lack of ability to, you know, really impair judgment. In thinking it occurs in one or two of every 1000 births, and is considered a clear psychiatric emergency, usually dictating hospitalization. I might change that to always dictating because you don't want to make an error. In the worst cases, it can lead to suicide and infanticide. And in fact, we know that four to 5% of the women who have postpartum psychosis are at risk for suicide, and one to 4% in terms of infanticide. So due to that, we want to hospitalize them. We don't want to take a chance. Another symptom that comes at this time is the the tendency, which isn't true in every perinatal disorder, for it to wax and wane. So maybe a family thinks, well, she's acting strange, you know, sort of bizarre behavior, or Who's she talking to, you know, there's no one else in the room. And then all of a sudden, she seems like herself again. So it waxes and wanes, which makes it particularly tricky and dangerous, because sometimes families think that these women are okay, oh, she's better, you know, we don't need to go to the hospital. Or many tragedies happen where maybe the family thinks, we'll watch her. We'll keep her at home. We'll watch her. We'll give her support. We're right here, and there's been many tragedies, suicides and infanticide, meaning taking the life of your baby, or, we say, filicide, or of other children that happen when families don't hospitalize a patient and a woman having this and maybe they go the bathroom, or they go and answer the call, a phone call, and within a second she is, you know, God forbid, jumping out a window or or hurting her children. And so it's, you know. So it's an important for for everyone to know about this. And the reason, in fact, it was in the New York Times is there's been a group of women led by some colleagues, Dr Meg Spinelli and verginc, a Dutch woman, a Dutch psychiatrist, has been leading the charge in getting This diagnosis into the DSM, which is sort of Bible of mental health conditions. It does not appear there. It appears as what we call a specifier. And so many psychiatrists and even you know when tragedies happen and it gets into the legal system because it isn't in the DSM. They think it doesn't exist, and it certainly does. And this would really, we feel it would really help move research and move the attention and education, which is so important. So thank you so much for giving space on your show to discuss this issue.

Rebecca Gleed: 13:45

Yeah, and some examples of specifiers might be a psychotic manic episode, depression with psychotic features, just so folks know what that specifier might look like, but as a standalone especially for birthing individuals with no psychiatric history, a standalone diagnosis would give space to that. For example, yes,

Susan Feingold: 14:10

it validates it. It gives it legitimacy as an actual diagnosis that that clinicians and researchers need to look at and even when these terrible tragedies happen that we hear about and are so focused on in the press at times and those mothers are demonized, they're oftentimes these cases of postpartum psychosis that's been missed, and because it doesn't appear in the DSM, women have a really hard time pleading an insanity defense or judges to take it seriously that this is an actual Diag. Gnosis. So at times in court this comes up, and some of my colleagues, they're doing expert witness work, have a hard time explaining to a jury or a judge or attorneys that this is an actual diagnosis when it doesn't appear in the Bible of other kinds of problems. And, you know, we even have that with postpartum depression. It's not really stand alone. It's depression, you know. And oftentimes, as I see women, as I code it for insurance companies, I have to code it, you know, major depression or an anxiety disorder. Other, you know, with the specifier in the perinatal with perinatal onset, that's the specifier so it minimizes it, you know, and each of us are doing our part. I've been working more in the area and the space of changing laws, because, in addition to the DSM, if the laws were changed as they are, in more than 30 other countries, starting in in the UK in 1938 That's how far behind we are here. And you know all these other countries, Australia, Canada, all these other countries that have these postpartum psychosis in there, in the law, women would get treatment instead of punishment, and in our country, they often receive punishment, are demonized and considered monsters when they're in the phase of an acute psychiatric illness that They certainly didn't see coming. You know, blindsides them, and you know that they end up getting punished for and their family, and there's loss of life.

Rebecca Gleed: 17:13

Absolutely, we'll include that New York Times article in the show notes too, so anyone interested can read that article. You know, what advice can we give the practitioner who might be a generalist or maybe a PCP who may not have experience of recognizing it? I'm just thinking back to myself, say, a decade ago, I was so glad when I had a mom come in. I was in an emergency psychiatric setting, and she had said, Well, you know, I'm thinking about changing the baby's name. And I was so glad that I came from a place of curiosity, of Tell me more. And as I got became evident that she believed the baby was possessed. There was a plan to withhold food and that. And then you get to know, even though she presented very well, this was she was in the throes of postpartum psychosis, got her hospitalized, got to see her on the other side of it. But if I had not had that background or training, I could have easily just laughed it off of oh, you know, some people, you know, change their minds, and you can change your baby's name with, you know, but I was so glad that I opened it up and just asked some questions. So what can we tell those practitioners who might not have that florid, psychotic individual who's very clearly needing emergency psychiatric help. What advice can we give to them?

