Being with Families in Community #079

In this week's episode, we're diving into a conversation around perinatal mental health, and how we screen for and provide better support to parents as they continue to navigate early parenthood.
 
Our expert this week, Dr. Erin Sadler is a psychologist at Children's National in their NICU who has focused her work around supporting infant mental health with starts with pregnancy and parents.

She will be sharing a little bit of the process that her hospital has used to implement a universal screening for caregivers around their mental health in both the ER and the NICU environments.

This episode is for all of you who are also looking to understand more about how we integrate our mental health care and resources into the standard medical care that we provide to families.

Join us for insights on:
~Removing barriers to connection
~Supporting vulnerable families and decreasing ACEs
~Universal mental health screening as standard of care
~Safety nets built into screening
~Therapeutic interventions for NICU caregivers
~Asking the "scary" questions about mental health

Connect with Dr Sadler and her work here.

Here is an addition resource recommended by Dr Sadler:
Two of our Children's National physicians discussing an article on the establishment our in-house PMH task force. 

Transcript

Maggie, RNC-OB  0:03  
Welcome to your birth partners, the podcast identifying gaps, acknowledging biases, and co-creating a trauma informed standard of birth care with change agents across the spectrum of birth work. I'm your host Maggie Runyon. I'm a birth nurse, educator and advocate who has been searching since 2010. The answers to how to provide better care during pregnancy, birth and postpartum. Through my own pregnancies and supporting births in home and hospitals around the country. I've seen firsthand many the systemic flaws that exist in perinatal care. Through these conversations, I'm thrilled to share with you insights and inspiration as we work collectively to transform birth care.

In this week's episode, we're diving into a conversation around perinatal mental health, and how we screen for and provide better support to parents as they continue to navigate early parenthood. We have an expert coming on Dr. Erin Sadler is a psychologist who has focused her work around supporting infant mental health with starts with pregnancy and parents, she will be sharing a little bit of the process that her hospital has used to implement a universal screening for caregivers around their mental health in both the ER and the NICU environments. And this episode is for all of you who are also looking to understand more about how we integrate our mental health care and resources into the standard medical care that we provide to families. I look forward to sharing her insights with you throughout this episode, onto the show. 

Oh, welcome Dr. Sadler, I am just so excited to be having you sharing about your expertise and your work here on the podcast, I would love for you to just tell our audience a little bit about kind of your your journey into this space and where you're proud. 

Dr. Erin Sadler, PsyD  1:52  
Yeah, thank you so much. I'm very, very excited to be here. When I think actually about my journey, I zoom all the way back to my own childhood, if you can believe it, and it may actually make a lot of sense. Naturally, I have a very, very large family on both sides. So I grew up with a ton of cousins. And I got to see a lot of my own first cousins grow up. So I was a teen or an adult when some of them are just born. So it was just always really interesting to me to watch how they develop. And so from there, I knew I wanted to work with children well into my undergrad career well into college. And what I found myself most interested in more specifically was actually infant mental health and thinking about our most vulnerable kiddos who really, quite literally don't have a voice and part because they don't speak our language just yet. And thinking about how tricky it can be trying to navigate a world where your only voice is a cry, and even then the adults around you may not understand what's happening, and the implications for kind of the environment on early childhood development. So that actually led me to an interest in studying child studies when I was in college. So my major actually was literally the study of children and, and their development. And the the intersection of kind of how communities and schools and families all intertwine in creating, really our entire community. That's the beginning portion. From there, I learned myself and how do I move into prevention. And that actually ended up getting me into perinatal mental health, as I think about if I can catch someone before they're out of the womb, where do I start? And that is really with the caregivers who are bringing them into the world.

