49. Reproductive Psychiatry & Birth Trauma with Dr. Kara Brown

In this episode of Nourished with Dr. Anikó, Dr. Anikó continues her perinatal and postpartum series with an in-depth, empowering conversation on reproductive psychiatry, birth trauma, and perinatal mood and anxiety disorders (PMADs).

Joined by reproductive psychiatrist Dr. Kara Brown, this episode brings clarity to one of the most under-discussed areas of maternal health: the intersection of hormones, mental health, and pregnancy and postpartum care.

Together, they explore what reproductive psychiatry really means, why birth trauma is more common than we think, and how experiences during pregnancy and childbirth can have lasting emotional and psychological impacts.

They also break down the spectrum of perinatal mood and anxiety disorders, why they are often misdiagnosed or overlooked, and the critical importance of individualized, nuanced care, especially when it comes to medication, diagnosis, and support systems.

EPISODE HIGHLIGHTS

03:00 What “perinatal” and “reproductive psychiatry” really mean

08:30 What birth trauma is and why it’s more common than we think

12:00 Risk factors for birth trauma and how it impacts long-term mental health

16:00 Healing from birth trauma, support options, and why grief matters

17:00 Understanding PMADs (perinatal mood and anxiety disorders)

20:00 Risk factors, hormonal sensitivity, and why support systems matter

30:00 Why PMADs are often misdiagnosed and the importance of accurate care

36:00 Where to seek help, resources, and support systems available

43:00 Warning signs vs. urgent mental health red flags

46:00 Debunking common myths about pregnancy, bonding, and “baby blues”

51:00 Medications during pregnancy, risks, and outdated medical guidance

56:00 What current research actually says about psychiatric medications

This episode is part of an ongoing series on perinatal and postpartum health, where we explore the care, support, and conversations every birthing parent deserves.

Be sure to follow Nourished with Dr. Anikó so you don’t miss upcoming episodes in this important series.

Dr. Kara Brown:

Dr. Kara Brown is a reproductive psychiatrist and founder of NOLA Reproductive Psychiatry, specializing in perinatal mental health care. She is an instructor with Postpartum Support International and has extensive training in women’s mental health, including fellowship experience at Brigham and Women’s Hospital and faculty work with Harvard Medical School.

Learn more at:
 Website: https://www.nolarepropsych.com

Psychology Today: Kara M Brown

Resources Mentioned:

Postpartum Support International (PSI): https://www.postpartum.net

PSI Helpline: 1-800-944-4773

Maternal Mental Health Hotline (24/7):
 1-833-TLC-MAMA

Mental Health Emergency: Call or text 988

Connect with Dr. Anikó:

Instagram: https://www.instagram.com/dr.aniko/

Website: https://www.draniko.com/

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Disclaimer:
The content of this podcast is for informational and entertainment purposes only and does not constitute medical advice, diagnosis, or treatment. The views expressed are those of the host and guests and do not substitute for professional medical advice. Always seek the guidance of your physician or other qualified healthcare provider with any questions you may have regarding your health or a medical condition. Never disregard professional medical advice or delay seeking it because of something you heard on this podcast.

Transcript

 [00:00:00] [00:01:00] Hello. Hello y'all, and welcome back to Nourished with Dr. Aniko. Today's episode is part of our Perinatal Health and Mental Health series, and my guest today is Reproductive psychiatrist and postpartum support international instructor, Dr.

Dr. Anikó: Cara Brown. Dr. Brown is a psychiatrist and the owner of Nola Reproductive Psychiatry, a private practice focusing on providing perinatal mental health care to birthing individuals in Louisiana and Mississippi. Dr. Brown completed her medical school training at Vanderbilt University School of Medicine and her psychiatry residency at the McGall Medical Center of Northwestern University.

She also completed a women's mental health fellowship at Brigham and Women's Hospital in Boston and stayed on his faculty at Harvard Medical School where she gained additional experience as a consulting [00:02:00] psychiatrist for the Massachusetts Child Psychiatry Access Program since 2018, Dr.

Brown has resided in New Orleans. What? What? And she served as the women's mental health co champion for the Southeast Louisiana Veterans Healthcare System for three years until moving into private practice full-time. She's an active member of Marsai of North America or Mona, the American Psychiatric Association, and the group for the Advancement of psychiatry.

Dr. Brown helps women make informed, empowered decisions, especially around medication, and she believes in presenting a menu of options to women and figuring out together which best meet individual goals. She created her practice to offer thoughtful unhurried stigma free care, and she emphasizes whole health practices in both her own and in her patients' day-to-day lives.

Her areas of particular interest and expertise are recovery from traumatic births and perinatal bipolar disorder. She's also [00:03:00] a proud mother of an 8-year-old boy. And a lover of wine and anime. Welcome Dr. Brown. 

Dr. Kara Brown: Thank you very much. And what a kind and generous introduction. I, I appreciate it. 

Dr. Anikó: Oh, of course.

I love reading about you and your achievements and your history and all the, all the advocacy work you've done as well. Um, and your love of anime. I didn't even know that until I read your bio. 

Dr. Kara Brown: Yes. Blur tonight. 

Dr. Anikó: Um, so a lot of people listening today may actually not have any idea what we're talking about when we talk about reproductive psychiatry.

So actually first I wanted to define perinatal because I'm sure some people don't know what perinatal means. It literally just means around the time of birth. So that could be before birth, after birth. So peri is around, natal is birth. So when we say perinatal, like perinatal mental health or perinatal health, that's referring to the time around childbirth.

But reproductive psychiatry [00:04:00] is another term that a lot of people haven't heard. So can you tell us what reproductive psychiatry is? 

Dr. Kara Brown: Yeah. Reproductive psychiatry is a subspecialty within psychiatry and it focuses on the impact of hormones as it would apply to mental health and wellbeing. And I think a lot of people do tend to use perinatal mental health and reproductive psychiatry interchangeably.

Um, but I would say that. Reproductive psychiatry encompasses more than just the perinatal period. And so thinking about, um, women that might have premenstrual symptoms, patients that are transitioning through perimenopause, they would also be appropriate for a perinatal psychiatrist to see. 

Dr. Anikó: That makes a lot of sense because yeah, reproduction isn't just when you are pregnant.

It's anything that has to do with the reproductive hormones and all of those cycles in your body and how that impacts us. And obviously as women or people who menstruate or could [00:05:00] menstruate or have menstruated or don't menstruate anymore, that has a major impact on our wellbeing, our mental health, and also how we process medications.

Yeah, so it really is a very intricate system. So my experience with people in the perinatal mental health world and the reproductive health world, and I'm definitely one of those people, is that a lot of us have really been called into this work by certain experiences or paths in our lives.

So can you tell us about the path or paths you took that led you into this work? 

Dr. Kara Brown: Yeah. Um, and some people may have heard me, if you know me, you might've heard me tell this story before. Um, but I, I went into psychiatry knowing that I wanted to do women's mental health. Um, I. An undergrad was, um, a dual major and one of my majors was English Lit and I had a focus on women's lit in particular.