Susan Feingold: 18:46

Well, I think they, you know, need to reach out. There's two ways, really, they can get training through Postpartum Support International. I'm on that advisory board, and I know you're also a very active member, and that's how we know each other. So there's an organization, and people can call that's one, 809 444, PPD, or they can find that their website, which is a wealth of information, there's support groups and all kinds of information and things you can read about, and they can help you get to somebody who does have training. Yeah, I'm very concerned about people seeing generalists. I mean, sort of how I started, when I was in the VA and navy, and I got my training, and you got yours, probably also through our experiences and all that. But there they can get training, because there's a big training push to help educate, really everyone. But. Certainly clinicians, but if you're not, then the next best thing, if you get a case and you have any doubts, is either consult, but certainly if you see symptoms like we're talking about, where something just strikes you as bizarre, the hairs on your neck are standing up better to always better to go with acting, you know, safely for the woman. So we'd rather someone be angry at you because you sent her to the hospital, rather than you miss someone, and you know, they took their life, or they took their children's life. I mean, these things come up, and often times I've been called to either consult on these cases or give an opinion or or things like that because of the advocacy work I've been doing for I mean, I'm still a clinician at heart, but I've been doing advocacy work on really moving postpartum psychosis legislation and laws in the US for now nine years, amazing, yeah, and that sort of happened just like you in the case you talked about you asked the questions. You know, you and we need to ask women these questions. But you know, I got started in advocacy work because they were looking for a doctor to testify in Illinois on a postpartum psychosis and depression criminal law that was being considered in a House subcommittee. I was never into the legal aspects in that way. And I saw, you know, an email coming through psi, Postpartum Support, international, looking for someone the night before I was to testify, and I felt like I had to do it, so I went to the drove to the house with another colleague, led us the menace, and we both testified in the house. Subcommittee had passed that day, went on to the Senate. There was opposition, and I called on my partner, who is a criminal defense attorney by, you know, many, many years in Illinois, and because they were saying this legislation was unconstitutional. And he went with me. We went back to Springfield, our capital, and we both testified in the Senate subcommittee, and then, basically, I got hooked and started doing this work. It became the first law in the nation in 2018 I'm proud to say, amazing. I have to give credit to two women who wrote the original legislation, Sims and Jackson, which I talk about in my book I have, yeah, I'll tell you about that, but the name of the book is called advocating for women with postpartum mental illness. And here is a picture I don't know. Well, obviously your listeners can it says A Guide to Changing the law on the national climate, because there's so much stigma about this illness. So anyway, it led me into this space. And as I was saying, these two women who were incarcerated for life with no parole, Sims and Jackson wrote the original legislation while in prison. And then Bill Ryan and an advocate in Illinois took it to to the legislature and, you know, and then I got involved, and Barry got involved. Barry Lewis with me, and we both kind of helped to push that legislation through in 2018 so since that time, I've been working in other states. Because naively, I thought once Illinois it became law, it would be like a domino effect across the country. It's been nine years. Now. I'm working in California. I volunteered to work as an advocate with a group there, and I've been working a. Lot in Massachusetts, and in fact, I testified to the Judicial Committee. There's a wonderful coalition of of people working in this space in Massachusetts trying to get a law in Massachusetts called an act. I forget the exact name it's. It's an act for the well being of new mothers and and infants, and it's such an important legislation. So I testified, and because, you know, I helped to get that law passed in Illinois. So I volunteered, worked on the wording and helping to write that legislation, but now I've been working to try to help get that law passed. So that's another thing that will really change things, I think there'll be more money to research this and yeah, so not to go off too much on a tangent, but yeah,

Rebecca Gleed: 26:11

well, I'd actually love to hear more if, if you can share what's wrapped up in the legislation and what impact does It have.