Maggie, RNC-OB  3:37  
Yes. Oh, my gosh, yes. It's powerful work here. I know, we've talked, you know, we think a lot about trauma. Yes, about trauma informed care. And obviously, that leads us to think about, you know, ACEs adverse childhood events, how that how that shapes all of us. And so absolutely, there is this piece of like, right, if we can prevent some of those if we can be ahead of the curb if you're interacting with caregivers, you know, and just thinking about as a as a bigger society, culture, how we support parents, how do we support children? How do we actually show up like there's so much power there. So I love that and I connected with your work at the National Perinatal Association conference back in May this year, and in particular, would love to kind of dive into maybe a little bit about what your what your day to day looks like.

And the poster that I saw you kind of sharing there about the program you have brought to kind of make sure we are assessing how folks are doing and checking in on perinatal mental health, outside of that magic three day window at the hospital and then a six week checkup thereafter. So if you wanted to share a little bit about that, 

Dr. Erin Sadler, PsyD  4:33  
happy to. I had the pleasure of working very closely with the medical director of our NICU. We actually came along back in 2019. So actually, I've only been with our hospital for a few years. prior to me getting it to Children's National, they received a grant an initial research grant to help pilot a universal screening program. From that they were able to realize that the acuity of the stress that a lot of Our families were experiencing really resulted in higher depressive symptoms and a lot of the caregivers. At that time they were looking more specifically at mothers. And I see right now we are across the board for whichever primary caregivers we have available, whether that's birthing parents non birthing, that includes grandparents foster parents, the whole gamut. So right now, my day to day is a little all over the place, I will say, my time is split up in a few different spaces. But my work with our NICU is really providing some of the therapeutic support after some of our universal screening happens, we have an amazing team of what we call the MRP. Med Team in truth, who does our universal screening in the emergency department of our hospital and in our NICU with the goal of being able to catch any parent that is coming in through a NICU or any parent that finds their way to our emergency department, with a child under the age of six months, knowing that we have this really, really unique opportunity to catch families who may not otherwise really show up in other spaces. So whether that's beyond that seek six weeks visit, or just a checkup at the pediatrician and kind of that first year, those markers that we may have unique opportunities, especially for more stressed parents who are seeking that extra support. And oftentimes the wee hours of the night, because our team is manning the station until the late hours.

Maggie, RNC-OB  6:26  
Yeah, oh my gosh, yeah, I know, we were speaking kind of in the pre recording time, about just how, and we've talked about this impasse before, but how many holes there are, and how we are kind of screening and assessing I know, you know, for instance, that's where we're at now, sure, before with discharges, they do their little quick screening, it's questions, it's very basic, we're just like, here's the thing here, you fill it out, they get a little one sheet handout that briefly covers Postpartum Mood disorders. And it is fine. As in baseline minimum, we need to do at least that. But thinking about like, how we present that information, the nuances there taking into account all the stigma that absolutely still follows folks around their their journey into parenthood, how they will be perceived, if they are struggling, emotionally and mentally with that transition. You know, there's there's a lot there. And I would love to talk on a little bit about that piece, like you said, for especially for really stressed parents, for parents who maybe are coming from operating in environments, where they have a lot of other life stressors, where they have a lot of things that can maybe set them up, they are more predisposed, they are at higher risk for struggling with that, how they otherwise kind of slipped through how you were having those conversations with them. If you want to maybe dive in a little bit into what that universal screening process looks like. For sure,