And so I went into med school actually thinking I was gonna go do ob. Um, and I was really [00:06:00] excited about being an excellent OB and providing wonderful, compassionate care and introducing a lot more time and thought into our appointments. And I got to my OB rotation And It Was awful. Um, it would be a really, really, really difficult uphill journey. And so kind of needed to pivot. And I had done really well on my psychiatry rotation, um, which preceded my ob rotation. I timed my OB rotation like perfectly, so I peak at the right moment and it did not happen as expected.

Um, and then while I was trying to figure out what to do, I found a psychiatrist who was doing reproductive psychiatry, Mike Calie. He's still at Vanderbilt. And I realized after spending a day shadowing this clinic, I wanted his job. He was doing exactly what I had hoped and envisioned to be able to do as an OB provider.

Um, and he didn't have to to do surgery. So. Kind of made the decision then and there, it did not involve any personal narratives myself, just [00:07:00] outside of a desire and knowing that I wanted to work with predominantly women, um, and tried to adapt it to my own skillset. So I went into residency knowing that I wanted to do reproductive psychiatry.

It is not a, like, it's an emerging field, and so did not have a lot of options in terms of post-residency training and was very, very lucky to get accepted into a fellowship in Boston at Brigham and stayed on there. Enjoyed my time there, did a lot of work in birth trauma. And then when we knew that, my husband and I knew we were moving to New Orleans, decided to go to VA in particular because they have a lot of resources in terms of, uh, trauma.

And so wanted to gain more expertise through that angle. Um. Then finally a couple years ago, pandemic happened, life happens. We have a small child who needed to be home a lot more. And so made the jump to private practice and I still miss teaching. I still miss my veterans. Um, so I try and [00:08:00] do it where I can.

And that kind of leads me to today. 

Dr. Anikó: Yeah. What a cool journey. And also, I mean, clearly you had always been drawn to the experience of women, you know, from your double major to your practice now, and you still do, you still are a PSI instructor and I imagine, you know, there's other opportunities for you to teach as well.

And you, and you were my PSI psychopharmacology instructor and you're a wonderful instructor. Um, so it shows, it shows how much you, you love to teach and how much, you know, like how rigorously you, uh, you know, this information and also that you can communicate it and that it really matters to you to do it well.

Dr. Kara Brown: Thanks. 

Dr. Anikó: Yeah. Well, so you mentioned birth trauma, so I actually wanted to ask you about that, that one of your areas of expertise is birth trauma. So can you tell us more about birth trauma, specifically, what it is for people who may not really be able to imagine into what that means? Because it can mean different things.

And then also how experiencing birth trauma [00:09:00] can impact us both short and long term. 

Dr. Kara Brown: Sure. And so I, I dropped the formal definition or one of the formal definitions. It's one of those things where the literature. does not have a universal definition, but I think the one that most will accept was coined by Cheryl Beck, who does a lot of research in the field and described birth trauma as an event occurring during the labor and delivery process that involves actual or threatened serious injury or death to the mother or her infant.

The birthing mother experiences intense fear, helplessness, loss of control and horror, and she later expanded that definition to include events during which the birthing mother perceives she's being stripped of her dignity.

Important to know, I think just because it's so common, so in the us. Roughly one in four women describe their birth experience as being traumatic. And so I think even in the absence of psychiatric symptoms, recognizing [00:10:00] how common it is is really important for folks to know and can be really destigmatizing.

I think there's this idea that if you, especially for people that have a birth that yields a healthy infant and they both get to go home, that healthy infant, nothing that comes before really matters, and it's simply not the case a lot of people struggle with, with having a birth experience that was intensely distressing and, and was not at all what they had predicted or had hoped for.

Dr. Anikó: Yeah. And I think that sentence of being stripped of their dignity, um, and I would imagine their power and agency too is all part of that. It's so validating for some people. 'cause like you said, I think there's a lot of people both in medicine and just lay people, you know, in your family and your friends that are like, whatever, you are happy, you're healthy, your baby's fine, don't worry about it.

And meanwhile, people are left with this very difficult experience that no one's even [00:11:00] acknowledging as a thing. Yeah. It's kind of like, well, who cares about that? Put that aside. And that can, that in itself can send us into a spiral. So what are some things that put us at higher risk for birth trauma? And then how does birth trauma then impact us?

Dr. Kara Brown: Well, I think to answer the first question in terms of thinking about maybe risk factors for birth traumas, um. Maybe dividing it up into sort of three categories. One would be sort of patient characteristics, things that individuals really can't change. Um, patients that have prior trauma history, patients that have a prior psychiatric history.

Um, first time mothers, um, members that are patients that are black and brown. Um, these are kind of things, core characteristics that increases the risk of birth being perceived as trauma. Certainly there can be obstetrical [00:12:00] factors, um, having a c-section, especially if that c-section was emergent. I saw a patient earlier today, she said, you know, the moment I was told I was gonna have a c-section to baby being here was 30 minutes.

Like not a lot of time to prepare. So certainly a c-section that's emergent over planned. Um, having a. Birth that requires vacuum or forceps, any type of instrument. Um, having a postpartum hemorrhage, having any type of complications in the newborn newborns that end up going to the nicu, um, for any duration of stay, mothers will perceive that birth, more likely to perceive the birth, I should say, as being traumatic.

Um, things that contribute to perception because all these things can happen, but if a woman doesn't perceive her birth as traumatic, then it's by definition not traumatic, but things that can contribute to that lack of information. If a patient feels that they did not get informed consent, something's being done to them.

If they perceive that there's lack of empathy for medical providers, providers talking about them while they're in the room, as if they're [00:13:00] not there. Um, if they lack support from their own partners, they feel like they're in this alone, they're isolated, um, if their pain is not adequately controlled, all of those things will also contribute to birth being perceived as traumatic.

Dr. Anikó: Which all of it makes perfect sense. And you did mention anyone who is black or brown is immediately at a higher risk. And we know that people who are black or brown are not listened to as much in the medical community and they have poor outcomes. Their pain is underestimated even when they're advocating for themselves.

So all of these things add up. I mean, that is the, it's very clear that that is a stripping of respect and dignity and agency. and also what you said about, if the person doesn't perceive it as traumatic, it's by definition not traumatic. So, you know, in the perinatal and reproductive health world, it's so important to tell the birth story and for the person who experienced it, to get the ownership over how their [00:14:00] narrative is formed for them. You know? And so I think sometimes just in the way that well-meaning people are like, oh, whatever, don't focus on that.

 what's important is that you're healthy and the baby's healthy. On the other hand, there's other situations where the person had a perfectly fine experience for them, and then outside person is like, oh, that was terrible. What a horrible way you were treated. What a horrible. So it's just like, just honor that person's story and let it be theirs.

 you don't have to insert your point of view unless they ask. of course if somebody asks and wants it, that's something different. But I think there's ways that we can. Invalidate people's experiences, both when they experience it as trauma and we don't want them to experience it as trauma or even when they don't experience it as trauma.

And that little like justice person in us is like, Hey, that was messed up. and that may be helpful on an advocacy level, like maybe you can report that to the hospital, but you don't need to involve the patient who did not actually have a traumatic experience. 

Dr. Kara Brown: That's a great point.

Absolutely. 

Dr. Anikó: And what are some [00:15:00] modalities that can help people recover from birth trauma? So if you or someone you love has experienced birth trauma, where could you seek support and where should you seek support? 

Dr. Kara Brown: Well, I think part of working through birth trauma is recognizing that there's grieving involved and, and that sometimes takes time no matter what.