Susan Feingold: 26:19

So the legislation in Illinois was a start, and we it's sort of a basic legislation which allows, and so I'm going to move into Massachusetts, which allows women who had not who who have been charged or sentenced. And also it's used for women who are, you know, newly creating, sort of a situation where they're in in the legal system, who have not been it hasn't been addressed that they had a perinatal depression or a psychosis. Is So, you know, the Illinois law basically provides these women an opportunity to have their case looked at again. So it gives them another chance. So if they're in prison for life for some tragedy, and it wasn't addressed at that time, or they weren't diagnosed or or it never came up in court. They have the opportunity to have a re sentencing hearing, and that has turned over the, you know, kind of turned over things so that, in fact, Sims, who was in prison for 32 years for postpartum psychosis, I was one of the expert witnesses on her re sentencing hearing. Well, really her clemency, and she received clemency in 2021 she is out and working hard as an advocate, and in fact, she was one of the people this morning who sent me that article, because we're in frequent contact, let's just say, and Jackson, the Other co writer of the legislation Illinois, was in prison, also over 30 years, for a domestic violence and domestic abuse situation. Anyway, you know, a felony. So what happened is now getting back to Massachusetts. In other states like Massachusetts, we've taken that legislation that passed in Illinois and made it even better. It's much more comprehensive. There's a focus on not only when women are in the courts, but prevention, which is so important, because we want to save babies. We want to save mothers and babies. We don't want to wait until a tragedy happens. We want to educate people. And so there is all of that, and there's getting women who are in the courts because of a postpartum psychosis. You know, basically there is a is the opportunity to get them to treatment instead of to spend their life in prison. And that's what's so important. It's a wonderful I mean, if I must say so myself, it's a wonderful legislation that a lot of people put their energy into writing and perfecting and is being led by. A wonderful coalition, so it's really important, and we're still waiting to hear from the Judicial Committee. It's been a few months, and I think they have to the end of this month, or maybe they'll extend it to make a decision if they're going to pass that legislation on and we have a chance to get it passed, and that would be a big plus for Massachusetts, and also to get things moving more in California and other states. Yeah. So yeah. Incidentally, one of the things that I did forget to say, there's probably plenty things I forgot to say, there's so much in this area of importance that that's so important, but is that some women can also, not only become rapidly psychotic after birth, But for some women, they can have what we call depression with psychosis. That means they are having a postpartum depression that becomes so severe that they start to become psychotic. And I myself feared that that was what was going on with me when I was so ill about 32 years ago, now almost 33 and you know that I was becoming psychotic. It was never diagnosed that way. But I you know, the more I've learned about it, and the more I've had questions whether that, in fact, was what was going on.

Rebecca Gleed: 31:46

I think, you know, part of the mission of this podcast, and we don't have to work very hard, it's incredible how you know it's shared. Or this person says, How can I help in this space? And so I hope that this can also be an invitation if you're a politician, or if you have any reason to help with the cause of getting some of this legislation promoted or, you know, shared with another state, this is such important work. I loved what you said about prevention. It's not just reactionary for some of these incarcerated individuals, but there can be prevention and education and advocacy to help these individuals get help and be recognized and be seen. Like you said, there are real women affected by this throughout the United States and globally, it's not just siloed. So you know, I'm thinking about a listener who may not have ever heard of postpartum psychosis. Can you speak to a few of those higher profile cases, such as Andrea Yates, Lindsay, Clancy and share? I mean, this is what that happened 2023 for Lindsay and Andrea Yates was 2001 if I'm getting the