Dr. Erin Sadler, PsyD  7:40  
we'll say on both ends. Our goal ultimately is to present our process as a standard of care. And I know in many hospital systems, the goal is to integrate universal screening as a standard of care. And so the way that we approach it is from the lens of this is just what we do this is part of our care for your child's care for your family. And we do our very best to destigmatize mental health just struggles in general with social emotional well being. So that is our first marker is we're here per usual, as we are with every other family that rolls into our NICU or with a young infant in our emergency department, that being our kind of first lay of the land. The second part of that is actually not so much of a family specific, but more systems wide, were making sure that we have a large presence and a common presence on our unit. So whether that is in the emergency department or in the NICU, where the nurses know that, Oh, I haven't seen the payment screen or come around. And then can ask the family. Have you seen this person? If not, again, this is a part of our standard of care. And so what the the team is expecting the medical team who is also in a similar, I would say it's almost a parallel process for the medical system and families of expecting mental health to come into play as part of our standard of care. And so for our team members, it's Oh, yes, this is part of what we expect to see at any point in time when we have an infant coming in to the NICU or a young infant coming into the emergency department. If I have a five month old here, why haven't I seen the screen or come in yet? Let me make sure they know this baby's here. So we can catch this parent. And then from the parent end, it is really doing our very, very best to normalize these experiences because they are so common, and approaching it from a space of a lot of grace and empathy and and care and consideration. Well, we'll say that one has one goal or a potential unique aspect of our universal screening program is that what is also built in is a bit of care coordination. And so our goal is to be able to also remove one of the barriers of not only have we screened you and we know it's elevated, but now we also have dedicated our time to making sure that you are connected to resources after we meet each other, especially for some of our families that come in through the emergency department, where this may be our only shot look at not only catching them to screen, but also catching them to connect them with care on occasions, especially for higher stress families, we may see them come in a couple of times in that first year. And so there may be another opportunity, but we don't approach it from the lens of we have more than one it's a, it's a one shot. And so how can we make sure that the way that we're approaching them can both help them recognize that we are here for you, and we promise we're here for you and every other family here, and so we're not singling anyone out by any means. And figuring out where the families are coming from and what types of support they would be more open to getting our foot in the door, if you will, as best as we can, and then opening up a little bit wider to get them connected.

Maggie, RNC-OB  10:44  
Such an amazing I mean, amazing program, loving everything you just spelled out that addresses so many of these, like kind of implementation issues that we see Yes, about screening, and reflect on my own personal experience. My son was hospitalized when he was three weeks old. And I think about that experience of going into the ER, it's always Friday night, right when these things happen. So Friday night at like 930, when I realized like, Oh, he's really not doing well, he needs an extra support, we go in there. And while they took fabulous care of him, and he, you know, stayed over for a couple nights and then was fine. Like the stress that that put on us and our family, I think back in retrospect about like how that particular instance, increased significantly some postpartum anxiety stuff for me, and how that singular moment how that impacted and how it might have felt different if I had someone there like walking alongside me in that piece of it, as well as they're taking excellent care of his medical issues. Right. And so I think about it, even just for folks who up till now, thought they were in a pretty low stress environment. Yeah, everything was fine. All these moments we have with our kids how you know, we're having a NICU, you've had a totally unexplained you know, you've had a totally healthy pregnancy, everything's been very smooth and all sudden, oh, my gosh, you have this NICU admission for some reason, like, how that adds to it? Oh, yes, you've been everything's going great. You feel like you're finding a rhythm with your family and this new addition to it. And then like, Oh, you have some one of these little scary things that happens to these tiny little babies. Like, that's how that like, that changes the way we are seeing or seeing the environment, how that impacts our mental health. So it's just really, really powerful there. And then I think maybe if you are happy, or if you are comfortable sharing it, and maybe a little bit of like the nitty gritty pieces of implementation, okay. Now this went around actually getting into the NICU in the ER, in particular kind of for those ox shifts, because, like I say, it often feels like on the parent perspective, things fall apart on weekends and evenings and at night, right? You have all of the abundance of support that you normally would. So how are you kind of looking at that for someone who predominant also works like night shift at the hospital? I know very well, how those are set up how we typically are less resource at that time, how did you What are some of those pieces of it?