And so trying to, not trying to rush or trying to avoid. Healing can actually make things worse. Um, I think there's an awareness that even though a larger percentage of patients will identify their birth as traumatic, not all will go on to have a diagnosis linked to that birth trauma. Um, some patients just may need support from their existing systems processing their experience with their obs if they've got a therapist already, their family, their friends.

Um, I know we'll talk about specific referral systems later on as well, but if patients are still struggling with their birthing experience [00:16:00] weeks after delivery, um, psychotherapy can be very, very helpful. Um, and, and so can medications. They can target sleep, they can target nightmares, they can target hyper arousal, um, and they can also sometimes be able to target overall mood and trauma response symptoms.

Dr. Anikó: Yeah, and that's an important point, right, is that it'll manifest differently for some people, right? Some people get flashbacks or nightmares or can't sleep or just have an overall kind of hypervigilance, hyper arousal. So there's a lot of ways that it can manifest. 

 so now let's talk about PMA ds, which is Perinatal Mood and anxiety disorders. And we had talked about the difference between maternal mental health conditions, which is like a bigger umbrella. So PMA DS is considered a maternal mental health condition, but not all maternal mental health conditions are PMA ds.

So for folks who have not heard of this, what are perinatal mood and anxiety disorders? 

Dr. Kara Brown: Yeah, I Would tell people that, uh, to think of it just as a spectrum of illnesses that can occur during [00:17:00] pregnancy up to one year postpartum. There are plenty that are advocating to acknowledge, diagnosing it up to two years postpartum.

Um, and that it's pretty darn common. So we estimate in the US about one in five to one in six women will experience PAD in their lifetime. 

Dr. Anikó: Yeah. And it's so common that it's actually the most common complication of pregnancy and childbirth. Correct. 

Dr. Kara Brown: Correct. So more than gestational diabetes, more than preeclampsia, more than the other things that we give a lot more urgency and attention to sometimes, but certainly is, there certainly is underdiagnosed and can really wreak havoc on individuals and family structures.

Dr. Anikó: Yeah. And not only moms or birthing parents are affected. Right. Also, dads and partners can be affected. 

Dr. Kara Brown: Yes. Yes. So I think somewhere around one in 10 fathers or non birthing parents will experience postpartum illness as well. Right. [00:18:00] And so thinking of not just the birthing individual, but the larger family structure in terms of how to provide support is really, really important.

Dr. Anikó: Yeah. And that was something I didn't know before. I did my training in perinatal mental health. And people even see, we even see peds in adoption situations, right? Both the birthing parents and the adopting parents. And that goes back to what we were talking about, like grief and loss and the importance of allowing that grief to move through, you know, and, and to inform.

I've done previous episodes on grief in particular, and we've talked about the grief informed life, where your grief is telling you what you love and what matters to you, you know? And if you let it teach you. Then it'll only lead you into a richer place, you know? So that idea of trying to suppress it and being like, I'm okay, it's fine.

We're actually missing an opportunity, not just to heal, but to learn and take that learning forward with us in our lives, you know, in our future decisions. 

Dr. Kara Brown: Yeah. And it's, it's very [00:19:00] hard and difficult to sit with grief, but like the saying goes, grief is patient, it will wait for you. And so it's, it's something that you cannot ultimately avoid.

Dr. Anikó: Yeah. Yeah. I've never heard that before. And it makes sense. Grief is patient and it will wait for you until you're ready, ready for it, you know? and what are some risk factors of developing ps? And obviously you can develop symptoms of PS without any of the risk factors, but what makes us more likely and more sort of susceptible, maybe not the perfect usage of the word, but layman's term more susceptible to the developing symptoms of pm a DS.

Dr. Kara Brown: Yeah, of course. having an existing psychiatric history is certainly going to increase your risk. having a history of hormonal sensitivity and people I think sometimes don't necessarily consider that. And that would include things like having noticeable premenstrual mood symptoms, having difficult responses with respect to [00:20:00] mood and anxiety while on birth control.

In response to hormonal birth control. Patients that require, assisted reproductive technology, they're undergoing IVF, they're taking medications for that and they notice that their moods are changing. These are all sort of evidence that hormone flux is driving something in terms of mood dysregulation.

And so that would increase their risk for symptoms during the perinatal period as well. having a family history of hormonal sensitivity as well would increase that risk. Having, less support, increased stress, kind of the things that we would associate with lower SES, that would be a risk factor for sure.

exposure to domestic violence. certainly we know that women when they are pregnant are at an increased risk if they're already in an abusive relationship of being harmed. having a dysregulated baby, and I think we probably don't talk about that one enough, but having a colicky baby or a baby that has a lot of complications, especially with feeding or sleep, can really, really, really be distressing and, and increase your risk, for [00:21:00] illness.

Dr. Anikó: Yeah, like having a baby in the NICU is a more extreme example, but like you're saying, having a baby that's just their temperament is just harder to settle, harder to feed. All of those things really make it more likely. Yeah. To get premeds, 

Dr. Kara Brown: it's distressing. If your baby is constantly crying and you're doing your best and you don't know what they need.

How distressing and how easy it is to internalize that as you being a bad mom. 

Dr. Anikó: Yeah. 

Dr. Kara Brown: Um, it makes sense why people would be more vulnerable in that situation. 

Dr. Anikó: yeah. Well, and two, so I had postpartum depression and that was before I did bi perinatal mental health training. And my own experience kind of led me into that world, to the point that when I started doing this work, I thought I had invented it.

And then meanwhile there's like all these organizations doing training around it and I was like, oh, well. I guess other people had the same idea. But, um, but that was when I found out that I actually had had risks with my second full-term pregnancy, which is that I'd had [00:22:00] losses before. I'd had losses between my first child and then my youngest child.

And I had had a big life change. Like we had like a big life event happen. Um, so if you move, like anything that takes you out of your stable kind of support system, and then obviously any predispositions to mental health. But one thing that I think we don't really talk about very much is like military families and female veterans, like military families are by definition kind of constantly being displaced from their original home.

And then they just kind of keep being displaced. And so it's just important to me, I think, to have awareness around this. Like I remember a family member. Moved all the way across the world, completely far from family and then got pregnant. And I remember just being like, I just want this to be on your radar, that you're like, you may need more support than you think because this is a risk.

You know, I don't think we always realized that. I certainly didn't think about [00:23:00] that when I chose to live far from my home of origin, that that would have some real consequences when I decided to have children. You know, that that lack of support and sort of root and, and community and family that can be there and help, um, I was so used to and happy to like live my life on my own.

And then once you have a child, you kind of can't play by those same rules anymore and it can have a real, really powerful impact. 

Dr. Kara Brown: Especially here, and I think for female veterans in particular, they have the additional hurdle of not being able to have OB care at va. So VA will outsource your care to the community if you are pregnant.

They have GYNs but they're not necessarily doing the labor and delivery, so fragmentation and care like necessarily happens. And that's tough if you have a community within the VA healthcare system as a veteran, and then you have to go out into the community, then you're hoping that there's a looping in.

But sometimes that, that [00:24:00] ball gets dropped and so that can be difficult. Um, and yes, like it's really, really, really important to have your village nearby. My mom is going to, if she listens to this, we'll be very happy.I missed my parents so much in Boston when I had my son and they live in Florida, and it was not the same.