Susan Feingold: 33:06

details, you are 2001 and the case in Massachusetts, which has been so sensationalized, Lindsay Clancy, I believe this next month is going to trial, okay? So, you know, I don't know if that's also, you know, affecting the judiciary or not, in terms of, you know, do we really want to pass this on at this time when there's a high profile case going on. But the most, I mean, the Andrea Yates case was very publicized, you know, where she drowned her, you know, killed her five children. And this was, you know, a, you know, she's still, in fact, in a mental institution and and, and because of Postpartum Support International and some of this, some of these different organizations that I'm involved in, it's really helped to also meet other people like I become colleagues and really almost friends with George parnam, who was Andrea Yates attorney back in 2001 and he still visits Andrea in The mental institution where she is to this day, her case comes up every once in a while, and you know, what he shared is she doesn't even want to get out of, you know, probably forensic unit that she's been living in all these years. But you know, even. These women when they get out, there is a fear that once they realize what they did, because so many of them are so ill that they're almost like not conscious of what's going on. So they're shocked that they took their baby's life. Some of them don't even know, so they're at high risk of suicide when they get out. But other, another high profile case, which I think really speaks to this disorder, and I've talked on it when I give presentations a lot, is the case in New York of Cynthia wachenheim. And this was a case in which a first time mother, and this often is the kind of thing we hear. She was a brilliant woman who was, in fact, working in the Supreme Court of New York, helping judges, writing for judges papers and researching and valedictorian, all this kind of, you know, top of her law school class, very bright, you know, really brilliant woman. Everyone thought she was amazing, and she had her first child, and started to have delusions where she believed that her baby was damaged because the baby bumped their head or they fell, and she kept telling her family, there's something wrong. He's he's going to be like this for life. He's damaged. It's my fault. I you know, I might have, you know, looked the other way, and he fell and hit his head, which you know happens to all of us. Mothers know this happens, and babies are pretty strong with these kind of things. And she went from one pediatric neurologist to another with the baby, and they kept saying, No, the baby's fine, that she's just a nervous mom, like nobody saw the signs, and even her family didn't know, and they thought maybe she had postpartum depression, but she was smart enough, and then unfortunately that in this case, where she realized people were starting to think she was odd because she kept saying the same thing over and over. So she stopped telling people, but she still believed the baby was damaged, and this was the case where she decided she she couldn't bear it any longer, because she loved this baby so much, and so she strapped the baby to Her chest with like a baby carrier, and jumped out of her high rise in New York. The miracle, the unfortunate miracle of it was she landed on her back. The baby only had a few scratches. The mother was Cynthia. Was, you know, gone, and, you know, and basically, this was a terrible tragedy, but the baby has, you know, grown up and is, you know, been raised by the Father, but she had postpartum psychosis, and no one recognized it, not the clinician she was seeing for depression that her family convinced her to see. The family didn't realize this was a thing, and so the more people that know so that was another very sensationalized case. But, you know, an example that doesn't make us think these women are just terrible people trying to kill their kids, right?

Rebecca Gleed: 39:14

So what a good example, and it's so easily missed, right? Just absolutely, yeah, yeah. Well, what? What else can we do to like, advocate and to educate? What does that look like?

Susan Feingold: 39:32

I think that certainly, if people that are listening live in Massachusetts, they could, you know, contact their representatives and tell them that they are in support of this bill, an act relative to the well being of new mothers and infants, H, meaning in the house 1924 and s in the Senate. 1171 and that was sponsored by Jim O'Day and Senator, Representative Jim O'Day. It was by, you know, both in the House and Senate, and by Senator Joan lovely. So, you know, I want to really highlight the work they've done, but also just to plug our book, which really happened in I think, 2019 after the law was passed, my partner, Barry Lewis, and I were presenting at the American Psychological Association Conference on the law in Illinois and the work we had done. And so you can also take a look at our book. It talks about how Sims and Jackson came up with the law. It's, you know, I think it's friendly for people who are not clinicians, as well as those who are or advocates, and it talks about how Barry and I work to get this law moving in Illinois, and what are the steps so that other people could take those steps, And hopefully we'll get more laws passed, and we'll get this diagnosis into the DSM so that, you know, so that women don't have to suffer and that there are no more tragedies.

Rebecca Gleed: 41:36

Yeah, absolutely, that's at the core, you know before, I don't want to miss an opportunity to gloss over, let's say we can safely get someone to a hospital. What, what would the family members the individual expect for treatment? What does treatment look like in a hospital?

Susan Feingold: 41:56

Yes. So what we know is that for many of these women, once they're on medication, they you know, they really do well. Sometimes they get well faster than women with postpartum depression, yeah, because their brain chemistry is so off that if they're on the right medications, and we know certain medications that really help these women. We feel it's often in the bipolar spectrum, but not always. 30% of the cases are cases that are not in the bipolar spectrum, but that means 70% or more are and so with medication, and then, as they, you know, are in touch with reality, to get therapy, because I've seen many women through the years, because even If they haven't, there has been no tragedy. They haven't committed suicide, they haven't hurt their children, they haven't heard anyone else. They still are often left with a feeling of, you know, shame and the stigma of this disorder and sort of the secrecy around it, and so they have to understand themselves, what happened to them, that they couldn't help this, that it's really biologically based, you know? And as we do, we learn more about this disorder. We're feeling it's involved with, certainly, hormones, because it happens following childbirth, but also maybe immune system. And you know that that all the different things that are going on at that point, plus a big precipitant is sleep deprivation, yes, because these women who are manic, one of the signs people should be on the lookout for is rapid speech and things like a woman who doesn't need to be sleeping. You know how exhausted new mothers are, and these women are like tons of energy and like, haven't slept in days, and taking on things, like, I'm going to start an organization, I'm going to change the world. And that's a sign of mania. So therapy after, you know, after the fact, maybe in the hospital, if she's regaining some sense of reality. But in the meantime, medication is core for these women, and hospitalization for their own safety and safety of their family and the baby and other people he. Because, you know, if they are just not right, they're really mentally ill.