Dr. Erin Sadler, PsyD  12:45  
For us, we were very, very fortunate to receive a very large philanthropic gift from the LSP clerk foundation that actually allowed us to essentially design the workflow that we felt like would work really well based on a lot of the barriers that we saw before. So a great example is those late nights where many families II thought the day was going okay, then suddenly at night, like wait a second, if something gets really wrong, it's an hour needing to come in. And so right now, our team, the way that it's built is that we're trying to catch as many hours as possible. So the one of our screeners is in the hospital as early as 8am, and the latest leaving around 11:30pm. And so we may not be catching the middle middle of the night, but certainly the late night hours. And so we're able to also allow some of our screeners to work weekends as well, again, a lot of their timing, it kind of flows in and out. So they work a full schedule, but not not there seven days a week there, the team is there seven days a week, but not each individual person, a part of that really came from some of the other really assessment of some of the screening that we were able to do before which we continue to do now where we're looking at, we're keeping very, very close eye on families that we have the ability to approach kind of what's getting in the way of not only catching them while they're there, because we do have some families who especially in the emergency department they're in. And whether it's they're in and back and out and discharged really quickly, or they're in for a while, but things are happening and so we're not able to catch them. They're really trying to get a good assessment on what's really getting in the way of us connecting and reaching family. Both of they're in the NICU as well, I think some of our biggest barriers right now in the NICU is separate from COVID, that families who are not always able to be on site during the day. And keeping that in mind or families who quite literally don't have the ability to travel to our NICU on any sort of regular basis for a plethora of reasons. And then for us, it's now thinking about now what is the next level of this universal screening look like knowing that these are really consistent barriers form ourselves at least being able to reach families?

Maggie, RNC-OB  14:49  
Yeah. It's a lot. A lot. Yeah. And I Yeah, so particularly think that the COVID piece to which I think obviously At this, at this stage of the trailing end of what we hope, trailing end of the pandemic, you know, as where as we're kind of things, I think a lot of visitation policies and yes, kind of the more stringent and they seem to really lifted east across, you know, most of the country. And so I don't think that's quite as much of an issue. But do you have like big takeaways that you that you kind of gained from that perspective, because this, if you want to tell me a little bit, timing wise, I know this, the majority of this kind of like rolled out kind of through the heart of the pandemic,

Dr. Erin Sadler, PsyD  15:29  
it sure did. I will say we pivoted very, very quickly to remote screening and and so building up our ability to push screening out to families, with the safety net on the back end of whatever comes back, regardless of what comes back, we have the ability to support families. So whether that's a really high screen with some extra scary, maybe suicidality in the mix, or a very low screen not needing much, but we still want to make sure resources are available, that our team worked very, very quickly to pivot with a another program that we collaborate with, still to this day, to do remote screening and some care coordination with families. In addition to that, we also piloted our first telehealth support program in the NICU where we were able to provide telehealth services to families who at that time, were not able to come into the hospital. And a lot of that is actually continued to this day, primarily for families who, again, for a number of reasons aren't able to make it into the NICU. More so during typical business hours, since the therapeutic services themselves are standard hours versus our screening, which has extended beyond Canada's typical business hours.

Maggie, RNC-OB  16:40  
Hmm, yeah, well, I think that is such a as we we've seen, like the power of telemedicine, and you're able to harness that throughout, you know, as a lesson learned throughout this that absolutely, like for so many families just getting it's not, it is not through lack of wanting to be there, right. It cannot be there at the bedside all the time. And it's, you know, the convenience factor of being able to join a telemedicine, you know, for for treatment for therapy for processing afterward. Like that's really, really important. I also wonder a little bit maybe about the, I think one of the pieces you had touched on briefly, and if you want to kind of delve into it, because I think one of the things that it feels scary for us as healthcare workers, when we screen someone fingers crossed, everything's great, right? We get like a low screening back, we get to get to kind of give them like, Hey, these are the helpful supportive resources, and it's all good. I think it scares those of us who particularly in probably in areas that maybe have less resources that don't have a dedicated psychologist who's there for perinatal health or don't have a little bit of this. What are some of these things we can do to really increase our universal screening and then have better responses to high scoring levels? They think that maybe stop them from asking, because it's kind of like the, what I would, I don't know, can't hurt me, or act on like that piece of it. It sounds it sounds terrible. But I think it's just a reality of folks that they're concerned about how to respond and how to adequately support someone, like you said, especially when we're having some of those kinds of like, the bigger scary things where there is, you know, suicidality, stuff like that I think we feel really uncomfortable about what then our role is, are we responsible for doing something like this, I think people get really concerned and start to get worried about the implications of like bringing in some sort of children's and Family Services do we need to admit, somehow we're taking this person who just brought their baby into the ER, and now we're saying, Actually, we need to take you and put you onto a psych hold, I think like, we start to really like, go very, very far down that rabbit hole, and I guess whelming for us, so maybe just touching on any, any of the stuff within that,