It, it just was not the same before. It was easy. Um, once a kid comes, it's, it's difficult. And we live in a country that does not support or give adequate time for people to recover after delivery. I mean, that's the other side of it, right? You need your village in part because your employer is going to mandate that you go to back to work far sooner than then sooner.

It's really reasonable or appropriate. And so all these things, will certainly increase exposure and risk to developing A-P-M-A-D, 

Dr. Anikó: right? And I mean, PA DS ob, I mean, I, I imagine that it's obvious to most of the people listening, but it's not like PA DS [00:25:00] stops in that person's body, right? Like the number one risk for the partner to develop peds is the birthing parent, the mom to have PMA Ds, right?

And then the people that kind of pay the biggest price for all of this, besides just the person. Themselves is the children. 'cause you have poor birth outcomes, you have lower birth weight, you have less adherence to recommendations like safe sleep guidelines and car seat safety and things like that.

Um, and who ends up really being affected is the entire family, which then you can argue affects all of society, you know. So I will jump on my soapbox like just for a second because it really, I really get a, my a be in my bonnet about this, that, that reproductive psychiatry. And I love that people are focusing on it.

And I love that people are specializing in it, but it is completely unacceptable to me that people know how to treat preeclampsia and gestational diabetes and do not know how to even diagnose, [00:26:00] recognize, or treat PMAS when it is this common and this devastating to society and individuals and families.

Um, and it really to me just is this indicator of how our current sort of Western medical system. It doesn't really care that much about women and children and families and even the, the childcare system, not having childcare, not being, having to go back to work. You know, obviously we want our village for so many reasons, but as you said so well, we need our village because our system isn't making space for us to have a family and recover.

And, you know, you give birth, it's a huge recovery. It's this huge sort of sacred transitional time that you're sort of trence like becoming a mother that isn't allotted. It isn't allowed for to the point that regular sort of practicing people in medicine, a lot of people do not know how to recognize or treat this disorder when all [00:27:00] of us in medicine treat people who could be pregnant, people who have been pregnant, people who currently are pregnant.

Um, and so it really is a. I just applaud everybody like you who is doing advocacy around this because we deserve so much better and so much better as possible. And you're doing this work in organizations like PSI and the Pate Mental Health Alliance. There's a lot of people doing this work, but I think it is important to call attention to the fact that the system is really, really broken and not serving, and not just, not serving, but dropping people in places where there is grave injury and danger that is not just on that one person, but on their entire family.

Dr. Kara Brown: Yeah. 

Dr. Anikó: So, okay. Soapbox over. So besides PMAD, so we talked about maternal mental health conditions. What are other mental health conditions that can present in the perinatal period?

Dr. Kara Brown: Well, I would say any mental health condition that one can have prior to pregnancy can flare during pregnancy itself. So A [00:28:00] DHD, um, bipolar disorder, panic disorder, OCD, eating disorders, um, all of those can have exacerbations during the pregnancy or postpartum period. And I think there's that kind of myth that if you come in with a preexisting illness, that like pregnancy is the happiest part of your life.

And so symptoms are a personal failing, but plenty of people struggle in pregnancy, um, and when you get the appropriate history, they've had symptoms prior. Um, but just thought for whatever reason that they weren't supposed to feel this way now. 

Dr. Anikó: Yeah. Well, and I think eating disorders too are sort of like a sleeper almost.

Like when you start to think about it, you're like, yeah, if you have disordered eating and all of a sudden your appetite is changing and you're gaining weight and your body's changing. That can be a really big trigger for people to sort of go back to disordered eating patterns or struggle with it. So it is a time that, you know, if you do have a history of that, it's a really smart [00:29:00] thing.

Even if you're sort of like recovered, um, it's smart to start to think about if you needed support, where could you go? And another, you know, interesting as a clinician, very not interesting. If you're experiencing, it's terrifying. But there's even phobias, right? Like even like a very intense fear of childbirth, toca phobia, you can develop phobia.

So there's a lot of things that can happen in this perinatal period. It doesn't mean we need to be afraid of it, it just means it's good to have an awareness so that if you start experiencing these things, you don't think like, A, I'm weird, or B, I'll get over it, or CI need to stuff it down and, and, or it's a personal failing, you know.

You can start to see like, oh, like I might need some support in this area. You know? 'cause I, you know, I love, I'm, I actually am a scout, so I do love to be prepared. Um, and so I feel like information is power and it only helps us to know what could possibly happen so that if it does, we know where to go.

Um, so can you tell us [00:30:00] about the challenges that patients and providers face now regarding the diagnosis and treatment of these conditions? And I'm gonna preface this by saying that when we spoke, we had a, you know, a conversation about what we wanted to talk about in the episode. And you were talking about how it used to really be like stigma, like people wouldn't come and share that they had these experiences and these symptoms and people weren't getting seen and diagnosed and things have changed a little bit though, like it feels like the stigma has reduced a little bit.

Obviously we still need to work on de-stigmatization, but what are challenges that we're facing now in terms of diagnosis and treatment that are a little bit different than when we were just trying to get people to sort of show themselves? 

Dr. Kara Brown: I think to the systems credit, they have increased awareness and screening protocols so that patients are being screened more for postpartum depression than they ever were.

[00:31:00] I think. The downside of that is that there still is a lack of awareness of other illnesses that can manifest themselves. And so patients may be erroneously diagnosed with depression. they may and treated as if they have unipolar depression. And by that I mean, um, if a mother comes to her OB and completes a screen and is indicating that she's not sleeping well, she's got a lot of irritability.

She may be given zol, often told she has postpartum depression, told to follow up with a therapist who's going to do some supportive work, which would be reasonable. But irritability and insomnia are, can be core symptoms of bipolar disorder. So what if she has bipolar disorder and she's having a hypomanic episode?

Being able to get the nuance there and being able to assess a little bit more carefully. That mother is going to need a mood stabilizer and probably sleep support. Um, and missing that [00:32:00] diagnosis can be really harmful. Or say a mother that's not sleeping and is a little irritable, but she has a panic disorder, she might really do well with CBT psychotherapy and medication.

Um, and again, if you're just using the screening and the one label of postpartum diagnosis as a catchall, you prevent women from receiving the custom care and support that they need. and for a lot of women, I think it's important because this is their first engagement for many with the mental healthcare system.

 and a bad experience, a bad seminal experience can shape how. They engage with mental health for the rest of their lives. It can, if it's done poorly, it limits their family size. They decide I will just rather not get pregnant again than to possibly go through this a second time or a third time. Um, so really, really is important to not only like the next steps are.

Getting the diagnosis right. And that unfortunately, [00:33:00] fortunately, unfortunately for the system, like it takes time. Like you need to do more than just issue a screen and prescribe a medication. You have to actually talk to patients. You have to gather more detail. Sometimes that actually means you need to talk to the spouse or the mother or other support systems that know this individual well.

It's, it's just not a quick and easy solution. And I think that can be tough for providers pushing up against really busy schedules with limited timeframes to see patients. But unfortunately it's a, it's a necessity to give excellent care. Um, and we don't like the system. We don't want it to just give good enough care.

We want excellent care. 

