21. Asking Better Questions: My Reflections on the Annual PSI Conference

Recently, I had the opportunity to attend the annual Postpartum Support International (PSI) Conference. While I came home with pages of notes, new research, and countless ideas, I realized I didn't come home with all the answers. 

Instead, I came home with better QUESTIONS.

In this episode, I'm sharing some of the biggest moments that stayed with me. From an unexpected encounter with a wish tree in Los Angeles, to powerful conversations about maternal mental health, advocacy, and the work that's still ahead of us, this was truly a life-changing experience

My hope is that this episode encourages both parents and providers to keep asking better questions, and to lead with compassion. Meaningful change happens one conversation, one family, and one community at a time. 

We still have a ton of work to do, but together, we have every reason to believe that better care, better systems, and more hopeful futures ARE possible!

Episode Recap:

• My reflections from the annual Postpartum Support International Conference
• Why asking better questions can transform perinatal mental healthcare
• How Kansas is expanding access to specialized perinatal mental health support
• The ongoing need for education surrounding postpartum psychosis
• Why every statistic represents a real family AND real story
• How healing one parent can positively impact future generations
• Replacing judgment with curiosity in healthcare & parenthood
• Building trust through compassionate, patient-centered care
• Why perinatal mental health is a public health issue (not just a parenting issue)
• Finding hope through advocacy, education + meaningful systems change

**Disclaimer: The content shared in this podcast is for educational and informational purposes only, and is not a substitute for therapy or mental health care. If you’re struggling or need support, please reach out to a licensed mental health professional in your area, because you don’t have to go through it alone.

Links/Resources:

• Postpartum Support International (PSI)
• Women Are Dying, Deb by Emily E. Johnson
• Follow on Instagram @tztherapy
• Check out my website