Rebecca Gleed: 45:07

And just like the power of a simple mental status exam for a practitioner, listening of, you know, asking those questions can be so helpful. Of what day is it today? How many sleep did you get? How's your appetite, energy levels, just doing that basic MSC can go a long way. Don't forget some of the basics. And then also, what I hear is it can be a challenge to get someone safely to a hospital, if, you know, if they're delusional, they don't think that they need help, or, you know, maybe it's challenging, because in a manic episode, someone with a lot of energy can be difficult to transport or whatever, but for someone to know the laws and their resources. For example, in the Commonwealth of Virginia, we have something called an emergency custody order where and you can request even a CIT a crisis intervention trained police officer who knows mental you know has some training in crisis intervention can help safely transport someone under an emergency custody order or helping family members understand. How do you actually get this person to an emergency department safely.

Susan Feingold: 46:24

Yeah, it's such a good point that you bring up, you know? And it sort of reminds me that you can call 911, I mean, I don't know if that's in every state I assume, and say that this is an emergency, because sometimes the family doesn't want to transport the person. So having someone come to the house and evaluate this person or transport them to the nearest emergency room is important. I think the other thing that it reminds me of so thank you so much for bringing it up. Is too often families ask the ill person, do you would you want to go to the hospital if we can't expect an ill person to diagnose themselves any more than asking? I mean, it's totally irrational. You know, you wouldn't ask someone who is having a heart attack. Do you think you're having a heart attack? Do you think this is cancer? You know, it that's what we do. We have to diagnose them. That's why we have training. And we've been in the field so it you don't want to err in that way. So better to call 911, or the police, you know, to come out. And there's times where even if a family is transporting a person to the hospital, and I maybe I'm don't have privileges in that hospital. I'm contacting the hospital and saying I'm sending in a patient. One of my patients is on the way, and I believe they're at risk for self or other harm because they're psychotic, you know, like, give them the hint the people that are going to be meeting them. Which reminds me, I had a patient, and it was so frustrating, but I saw her the first time, 30 years ago. I had just started my practice, she had a psychosis, and with menopause, she's had another problem, and so she started to become psychotic. And the psychiatrist and I were working diligently, I mean, almost talking daily, because both of us were really concerned what we were seeing, and we sent her to the hospital. I think I had seen her recently and detected that she was paranoid, which is another sign and thinking people were watching her and she was becoming psychotic, and so I contacted the psychiatrist, I asked her husband to that we need to call 911, or send her to the hospital. And the hospital emergency room discharged her. They thought she didn't need to be hospitalized, and the psychiatrist and I were talking, and we called them back. We said we're sending her back in. She is psychotic. She needs to be hospitalized. And then they did hospitalize her, but you. Know, I mean, amazing sometimes these stories, so you have to be very proactive and assertive in these cases and really take care of your patients. Because, yeah, I mean, it could have been a tragedy, so,

Rebecca Gleed: 50:20

but a 10 minute call to the hospital and just asking to talk to the attending or communications or whoever can go a long way. And that might take you 1015, minutes to just say, hey, sending someone, and in an emergency you can, you can share that information.

Susan Feingold: 50:37

Yeah, I think, in fact, it's a good idea, because it could be that there, there's the, you know, some person doing assessments, and they might not be educated about this, so if they don't ask the right questions, which sort of is how we started with you talking about how You probed more if you don't ask the right questions. You know, sometimes that you don't you miss something, and this is too important a thing to miss. You know, it's really life that we're talking about, definitely.

Rebecca Gleed: 51:18

And as a practitioner, just to provide more education for maybe a practitioner listening is sometimes in the hospital, they'll even have a psych liaison. And so you can even request that, can, can you have the psych liaison be ready to assess this individual who's going to be in need of a full assessment?

Susan Feingold: 51:39

And you know, there's only in our country, this is very different, again, in Europe and other places, but there's only a few mother baby units. So if you're lucky enough to be, let's say in North Carolina, and send your, you know, around Chapel Hill, and you send your patient over to the psych unit there, where they have a mother baby unit, and maybe go consult with the hospital that you've sent them into, then you know the woman has a better chance of being identified properly and diagnosed properly, but otherwise, you know, it might be missed. You know, I'm one of those people who, when I see mothers with new babies, and we get into talking, you know, I don't only ask, So tell me, how's the baby? I ask, how's the mother doing? Yes, sleeping? Is she sleeping? Because we know sleep difficulties is so sleep is so core, and if she's not sleeping or having difficulty sleeping, or has no appetite or isn't functioning, even if it isn't psychosis, it could very well be another perinatal mood and anxiety disorder like depression or or anxiety. Yeah, so you know, if she's not functioning and a woman isn't feeling like herself, we want to gather help. We don't always have to send those patients to the hospital, but we do want to identify them and have them see a perinatal mental health practitioner or someone who specializes in reproductive mental health like we do?