Dr. Anikó: Absolutely. And I think one of the things, and it's not something that providers want, because we all want to spend time with our patients. We all want to take that really. Detailed medical history because it's in the history that we get so much information. I mean, it's usually, you know, sometimes you do need labs [00:34:00] and that kind of thing, but so much of our diagnosis and information, especially in psychiatry, you know, comes from a really detailed, rigorous.

Patient history. And that doesn't happen in a second. And especially in psychiatry, where people have some shame around it sometimes and don't wanna share it. And it takes building a relationship and it takes, like you were saying, talking to more people, saying, has this ever happened before? Did they ever have an episode where they weren't sleeping a lot?

Because what a lot of people listening might not know is that if you give antidepressants to somebody who actually has bipolar that you think has depression, that can set off a manic episode, you know, which can, you know, isn't always the worst thing in the world, but can be like, can actually be incredibly dangerous at times with certain people and in certain situations.

So really having somebody who's experienced, and can appreciate the nuance and can address the nuance is really, really important. And one thing, you were talk, one thing you said that I just wanna make sure to include, 'cause I just think it's [00:35:00] so brilliant when we were talking, you said, yeah, you know, there's people who, you know, sometimes people don't know what to do as providers and so they're kind of hesitant to even do the diagnosis.

Like, they'll kind of just be like, oh, I think it'll be okay and let kind of kick the can down the road a little bit. You know, where it's like, let's see how you're doing in a couple of weeks. And what you said in our conversation was like, yeah, you don't want, people don't wanna open up a can of worms if you don't know what to do with worms.

You know? So they're like, Hmm, whatever. Let's not even open the lip. 'cause I don't know what to do with what's inside. And so. When people are finding themselves, and we'll get into sort of warning signs and symptoms to look out for. And even like true red flag kind of emergency, like call 9 8, 8 right now, kind of signs.

Um, but there are a lot of organizations that are meeting that need between what the system has been set up for and is capable of providing and the really expertise information that certain people, certain [00:36:00] providers can provide. So if you are a patient, and you're suspecting that something's going on and you may need support, what are your recommendations as to where to go to seek care?

Dr. Kara Brown: Yeah, the reality is that's a tough one. Um, and there's no ideal solution, I would say for a lot of people. A reasonable first stop is. Would be their obs, um, just because you would hope that they would know of existing support systems that they are able to readily refer and engage patients in care. Um, if you have an OB that is not, let's say, psychologically minded or is not aware, um, you may really have to push and advocate for yourself.

Um, many states, including Louisiana, um, have perinatal, uh, access lines, and some of them are for patients only. Some of them are for providers only. Some are for [00:37:00] both. But that is an excellent resource for being able to call, um, getting referrals, getting plugged in with resources. Um, certainly in Massachusetts we had Mcpa for Moms, which was an amazing resource.

Any patient. Any provider in the state could call touch base with a care coordinator who would listen, give feedback, give recommendations, and if needed they would schedule a consult for us as psychiatrists that were running the program to talk to their provider,

 and then if needed, set up an actual face-to-face consult, which was really cool. So you'd have patients from all over the state driving in for a one-time consult, and then they would leave and their OBS would leave with a solid treatment plan in place. Um, and so several states have programs that are under-resourced but also underutilized.

I think there's just not. Good awareness. Um, and so that would be another place potentially [00:38:00] for finding out who might be available as a resource, um, to seek care, postpartum support, international. And I know we'll talk about them at length, but I can't say enough good things. Like they have an excellent directory in terms of being able to pop in.

I live in the state. Okay, you live in the state. Here are all the people that are certified that are expressing an interest. Um, and you can hopefully find a provider in that way too. 

Dr. Anikó: Yeah, I have definitely gotten calls and we've even communicated about people that have sort of sent out, um, the request to be seen by a provider and just from the provider end too, you know, even if, 'cause you know, sometimes we'll get a call or a, or a message from somebody that says like, I don't have insurance, I can't pay for care.

And there are support groups, like there are places that, that we can plug people into. Um, sometimes through the university, Tulane used to have a really great fourth trimester, um. Program as well. Um, so the perinatal [00:39:00] providers, even if they can't see you directly, they can plug you in with other resources that could be helpful as well.

Um, and so we will also talk about, we'll talk about the PSI helpline, so well, we might as well talk about it right now, just the helpline so that if people are, you said, reach out to your ob, certainly if you already have a psychiatrist or a therapist to reach out to them. But there's also the PSI helpline that you can call at any time.

 and we'll include those in the show notes. And then there's the maternal mental health hotline, which is 1 8 3 3 TLC. Mama. It's easy to remember, but that can be a really great place to start and to start being plugged into some real care and real support. And then what I just. I think is so remarkable.

And also so few people to your point, have heard about it. There's also provider to provider consultations that PSI provides. So if for some reason a provider feels kind of what you were saying about that amazing program in Massachusetts, [00:40:00] which, you know, just goes to show like we can create better systems and, and we do, but it takes some time and some, some advocacy.

Um, but if, if as a provider you feel under-resourced and you don't really know where to refer or how to treat, can you tell us about the provider to provider opportunities potentially, um, to, to get some support? 

Dr. Kara Brown: I mean, certainly if you don't have a perinatal access line, postpartum support has you covered.

And so the purpose of their provider to provider consultations is that you can ask a specific question. I have a patient, she's 14 weeks pregnant, she's on Seroquel, she's wanting to think about stopping medication or tapering down. I'm not sure what to tell her. Can you assist? And yes, you can speak with an expert and they'll probably ask for a little bit more detail, but you will end up receiving sort of a more nuanced guide to way of thinking about approaching her care [00:41:00] than simply, well, it's category so-and-so, which is of course outdated as we know.

Like we don't do that. But again, that's sort of the older information that was available that people I think were over relying on to kind of make complicated decisions around medications. and now. Having that access to a provider directly can, can hopefully help give a little bit more detail and complexity to a patient case 

Dr. Anikó: and I think it's also really wonderful. We will get back to the outdated ness of the categories of the medication when we talk about medications. Yeah, that's the perfect face for that. Aw, I know. But I think it's so important for a providers to know this and then if providers don't know it, that patients know it and they can say, Hey.

Like if you, if this isn't your jam or you, this isn't your particular area of expertise, can you call this provider to provider hotline? You know, like, it doesn't have to necessarily be information the provider already has. [00:42:00] It's something that the patient can even come with, you know? Um, just the more people who know about it, the better, you know.

 and so can you, so like we talked about, can you share some mental health kind of warning signs to notice that are like, you know, I should, I, I should take this seriously and I should get seen. I mean, I'm always an advocate of like, when in doubt get seen, there is no downside to going to get seen. And them saying, this is benign, you know?

But also if you, if you are getting the message that it's benign and that's actually not your experience. 'cause that also happens too, you know, to, to trust, trust your gut. That, that, if you're feeling like you're not okay. To just keep, keep advocating for yourself and keep seeking support. So what are some warning signs, which are like, notice this, maybe get evaluated, and then some like flashing red go immediately, like, call 9 8 8.

Like, get support right this second. 

Dr. Kara Brown: I would say some of the general warning [00:43:00] signs would be things like crying spells, um, feeling like you're not bonded with your baby. Um, guilty ruminations. Again, the feeling that you're, you're not doing a good enough job, that you're, you're lacking in some way. Um, irritability that's kind of persistent and not sort of directed to an appropriate situation.