Transcript

SPEAKER_00 0:00

Hi friends, welcome to Reproductively Speaking. I'm Karen Spiker, and every week we will explore the intersection of parenthood, purpose, and mental well-being for honest stories, expert insights, and practical tools for everyday life. Grab your coffee, take a deep breath, and let's get into today's episode. Hey friends, welcome back to Reproductively Speaking. I'm Taryn Sweigert, your host, and I'm so glad that you're here. A couple of weeks ago, I had the opportunity to travel to Los Angeles for the annual Postpartum Support International Conference. If you've never heard of PSI before, it's a national nonprofit organization dedicated to promoting awareness, prevention, and treatment of mental health issues that are related to childbearing, both to public and professional communities around the world. And so every year, providers and researchers, advocates, parents, doulas, nurses, therapists, and so many other professionals around the country and around the world gather to learn from one another and continue pushing research and all of the things in the field of perinatal mental health forward. And as I sat down to start planning and recording this episode, I felt a little overwhelmed and I wasn't quite sure how to talk about it. And not because I didn't have enough to say, but almost the opposite. Like I have so much to say. I came home with pages and pages of notes and more books to read and research and ideas and just all sorts of conversations that have stayed with me. Um, and questions that I haven't been able to stop thinking about. And the more that I reflected over those four days, the more that I realized that I didn't come home with all of the answers. I came home with better questions. But before I tell you about the conference, I actually want to tell you about a tree. Because somehow I think that the tree sort of became like the beginning of this entire episode. So, sidebar. And if you know me, you know this isn't unlike how I am. Um, so it happened while I was walking around the city of LA. Uh, I stumbled across this beautiful tree. It was sunset, getting dark. And at first I didn't really know what I was looking at, but as I got closer, I realized that the branches were covered with hundreds, maybe even thousands, of little paper tags. And every single tag was someone's wish. And I probably stood there for 15 or 20 minutes just reading them. And some were written by children, some by adults, some were written in languages that I couldn't even read. Some wished for peace, some wished for love, some wished for a family member to get better who was sick, some wished for their own better health or success, some were really funny, and some absolutely broke my heart. And standing there, reading The Hopes of Complete Strangers, I had this overwhelming realization that there are so many days where our world feels so incredibly divided. And we spend so much time focusing on what makes us different, different opinions, different backgrounds, different experiences, different beliefs. But standing underneath that tree, I realized something. When you strip everything else away, we're all hoping for many of the same things. Um, to be loved, to love, to feel safe, to know that our families are okay, to experience a little bit more joy, a little bit more peace, a little less suffering. And looking back now, I don't think that I realized it at that moment, but that little wish tree sort of became the lens through which I experienced the entire conference. Because I think at the heart of perinatal mental health, that's really what all of us are working towards. Not perfection, not having all of the answers, just helping families suffer a little less and helping them feel a little less alone and helping them hold on to hope. And, you know, I've been working in perinatal mental health for almost 10 years. And one thing that's always been important to me is not that I'm just doing this work in my therapy office every day. As much as I love sitting across from clients, I've always believed that I also have to work upstream, build better systems, educate providers, advocate for policy changes, collaborate across disciplines, because while therapy changes lives one family at a time, systems also have the ability to change thousands. And so at the conference, one of the really unique things that I was able to do was be there not just as a therapist. I was also there representing some of the work that uh we're doing across the state of Kansas here. Um and for those of you who don't know, Kansas was awarded a federal grant to establish what's called a psychiatric access program. And I know that that probably sounds incredibly technical, but here's why it matters. So imagine that you're an OBGYN in a rural community or a family physician or a pediatrician, and you have a patient who comes in who's pregnant or postpartum. And maybe they're struggling with anxiety, or maybe they're experiencing depression, maybe they have bipolar disorder, maybe they need medication, but you're unsure like what's the safest medication during pregnancy or when they're breastfeeding. And so instead of feeling like you have to figure it out all alone, um, you now have access to a psychiatrist who specializes in perenatal mental health, and you can literally just pick up the phone, ask all your questions, consult about medications, talk through substance use, discuss lactation, get a referral to a therapist, and that expertise helps you to create a plan and it can be it can allow you to reach providers all across the state. So not just in Wichita, not just in Kansas City, but also in rural communities where specialty care can be incredibly difficult to access. And I think that matters. It matters because where you live shouldn't determine whether you receive quality mental health or physical health care during one of the most vulnerable seasons of your life. And beyond that, through the psychiatric access program, we've also had opportunities to provide trainings and scholarships