Rebecca Gleed: 53:40

Yeah, absolutely sleep as a risk factor is is huge. What else do we need to share with the audience?

Susan Feingold: 53:49

Hmm, I think that what we need to share is that healthy moms and families produce happy children. Yes, and that if we can help people be healthy and sort of bust the stigma that you know this is the most perfect time, because we know that there are a lot of women out there and men and families struggling, that if they can get help, this can turn it around for not only them, but for their children and the next generation.

Rebecca Gleed: 54:33

Yeah, I loved I'm going to keep accentuating you said prevention, but also imagine the trickle effect, if we've got healthy parents, that's going to have, you know, a wide impact, absolutely, yeah, and the systems piece that every part matters, not it's not just legislation that matters, but also the mental health system and the. Potentially law enforcement, their role, and all of these different systems working together. And there are folks doing this work, such as Postpartum Support International, there are resources to support the cause Absolutely.

Susan Feingold: 55:16

And you know, if you're living in a state and you, let me, I guess you'd be living this state if you're listening. But if you're in the US, and you're living in the state that does not have this legislation, which is almost every state, feel free to reach out and to reach out to psi, to reach out to me, to reach out to Becky, that you'd like to get involved, because we need more advocates. I mean, as as I'm getting older and my colleagues are getting older, we need other people to kind of carry the baton and take this forward and get the US so that there aren't such harsh laws punishing women who are ill, but instead identifying them early and getting them to treatment, the suit, I guess my the take home message is, the sooner you're identified and treated the sooner you'll get well,

Rebecca Gleed: 56:23

yes, what a beautiful call to action and and statement. Where can folks find you, and where can we buy your book?

Susan Feingold: 56:34

Oh, so nice that you asked you can look me up on my website, and that's Dr Susan B as in Benjamin. My maiden name Feingold, F, E, I N, G, o, l, d.com, so you can look at my website. I probably have to update it some of the new things I've been doing. And you can also find me through Postpartum Support International, because I'm on their advisory board and on their professional lists, and you can buy our book, and maybe it can help you sort of know what role you would like to have in this, in this important work at either Amazon, as most of us are shopping@amazon.com or you can get it directly from our publisher, Roman and Littlefield. And on my website, I do have some links to, you know, to that book and another one I'm just about to republish, called navigating women's mental health, and it's really also stories about about how this can be a life changing experience, as maybe it was for us both in working in this space, but also it can be a life changing experience of growing that is not always. Even if it's the worst time of your life, it can turn around. And there's many stories of women I've worked with who've said I've developed so much, I've grown so much from this experience. And so I guess I wanted to write about, you know, that positive way that for some people, yes, it can be a terrible time and a tragedy like we've been talking about, but for other people, it can also sometimes lead to major growth and transformation.

Rebecca Gleed: 58:57

So Well, thank you for your prolific work, and I'm so excited to get my hands on those books.

Susan Feingold: 59:04

Thank you. Yeah, thank you for the work you're doing. I mean, it's so important.

Rebecca Gleed: 59:10

It is, and I just to touch on what you had just said is, you know, we're talking all about treatment and disorders and illness, but what you're saying is, too there's the other side of it to offer a little bit of hope that with treatment, you will be well. I love what you know Wendy Davis has there's the other side of it that in the growth piece is just what a beautiful note to end on, that you you can be well,

Susan Feingold: 59:37

and you can be even almost more than well. You can be like a not only a beacon of light, but you can be more than you were before this affliction happened to you. You know, you can really blossom. Yeah.

Rebecca Gleed: 59:57

Well, thank you again. This is Doctor Sue. In fine gold. You can go to her website, read her books. Thank you so much for coming on today.

Susan Feingold: 1:00:06

Thank you for having me.

Lana Manikowski: 1:00:11

If you would like to learn more about how we can help, visit our website at perinatal reproductive wellness.com, and while you are there, check out the latest edition of our book, employed motherhood. We also invite you to follow us on social media at employed motherhood. Finally, if you enjoyed listening to the show, please subscribe and rate it. Thank you.