Sometimes people will be like, I'm irritable, and then they describe the situation and I'm like, I'm irritable on your behalf. Like, that makes sense. If it's general out of your control, not appropriate to a situation and you can recognize that it's excessive, like that is a core symptom. things that would make me a little bit more worried for urgent care, if you're not sleeping despite the ability to do so.

So sometimes the people, I, I'm not sleeping, of course, like that is very common. But I think again, in terms of a thinking about perinatal bipolar disorder, like the inability to do so when you have the opportunity. So I'm not sleeping, but turns out husband is taking the baby overnight. I have a full eight hours because there's a bottle of pump milk and I [00:44:00] can sleep, but I don't, and I stay awake and I'm not even tired.

That's more urgent. That's more concerning. Any paranoia or suspiciousness. hard to sometimes have that internal awareness if it's happening, but if other people are raising it as a concern, it would be worth sort of more urgent care. and then of course, any thoughts that, like the family would be better off if I just weren't here.

I just wish I could get in the car and go, um, I'm, I'm at the edge. And then the frank suicidal ideation, like those would of course be more urgent warning signs to get care. 

Dr. Anikó: Right, right. And homicidal, obviously it falls in that category. And then of course any hallucinations, whether that's hearing voices or seeing things. I think it's important too for family members and friends to also know these warning signs because sometimes the person experiencing it either doesn't have the insight or is just sort of not, not as aware anymore. So I think that's also a super valuable thing for if your family's saying [00:45:00] you're behaving strangely, believe them, you know, and seek care.

And hopefully your family will also be helping you seek care. Because it's pretty hard to be your own advocate when you're suffering so greatly. You know, and I think too, the misconception that PMA Ds is just like crying all the time, you know, like it can be anxiety, it can be, you can have perinatal OCD like you said.

I mean, there's so many ways that things can manifest. and. You deserve and need support. But I think, you know, people, if it's not somebody just crumpled in a ball just crying endlessly, they don't always see it. They might be like, oh, she got really weird. And like, she's so particular about things now that she's a mom and meanwhile this poor person has perinatal anxiety disorder.

You know, and they're just sort of being written off as like, well, she got weird when she became a mom. So the more, again, the more awareness that we have about how this looks, how it can present, the better off we are. So Dr. Brown and I wanted to take a moment to kind of debunk some myths together today.

So I'm gonna share some [00:46:00] myths, and then Dr. Brown is gonna give us the reality check. I wish I had like a buzzer that was like www reality check. Um, I don't think our listeners want to hear like a huge horn over and over again, but I like the idea of that. Anyway. So the first one is that pregnancy and postpartum should be the happiest times in your life.

Is that true, Dr. Brown? 

Dr. Kara Brown: No. And I, I, the reality is pregnancy is a medical event like labor and delivery is, it's, it's a lot. It's a major transition. And I think, thankfully, I think COVID dispelled that for a lot of people. I think there's more acceptance that the world at large can contribute to not feeling particularly thrilled or excited.

Um, I think there's more awareness too, as we know about physical co. Like, if you're not feeling great because you're throwing up all the time, like of course you're not gonna feel great. Of course it's not gonna be the happiest time of your life. If you're sick, you're on bed rest. Like you, you might struggle.

Um, so I [00:47:00] think there's a, that has been mostly debunked, but it's still a little, there's, there's still room for improvement there. 

Dr. Anikó: Mm-hmm. 

Dr. Kara Brown: Um, many people don't have a great experience in pregnancy, and that is okay. 

Dr. Anikó: Yeah. And this doesn't mean nobody does. I mean, plenty of people do have an amazing time in pregnancy and postpartum, but just because you don't, doesn't mean you're doing anything wrong.

Or there's some anomaly. Like there's a, there's a huge spectrum of how people experience this time, and it's dependent on the vast number of things. All right. So if I'm, the second one is if I'm not bonding with my baby right away, kind of like my baby's kind of boring, or I don't enjoy this, something is wrong with me.

True or false, Dr. Brown. 

Dr. Kara Brown: absolutely false. that's totally normal. Babies, especially when they're young. I know. You know, like developmentally, they're not necessarily given a ton back. I would say, and especially after birth trauma, that idea of attachment might be delayed and still come a [00:48:00] little bit later.

 But the idea that you need to be bonded right away, that you need to be in love with the baby phase. Nah, a lot of people don't. And, and that's fine too. 

Dr. Anikó: Yeah, that's, so I think that's so validating for so many people to hear. And I definitely saw it in the office sometimes and you know, with the right family, you know, 'cause they don't even look at you directly for a couple months, you know.

And I remember just joking with parents just like so rude, right? You grow this baby and they like, don't even look at you. You know? And some people enjoy every cuddle and every smell and, and others don't. And like it's all okay. You know? Um, and like you said, there can be also delayed attachment depending on the kind of birth experience you had or even the pregnancy you had.

And there's a lot of factors that go into it. Alright. the next one, p Mads or perinatal Mood and anxiety disorders are the same as baby blues. 

Dr. Kara Brown: when we think of baby blues,

 We're thinking of something that's time limited and that's mild.

So [00:49:00] it's not uncommon for women to describe crime spells feeling overwhelmed. having second thoughts, having anxious ruminations. All of those are normal, and all of those are pretty common. So 75 to 80% of women will experience baby blues and when baby blues end usually around the two week postpartum period.

So when I'm checking in with patients, I usually will schedule them at postpartum week two to three because if they're still having symptoms after that, that makes me more worried. that makes me more worried that they might be developing postpartum depression or an exacerbation of their other illness.

If they have a preexisting, it just makes me more worried that something else might be going on. baby blues is not associated with suicidal ideation. baby blues is not associated with a decrease or a decline in functioning. So that's the other thing. baby blues, if you're feeling overwhelmed, but you're attending to task.

Falls within the normal scope of experience. If you're bedbound because you're riddled with [00:50:00] guilt and anxiety, that would be a warning sign that it's, it's something more serious that Lauren's treatment. 

Dr. Anikó: Mm-hmm. Yeah, that makes a lot of sense. And certainly anything that shows up after three weeks or a month in or something, it's unfortunate.

I mean, I'm glad that people know about baby blues and that it's so common, but what's unfortunate is that sometimes things get written off as baby blues when it's clearly not that, and then people go undiagnosed and untreated when they really could use some support. 

Dr. Kara Brown: if you are showing up for your six week postpartum check. Like it's not baby blues at that point. And so being able to recognize and, and push back. 'cause sometimes I think well-intentioned obs will still say, well, let's wait and see.

But like if it's the six week postpartum check and you're, you're feeling poorly, it's not baby boos by definition. So it, it would warrant, even if it's milder illness, it would warrant being addressed. 

Dr. Anikó: That's such a pearl of wisdom. And I do need to give a shout out to my midwives because they definitely recognize my [00:51:00] postpartum depression.

And I was very like. I was like, this questionnaire is stupid. Of course I don't have great, of course I'm not sleeping well, of course I don't enjoy the things I am, I can't do the things I used to do. but I was already seeing a therapist. And so they did their, they did their due diligence. They did spot it.