and build sort of like this stronger workforce so that more families across the state of Kansas can receive this specialized care closer to their home. And I'll be honest, sitting in a room with psychiatric access programs from all across the country made me feel incredibly proud of what Kansas is doing. Were we sharing ideas? Sure. Were we learning from each other and from what other states are doing, of course. But it was also just a reminder that Kansas is contributing meaningful work to this national conversation. And I don't think that enough people know about that and that enough people celebrate that. So there's that little tidbit. But you know, I always have like colleagues or friends or family or whatever ask me, like, okay, how was the conference? What did you take away from the conference? And I've actually had a really hard time with that because my answer isn't just like one emotion or one thing. I think I came home feeling incredibly frustrated and incredibly hopeful at the exact same time. I was frustrated because I was just reminded how much work there still is to do, that there are still parents who are not being screened for mental health conditions. There are still communities where families have to drive hours to receive prenatal care. There are still providers who don't feel confident recognizing postpartum mental health disorders. There are fathers who are never asked how they're doing. There are still parents who are suffering in silence because they're terrified of being judged for whatever symptoms or experiences that they're having. And there's still so many families that are falling through the cracks. And I also came home incredibly energized because I spent four days surrounded by thousands of people who have dedicated their lives to making this better. People who wake up every single day asking, how can we improve this? How can we reach more families? How can we build better systems? How can we prevent suffering before it happens? And I think that's what hope looks like. Hope isn't pretending everything's okay. Hope is looking directly at the problems and deciding that they're worth solving anyway. And that was probably my biggest emotional takeaway. I didn't come home super discouraged. I came home ready to dig in even deeper, ready to continue advocating, uh, ready to continue asking hard questions, and ready to continue building these sustainable changes here in our state of Kansas because families deserve more than just a temporary solution. They deserve systems that are actually going to support them and their needs. And the more that I continue to reflect over those couple of days, the more that I realized that there was one question that kept coming up sort of throughout every session that I attended. And it wasn't always asked sort of like in the same way, but it was always there. And it was this What if we've been asking the wrong questions? And that question just followed me through almost every breakout session I attended. There was one session that I don't think I'll ever forget. It was a panel discussion on postpartum psychosis. And this year actually marks 25 years since Andrea Yates experienced postpartum psychosis and drowned her five children. I imagine that most of you listening have heard that name before. Maybe you're like me, maybe you remember exactly where you were when you first heard the story. I know for me, like I remember the headlines and I remember the shock and the horror and all of the terrible things that people said about her or believed about her. But I don't really remember like anyone talking about like what postpartum psychosis actually was. I don't uh really remember anyone explaining that it was rare. I don't remember anyone talking about like the warning signs or talking about treatment or recovery or even just hope. The story just ended with tragedy and she was a murderer. And for so many people, I feel like that's still where the story ends. One of the panelists was actually Andrea Yates' attorney. And toward the end of that session, they actually read a message from Andrea herself. Every year, PSI does a fundraiser at their conference where they auction off aprons that are made by Andrea and they go to the Yates Family Foundation fund, uh, which is helping to provide, you know, obviously resources for her kids, but it goes towards education and research and resources for other families that are impacted by uh postpartum psychosis. When they did this, I don't know that I've ever experienced a room quite like that. A room full of thousands of people, and it was completely silent. No one was looking at their phones, no one whispering, just listening. And I thought to myself, you know, 25 years later, and we're still learning. We're still trying to understand, we're still trying to educate, we're still trying to improve treatment and recognize warning signs sooner, reduce stigma. Um, we're still trying to make sure that families know that they're not alone. And honestly, that gave me hope. Not because that the tragedy changed. Um, the tragedy happened, and unfortunately, tragedies do still happen, but because of our willingness to learn from it has. Um, because today the conversation is ongoing, it continues, and we're asking questions like, how do we prevent this? How do we educate providers? How do we educate families? Um, how can we identify a symptom sooner? How can we ensure that someone gets emergency care before a crisis occurs? And that's progress. It's not enough, but it's progress. And while we're talking about postpartum psychosis, I'll just, I just think it's important to say this. Sometimes when people hear a postpartum psychosis, they become terrified, especially expectant parents. I think because of how it's often vilified in the media and what's said about these people when these tragedies occur. But the majority of individuals who experience postpartum psychosis do not harm themselves or anyone else. However, there is always a risk of danger because psychosis includes these delusional