Dr. Erin Sadler, PsyD  18:34  
for sure. I'm happy to. And I even though I am a psychologist, I think the blending of the medical model is just as helpful in that and I say that in the land of if a parent comes in and has a medical emergency while in the hospital with their child, we're going to do everything we can to make sure that we have the support that they need to whether it's suddenly have parents having a diabetic, something's happening, so their sugar drops, or they're needing some sort of support. That it it is second nature for to say, Oh, well, clearly, we just support them. And we do what we know to be true for what they're needing medically. And it works the same for us in in the land of high risk when it comes to mental health and mental illness. And that are these families are walking around quite stressed. And it is actually to the benefit of the child and to the well being of the children that we're taking care of that we're also making sure that the the environments that we're sending them home to are as supported as possible. So I say I say all that to say, while it can certainly be scary to ask the scary questions, it is incredibly important to ask them, while also making sure that in the system that we're working with feels ready to support an act and has a plan, knowing that there are also gradations and what's needed. So having some thoughts that are scary to a parent in one answer, whether it's not about death or feeling a lot of guilt and feeling just hopeless or helpless, in many ways, is certainly very different than a family or a parent who is having what we consider much more active suicidality and where they're feeling like, Nope, I'm not safe with myself, I, if I leave this room, I am not safe alone by myself. And there are certainly ways that we can work with within our hospital systems and with our teams to make sure that we have adequate responses for those various levels of the scary thoughts and the scary experiences. Our in house team works very closely with our crisis response team within the hospital. And so we have, again, kind of a very quick ability to connect with individuals within our hospital that are connected to more local services for adults, that can then assist us when when we really do have to pass the baton. So we moved from a space of while it has been a responsibility for this child to assess the the environment that they're moving into, there may be another environment that is there, or it's needed to then intervene with the family or support the family and from an adult perspective. And that may be having someone else kind of come in or being able to connect families very quickly with community services that can maybe I know, we've had examples or times in our work already with our program, where we're needing to call up a psychologist office or psychiatry office locally and say, Hey, we need to get this moment today or tomorrow. Do you have any room or some other community organization that can assist us in connecting them pretty quickly with care.

Maggie, RNC-OB  21:34  
Hmm, yeah. Oh, absolutely. You know, as we're talking throughout this whole season, about community, I feel like that, that piece of it of just having that connection in between these kind of the inpatient outpatient slash feeling of the ER, if it right, and then really getting into like, the full how does this look, when you're out of this crisis moment, this, you know, particularly intense piece? How do we connect those and I think to maybe if you want to go into a little bit about how you kind of whether it was setting up like referral networks, or just like, getting into integrated more into the community in terms of, I know, you said, like, when someone is someone you know, test hire, you have kind of set researchers to make sure that they actually connect with a resource versus like the handing over of, here's a bunch of folks who are in the community, try to reach out and see who maybe takes your insurance or whatever those kind of conversations, how have you kind of crafted that piece of the support program.