But that's so important I want to say it again, that if you're having symptoms at your six week postpartum visit, it is not baby blues. Like by definition. That's really, really important. okay, another obvious one, right? Everybody needs to come off their psych meds when they get pregnant, right?

Ideally before they get pregnant, right? and you should stay off of them throughout pregnancy and breastfeeding. 

Dr. Kara Brown: this one breaks my heart 'cause you'll still see providers again. Probably well intentioned, but certainly not psychologically minded, making the recommendation or encouraging patients to do this.

sometimes without even looping in their psychiatric provider, which always bothers me. I'm like, you could at least have them call [00:52:00] me. but absolutely not. We certainly know that with pregnancy, I tell patients, you don't get to make a risk, rejoice, unfortunately. So it's more of a risk, risk analysis, untreated and undertreated.

'cause I think that's important too. Illness is a fetal exposure and is a risk, same as the medication. And so you get to make a decision based on the fact that there's no ideal choice in terms of eliminating all risk with the respective medication versus illness. there will be some risk involved potentially, and.

You get to make the choice that then feels best for you, keeps you healthy, keeps you happy, and I guess I would put a shout out or a plug for preconception planning because I do think that there are some cases where maybe a woman does want to consider stopping medication in anticipation of pregnancy work could be appropriate.

But if her [00:53:00] plan is just to wait until the positive pregnancy test and then stop the medication abruptly, that actually can be riskier than if she had have identified and made a plan months in advance to do so and watch carefully. I think preconception planning whenever possible, gives you more options, I guess I would say, right?

More options to consider, 

Dr. Anikó: right? Because the hormones, the hormonal changes of pregnancy and childbirth and postpartum obviously have a huge impact on your mental health symptoms. And you know this. Is so prevalently thought that people will stop their own medications. So not even consulting a doctor or a provider, you know. And so can you talk a little bit about the risk of untreated and undertreated mental health conditions in pregnancy? Like to the, to the fetus? 

Dr. Kara Brown: I think some of the risks, and it depends on the illness too, so I'll put that out there. I think as we [00:54:00] conceptualize a lot of the depressive, I'll exclude bipolar disorder, um, and anxiety disorders.

There are impacts in terms of associations with babies being a little bit small for gestational age, preterm labor. These tend to not be clinically. Significant differences, but there are measurable differences that are worth being aware of. I think for a lot of people, hypertensive disorders in pregnancy, there's not a lot of awareness that untreated uncontrolled anxiety does increase their risk.

certainly having a difficult pregnancy increases your risk for having postpartum illness too. And the ability to function properly in terms of a mother infant dyad can be disrupted. not being able to do the things that you wanna do in those early postpartum months, making your pediatrician appointments, making your own follow-up appointments, getting back on [00:55:00] birth control, if that's important to you.

 like you said earlier, using car seats, safety devices, things like that. all those things kind of are at risk if you are untreated or undertreated. 

Dr. Anikó: Yeah, and I think it's such an important point because it does sometimes feel like when medications and you know, not everybody needs medications.

Sometimes you do in emergent situations you do. Um, but it is a treatment option that people should be presented with along with all the risks. But it sometimes feels like people feel like they're choosing between like medication that's risky and then not medication that's not risky. And the reality is like not, medication is risky too.

You're just choosing between, like you said, very well. Sort of a, not, not ideal situations because both have risk, but you get to decide and be guided by an experienced provider around all of that. So we touched on it very, very quickly, earlier about sort of the recommendations, around [00:56:00] medications that are based on very old data.

So can you tell us what the actual situation is? Because, you know, even as a pediatrician, there's, there's psychiatric medications that I studied, like Lithium for example, that was like, no, no, no, you don't use it during pregnancy. It causes these birth defects. But what is the actuality present day knowledge about psychiatric medications?

Dr. Kara Brown: I would say a couple things to think about would be that probably because of stigma, we have a lot more research on psychotropic meds compared to. Other specialties. and so again, like we have an evolving and growing literature simply because people are so fearful of taking medication out of the idea that it might harm their baby and that they should be able to control and manage their mental health on their own, which it's a shame.

That being said, I would say we have robust data looking at SSRIs in pregnancy, those will probably be the best studied, um, in terms of [00:57:00] Depth and breadth of research. I would say mood stabilizers tend to have a lot of literature as well, because a lot of them are used by our colleagues in neurology.

And so we can draw upon their research looking at the seizure, anti-seizure medications. and so anti-epileptics like Lamictal, or Gabapentin or Tegratal or Trileptal, a lot of those medications like we can pull from neurology's guidance there and extrapolate for our own use. So I would say those two categories are the most well studied.

 there are pregnancy data registries everywhere. certainly Mass Brigham, has a huge and growing registry looking at atypical antipsychotics in pregnancy and they're constantly recruiting and you don't have to do anything except for be willing to provide information like.

To be contacted, just to kind of continue to gather more cases, more exposures, and being able to determine are there any causal outcomes related to it. 

Dr. Anikó: Yeah, [00:58:00] that's great. That's a such a great resource. And also, this is somewhat related, it's not exactly the same, but I also wanted to just put out the infant risk hotline because just like a lot of people say, you know, this medication is not compatible with pregnancy.

A lot of people believe that certain medications are not compatible with breastfeeding. Um, and the more data that we get, the more we realize that that's just been overdone to the point that it interrupts breastfeeding, right? Where they're like, you're gonna have to pump and dump after your x-ray or whatever it is.

Um, and infant risk hotline is another great resource for people who are breastfeeding, who want to, um, either educate their providers or themselves on, um, what medicines are safe and are not during breastfeeding. But it's a lot more than we thought earlier based on the more recent data that we're getting.

Dr. Kara Brown: Yeah, I think traditionally we used to think of medication risk in the sort of categories, FDA categories of [00:59:00] A, B, C, D, X. And I mean that's more than a decade now since they scrap that. And so I think even at the sort of larger systemic level, there's a recognition that to label A medication B or C or D is an injustice to the woman taking the medication who might need a more nuanced approach, the impact of a medication on her day-to-day functioning.

Again, that risk. Risk. I just saw a patient earlier this morning with a DHD when she's not on her stimulant, she, she crashes cars. Like she gets into their safety issues and so to say you can't stay on your medication because it's a certain category. But it would be okay if you drove your infant child while you're pregnant to daycare and potentially get in a car accident.

That just makes no sense. It's, it lacks nuance. It lacks, it lacks compassion. It lacks the specificity needed and sort of required to get good care. I think. [01:00:00] 

Dr. Anikó: Absolutely. I mean, I think if there's any big thing that I feel like all physicians are fighting for right now, it's the individualization of care and the right and the agency to be able to treat their individual patient as an individual that maybe this medication wouldn't be right for that person, but it's right for this person for all of these reasons that we've determined.

 and for the people who aren't familiar with that, system that you were talking about, that was scrapped a decade ago, which I think a lot of people don't know. Can you just quickly go over the sort of what the categories were and the, and also the fact that it's not relevant anymore?

Dr. Kara Brown: So yeah. A, B, C, D, XA meant no risk in controlled human studies. B meant no risk in animal studies, but no human studies or vice versa. C meant that risk could not be ruled out and that there existed animal studies that could show adverse [01:01:00] events. D indicated that there is positive evidence of human fetal risk, and then X meant absolutely contraindicated risks are always gonna outweigh the benefits.