thoughts and irrational judgment. So the good news is it's treatable and recovery is possible. Many people go on to live meaningful, beautiful lives and their families heal. And I just think that's why education matters so much, because knowing what to look for can literally save lives. And, you know, one of the things I kept coming back to throughout the conference was the idea that education changes outcomes. You know, when parents understand intrusive thoughts, they're less afraid to talk about them. When parents know the signs of postpartum psychosis, they know when it's time to seek immediate help. And when providers recognize symptoms, treatment can start sooner. So this knowledge, it's not going to erase the suffering, but it absolutely has the ability to change stories. And that's why I just continue to believe so deeply in education. At the conference, I had the opportunity to meet Emily Johnson. And if you haven't heard of Emily, she's the author of the book Women Are Dying, Deb. And I have to tell you, firstly, this book is amazing. And I think it should be a required read for anyone who works in perinatal mental health. But Emily is exactly the kind of person that you'd hope she'd be. She was warm and approachable, and she just immediately made me feel comfortable. She signed my book and we chatted for just a minute. And I remember thanking her and not just for writing the book, but for being brave enough to tell the truth about her experience and her story, because telling the truth about maternal health isn't always comfortable. And sometimes it means talking about maternal mortality. It means talking about disparities and mistakes that healthcare systems have made. And it means talking about healthcare systems that don't always work the way that we hope they will. It means talking about families who fall through the cracks. And, you know, these aren't easy conversations, but they're necessary ones. And during our conversation, I remember telling her, like, I had had my book all tabbed up and things highlighted and underlined. And I was just like, I can't wait to take this back to Kansas. And I realized that's really why conferences matter. It's, you know, it's not just about collecting information and not just about getting our CEUs so we can renew our license, but it's also asking this question of like, well, okay, what am I going to do differently because I learned this? How do we take these conversations home? And how do we make them matter for the families that are sitting right in front of us every single day? Because at the conference, every statistic that we discussed represented a real person. Every diagnosis was somebody's daughter or someone's partner, someone's best friend, someone's coworker, someone's mom. And I actually wrote that like in the margin of my notebook when I was taking notes like every statistic is someone's story. And that sentence has followed me through the rest of the days since I left the conference, because once you start looking at these statistics that way, they stop feeling like numbers and they start feeling like people. Sometimes we talk about maternal mental health as though we're only helping one person, one family, but that's not really true. Uh, and Emily talks about this in her book. But, you know, because untreated maternal mental health conditions don't stop with one generation. Um, research has shown that untreated anxiety or depression or chronic stress during pregnancy can actually impact a child's emotional and behavioral health. Okay, so those children are impacted, those children grow up, and some may become parents themselves. So they're going to bring their own experiences into parenthood, which then shapes the next generation and then the next and then the next, right? So you see where I'm going with this. So when we help one parent heal, we're doing so much more than helping one person. We're interrupting the cycle, we're changing family trees, and you know, healing isn't just personal, it's generational. And I think that we just don't talk about that enough. And this idea of healing across generations sort of leads me into another conversation or uh topic that kept coming up throughout the conference. And one of the other sessions that I attended was um introducing a liberation framework to perineatal mental health. And this is sort of where like these questions continued, right? So as therapists, we spend a lot of time trying to understand context. Instead of simply labeling symptoms, we might ask, like, what happened or what barriers exist? What losses are they carrying? What symptoms have supported or failed them? Because every parent carries a story into their healthcare, into the delivery room. And some stories are filled with support, and other stories are filled with grief and trauma or financial stress, discrimination, and context changes everything. And one of the phrases that was discussed during this breakout session was uh this idea that mistrust is earned. And I wrote it down immediately because it felt so true. Because sometimes in healthcare, we expect this trust to be automatic. We think I'm the provider, you should trust me. But for so many families, trust has already been broken long before they even walk into our office. Maybe they had pain that wasn't believed or dismissed during past pregnancies or during their current pregnancy. Um, maybe they experienced some sort of racism or discrimination. Maybe they've had pregnancy losses. Maybe they're navigating infertility, maybe they had a traumatic birth, or, you know, maybe they were judged for formula feeding or breastfeeding or going back to work or staying home. There's just so many things, right? Maybe every interaction that they have ever had with a healthcare professional has left them feeling smaller instead of safer. And if any of that is true, then the mistrust that they are experiencing is not irrational. It's understandable. And that realization doesn't mean that we stop providing recommendations. It doesn't mean the evidence doesn't