Dr. Erin Sadler, PsyD  22:22  
We've done it really collectively with across our what our consider our more general PMAD team, if you will. So we have our medical social workers who are embedded in our NICU more specifically, and they have a plethora of resources that we've used to help build our PMAD programming be that team and that I get to be a part of they actually part of their time is really dedicated to making sure that connection is is really that we're closing the loop with these community, community groups, whether it's okay, we found this appointment for you, but they need parents, they need you to call to you want me to call with you. Just schedule the appointment, make sure you have the information that you need. Have we looked at transportation for you, if you're having to travel? How can we assist you with that? And then once that appointment is scheduled and ready, then we do have a? It is? Let's say there's a lot of detail involved in our tracking systems here. But okay, so and so it was meant to have an appointment on this day, did they make it? So now I'm calling parent to say, Hey, did you make it to the appointment? How was it that they schedule a follow up for you? Great, do you have any questions? So we really do try to make sure that families are taking away that extra burden of families or in many cases, a lot of our parents are quite overwhelmed with what's happening, especially in the NICU, and having to make yet another phone call, wait for five minutes have all this information at the ready. It really is a limiting factor for many of our families getting connected and following through. And I think for many of the families that we work with, because they know that, hey, someone's going to call me afterwards, just to check in on me that that I think the way I've seen it work is that it is an added kind of motivator. But also it feels really safe because you know that as best as we can, they're not going to kind of slip through the cracks because we are keeping a close eye on making sure that okay, we missed this appointment, we figured out why we know what the barrier was. And now we can plan again for this new this new step

Maggie, RNC-OB  24:14  
that we have. Yeah, that like loving accountability. not simple. Yes. Issue. Exactly. Like you have the support and you have to fall back on and just That's right, when things aren't working the way you even thought they were a couple days ago seemed like yeah, of course we have to do that. And now it hasn't. Yes. Having someone to walk through that. Because absolutely, I think it's just there are so many things that parents are navigating in any given day. Especially, I mean, I feel like every parent I know is just constantly reeling with like, all of the things that they have to back up all of the many stressors and that is all the time and it especially when you have an additional medical complication with your child, you're balancing all of that, like you can just get it's too hard and I think we as parents are so apt to push our own needs off right If we're going to just keep focusing, we're going to keep focusing on the baby repeats for anything about this kiddo. So yeah, I mean, just I think that power of someone being there to be like, No, but I'm also I'm here for you. That's right. Maybe it's covered here. And I'm here to make sure that you're okay. Like, that's just really powerful.

Dr. Erin Sadler, PsyD  25:13  
I say it all the time, they say, you know, we're team parent, the babies have an amazing team 15 to 20 people give or take. And you know, we are Team parent, that is our sole purpose. Actually, I often like to use the airplane analogy, when they tell you to put your mask on first, before helping others, let's say, you know, this is the time where we have to make sure that your mask is tight, that you're getting all the oxygen all the flow in that you need before we can worry about kind of being here for baby, because being here for babies being here for yourself. And so what that means is, what do we need to do for you right now?

Maggie, RNC-OB  25:47  
Oh, yes, love that. That is just it's really hard for parents to accept that.

Dr. Erin Sadler, PsyD  25:53  
It is. And it's tricky, because for me, I all of my parents work stems from infant mental health. And so I say, you know, the only reason why this is so important that I needed this extra training to do this extra work is because of how strongly impact is on this baby here. And so it is, we have this entire specialty dedicated to making sure that families are supported during this very, very, very vulnerable time. It's such a vulnerable time.

Maggie, RNC-OB  26:18  
It is, do you have any insight for you know, those of our listeners, I would say, you know, a fair amount of our listeners are non clinical, you know, they're not really affiliated with a hospital, are there kind of particular steps that they could take or avenues they could pursue for trying to, you know, kind of check in, in a, in a loving and supportive way with their local hospitals about kind of where they're at in terms of universal screening around, you know, PMADs, and if there's support there, like, what are the kind of steps that a kind of relative outsider can do to make sure this is happening in their community?