Dr. Anikó: Right. And I think it's that sentence that is so problematic that they just made a statement across the board that risks will always outweigh benefits. And that's just not the case for a lot of, a lot of things that ended up in that X category. and to be clear, this was specifically medications taken during pregnancy and their effects on the fetal development.

 okay. Well, let's talk quickly about PSII have like a couple more questions, but I wanted to, 'cause we kind of touched on PSI and we said there's helplines. So tell us about PSI. 

Dr. Kara Brown: Sure. Um, PSI stands for Postpartum Support International. Their website is postpartum.net. and it is an amazing organization.

I don't think I realized despite seeing them at the MONA Conference in Toronto, like, but there is a Canadian presence, but [01:02:00] there is, it's North America. Um, and PSI does a lot, um, at multiple different levels. So they do a lot of work on the advocacy side. Um, but they also are available. At a resource level for patients and providers.

And so in terms of resources for providers, we talked a little bit about the consultation line. They also have monthly groups, um, that are option. You can just come when you want. If you have a case question. I used to run one of the groups on Fridays until my schedule changed, but once a month we'd log in and anybody from anywhere could call.

I have this question. I have this patient. Okay, goodbye. I'm in the middle of my lunch, I'm logging off. And then it's a, it's a wonderful free resource. Um, PSI has a lot of trainings. They have a lot of webinars and seminars that go on. They're constantly, if you sign up for their listserv, like they'll let you know.

A [01:03:00] lot is online, but a lot is local. Um, they have annual conferences. Um. They have a specific program to train patient, or, or not patients, excuse me, providers, um, in perinatal mental health. Um, certainly it's not as comprehensive as if, uh, you did a fellowship or something like that, but I think it still gives enough education to feel confident with the basics and some of the more difficult cases.

 and so they do these two day trainings several times a year. They always do it at their conference. I know for the state of Louisiana there, there's actually gonna be a training coming up next month that will be a two day, for people that are interested more in the therapy side, they have advanced psychotherapeutic, conferences as well, and trainings as well.

It's, they, they do a lot. And then on the provider side, I would say they have a ton of online support groups. So that was really, again, COVID [01:04:00] led to a lot of groups that had been local. Going ahead and consolidating and becoming larger groups online. So I think they have over 25 different support groups for a variety of different types of needs and groups.

And so again, you can drop in when you're, you're interested. You don't have to necessarily commit to attending for a certain amount of time, but a wealth of information. They're all led by trained individuals. Um, those groups can be a great way for patients to, again, sort of recognize that. What might feel like, oh my goodness, I am crazy.

It is just me is a common experience that women all over from all walks of life are experiencing. So I can't say enough good things about their support groups. They also have some support groups for dads. so I'll put a plug for that as well. Um, they also have an online directory, and I think we talked about it a little bit earlier.

So you can say, I live in XY state, and you can, am I interested in medications and people that can [01:05:00] prescribe? Am I interested in therapy? And you can sort of filter and use their directory to find a provider or two that might be a potential good fit for you. So they have a, they have a lot. it's an amazing organization.

They're constantly doing advocacy work. I think there are chapters in every single state. Usually there'll be like one state at a time that's like an outlier where like somebody has dropped and then they fill the spot. But the. There's an active chapter in, in all states. So, if you're interested in learning more or potentially becoming involved yourself, um, a lot of this is peer driven patients that have experienced.

PMAD, they've experienced something more serious. They want to give back, are able to do so through PSI. So it's a, it's a great organization. I can't speak highly enough of them. 

Dr. Anikó: Yeah, I agree. And it's such a, it's like a group of kindred spirits. When I went to the conference, it just felt like, I just remember being in some of the seminars and everybody starting to cry and we were like, you do, I [01:06:00] know.

You know. Um, and if you go to the website, at the bottom of the page is an area for help seekers. So that would be for patients to, for support hotline, support groups, materials, resources, and like you said, that great provider directory. And then there's another section that says for professionals. So that's the training and the webinars.

And if you actually do wanna get certified. the PSI conference this summer in 2026 is going to be in Los Angeles, and I, uh, provided the maternal mental health hotline earlier, but the PSI helpline is 1-800-944-FOUR 7 7 3. And The Maternal mental health hotline again is 8 3 3 T-L-C-M-A-M-A, and for mental health crises and emergencies, you would call 9 8 8.

That's like the 9 1 1 for mental health. Um, and so how can people get in touch with you if they're interested in working with you or learning from you? 

Dr. Kara Brown: Yeah. I am licensed in Louisiana, Mississippi, and Massachusetts, so I only [01:07:00] see patients there for, for medical care. I'll educate anybody anywhere. I really do love teaching and I, I do miss doing it as a primary duty.

people can reach out to me either. I have a Psychology Today profile, Kara M Brown. There are several Kara Browns, which is kind of interesting, who are in healthcare. So Kara m Brown will take you to me. and my website is Nola Repro psych, N-O-L-A-R-E-P-R-O-P-S-Y-C h.com. People can touch base with me there 

 and I'm on Instagram. I don't run my own Instagram, so I always forget to mention my socials, but my social media manager, Mary Beth, will be happy to engage and connect. so Instagram as well. 

 all in the Nola Repro side candle. 

Dr. Anikó: and what kind of services do you provide? So you see patients in person in Louisiana, Mississippi, and then what other in, in Massachusetts as well? 

Dr. Kara Brown: Yeah, I'll come to Massachusetts once a year, and see patients face-to-face [01:08:00] and the rest of our work is virtual.

 same with Mississippi. Sometimes if they're like close enough that they want to come into Louisiana and see me at New Orleans, I'm happy to do so. But I try and make a trip to Jackson at least once a year, to see patients in person if they want. Um, I offer medication management. I offer second opinion consults.

I love putting together preconception plans. So if you have a provider and they're not sure what to do, but you want me to give them a roadmap, like happy to do so. Um, and then for a select amount of patients, I will also do psychotherapy. usually it's around, Provider burnout if they try and like go back into work after a baby and kind of, like, this is a lot and like medicine is a lot, so let's, let's reassess.

but yeah. 

Dr. Anikó: Yeah, I just feel like your whole, I don't know, it's like you become this like web instead of having any walls. I don't know. I feel like especially soon after [01:09:00] I had my children, I just felt so porous, you know, that I was just sort of taking everything in, in a way that was very overwhelming.

But, but I really, I think especially. This idea of getting like a roadmap from you, like a provider who maybe isn't well versed in this and the patient can reach out to you and be like, Hey, can you help us create a plan? Um, but what an amazing, I know everything you, you offer is amazing, but you know, for people that can't see you directly, that's another way that they can, you know, benefit from your expertise.

 Well, thank you so much for being on Nourish Today. It was so lovely to talk to you and we've met and interacted over email and things before, but this is the longest we've ever spoken. It really was a pleasure. 

Dr. Kara Brown: Likewise. And thank you for having me. I, I really appreciate it. 

Dr. Anikó: Well, thank you all for being here with us and I hope this helped.

I can't imagine that it didn't, because Dr. Brown is such a wealth of information and [01:10:00] compassion and fierceness fierce protection of her patients. and so I hope you take this forward with you to help the help of yourself or a loved one. And I will see y'all next week. Take care of y'all. 

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