matter. It just simply reminds us that trust is something that we're not entitled to. It's not something that we can demand. It's something that we build and we earn over time. And also during this liberation breakout session, we talked about this idea of non-compliance. And if you've worked in healthcare for any length of time, you've probably heard it, right? Like the patient is noncompliant, um, noncompliant with treatment. And I found myself wondering like, what if we just retired that phrase? Because when I think about pregnancy and birth, these things involve deeply personal decisions, right? People are weighing their values, their experiences, their fears, their faith, their family, culture, their finances, their previous trauma. And sometimes, yes, they will make decisions that are different than what you and I might choose. And that doesn't necessarily mean that they're non-compliant. Maybe they didn't have transportation. Maybe they couldn't find childcare. Maybe they couldn't afford to miss work. Maybe they were just really overwhelmed. Maybe they didn't understand, right? Like a recommendation was made and they didn't understand why the recommendation was being made. Or maybe they understood it perfectly and they just wanted to choose something different. There should be no noncompliance in perinatal mental health care or just perinatal health care in general, because I just feel like pregnancy and birth are just so deeply personal. It's not our role to force people into any one pathway. It's to provide information and education, build trust, respect autonomy, and help people make informed decisions that align with their values. That doesn't mean that every decision that people are going to make is risk free, but it means that we recognize them as partners in their own care and that they're not just sort of like these passive recipients of it. And like, how often do you think that providers, whether it be a mental health provider or a healthcare provider, how often do you think that we're labeling people as noncompliant or difficult instead of trying to understand them? And I I think it was in this session or maybe this session and a couple others where I just sort of started like asking, you know, what would happen if we just started to be a little bit more curious, right? So like instead of asking well, why didn't she come back to her next appointment? What if the question was, well, what got in the way? Or instead of asking, well, why won't she take medication? What if we asked, what are her concerns? What concerns does she have? Instead of asking, why isn't dad more involved? What if we asked the question, well, has anyone invited him into the conversation? Instead of asking, why is she so anxious? What if we asked, what has she been carrying? Because curiosity communicates this notion of like, I believe that there's more to the story or that there's something deeper going on. And I just really believe that every time that we choose curiosity over judgment, we create a little bit more space for healing. And I think that that's so, so important. You know, sometimes people think that maternal mental health is a niche issue, but it's not. More than 85% of women will become mothers at some point in their lives. And statistically speaking, we welcome approximately three and a half million babies into the world each year in the United States alone. And that's not a small population, right? So this is one of the most common human experiences there is, which means that perinatal mental health isn't just a woman's issue. It's a public health issue. It's a family issue. It's a community issue because when parents are supported, children thrive families thrive and communities thrive. When I think back to Los Angeles and the PSI conference, I don't think I'll remember like a specific PowerPoint slide, though I will say there were some really powerful presentations that I definitely took a lot from. And I know I definitely am not going to remember every single statistic and I've already forgotten all of the names, the breakout sessions and half the speakers. But I don't think that I'll ever really forget that tree. That tree full of hundreds of wishes written by complete strangers, different languages, different lives, different stories. And yet almost every one of them came back to the same things things like love, safety, health, peace, belonging, hope. And maybe that's all perinatal mental health has ever been about just helping parents hold on to hope, helping families feel seen, helping communities remember that no one has ever meant to navigate pregnancy or birth or parenthood alone. And you know we still have a lot of work to do. But maybe that's what gives me hope that every person who attended this conference is now back in their community. They're sitting with their patients, with their clients, they might be teaching residents, they're changing their policies, they're building community programs, maybe they're mentoring students and you know they're asking better questions. And while one conference doesn't change the world thousands of people going home and doing one thing differently just might. So thank you so much for spending this time with me today. If this conversation resonated with you, I hope that you'll share it with another parent or provider or professional or just really anyone who cares about families because the more that we talk about these things, the more we normalize them, the more likely that someone is to get the help that they need. So until next time, take good care of yourselves and take good care of each other. We'll see you soon. Hey thanks for being here and spending some time with me on Reproductively Speaking. I hope today's conversation left you feeling a little more seen, supported and maybe even inspired. If it did share this episode with a friend who might need it. And don't forget to subscribe or leave a review. It truly makes a difference. Until next time take care of your mind, your relationships and yourself. You got this