Dr. Erin Sadler, PsyD  26:47  
Fair enough, I move, I guess in the land of checking in in their hospital systems, safe scan scanning websites first. And just to see if there are some oftentimes the way that I've seen the movement right now. And they feel there's there's a lot of great funding around perinatal mental health and trying to make sure that we're building programs. And so if there's been, whether it's new projects that are happening around it, that you may be able to see and read about that may be a good in to know something is happening, I can talk for days about some of the challenges that we've run into. So I will say that each hospital system mean that the resources available, the manpower, the time, that a lot of that can pose different limits to what hospitals are able to do. But I do think, depending on where within the hospital, it can never hurt to to see if there's maybe a parent advisory council or some sort of hospital based parent group that may be that may have an ear to the ground. And their role is to kind of be there to help support some of the programming, that we work very closely with our Parent Advisory Council within the NICU. And so these are NICU alum parents who are part of their just, again, life's mission is to be able to help hear about the programming that we're doing, but then give, give us a lot of feedback on Well, when I was in there, this actually would not have been great, or, or Yes, exactly what we needed. But they would likely have a good kind of temperature, kind of check on what may be in the works from again, a space of that's very loving to just hear and notice a curious mind quite interested. Otherwise, I would say just reaching out to folks, I know that the more that we hear from stakeholders, community members who are interested in in activities, it helps us continue with programming when we can say see, we have these parents X number of parents who say yes, thank you so much for, for having this screening, it was very helpful for us to know that we were supported, because it continues to give us really good, though we know the evidence is there that the our work is important, but kind of really anecdotal evidence that are coming from the people that are being impacted that that canbring a lot of support for us too.

Maggie, RNC-OB  28:56  
Oh, yeah. Okay, love it. And then you know, if you want to just a little bit more broadly kind of speaking to how have you kind of found your place within the hierarchy of perinatal health care

Dr. Erin Sadler, PsyD  29:08  
Oof. I will say that, if I myself, embedded in a couple of networks, the national network of NICU psychologist is one of them, where I'm kind of embedded in a land where there's, as I say, small compared to maybe other groups of providers that are specialist providers, but embedding myself with individuals who are doing the most closely related work as myself has been really helpful to get an idea of what other maybe even hierarchies may look like across different cities, different hospital systems. And for myself, it's been I know what my my end goal is, which is to literally just each one, reach one. So be able to connect with as many families as I can leave an impact even if it's just to get them to the next person that my goal is just to make sure that they had someone there are with them along the way. So I use what I just know to be true about the work that I'm doing to really say, Nope, this is what I need. And this is what the families need, and really do my best to advocate, especially in systems that, and I say it's like a parallel process where the medical system in and of itself is, is really shifting in a space where integrated behavioral health or mental health is, is really woven into into the entire workflow of the medical model. And that has been unique because I feel like I'm really, I'm just moseying along helping to weave myself into a medical system. That is, in some cases, well, I find that no one is denying that this is important work. But figuring out how it fits in a system that has been moving and grooving for a really long time. And it's not, it's not asking for change, necessarily, but recognizes the importance of it and says, you know, just kind of attach your horse to the back of it sticking to the back of our trail here versus Oh, no, like, I actually, I need a separate harness. And we're we're walking together versus me just kind of on the tail end of what's happening here. But I will say it's finding, even just consider them champions in my head, but individuals who not only recognize the importance of this work, but really also feel quite motivated across different disciplines, has been helpful, because then I at least know that the work I'm doing has an advocate somewhere in whether it's within nursing or within our Fellows Program, that there's someone else in there who can make sure that we are woven in versus just attached on the end, but really embedded in the the entire hiring process.

Maggie, RNC-OB  31:49  
Yeah, gosh, that's such a challenge. I think that that is a great like imagery. They're thinking about that different way. And I think for in so many, the facilities that I've been in, I think it it doesn't have kind of just being tacked on at the end of it like, and I don't, obviously, I don't think that it's coming from a negative place in systems, I think it is a major, I think the importance of paying attention to mental health 2pm adds, within the greater perinatal care scope was a major blank spot. For many people. It should not have been, but it was and you know, so we, as we found ourselves in that I think there is a need in most many systems, to to really take it all the way back and to re envision how you build the system up, right, with equal attention paid to the medical piece of pregnancy and birth. And I think in a US healthcare system that over medicalizes birth constantly we have we just have so much emphasis on that piece of it. And so I think it has to be really conscious process for sure, folks to recognize that like, Oh, yes, and this matters a lot. And mental health matters a lot. And I think especially when we are, you know, when we've talked about the rates of the bads of birth, trauma, all of these things that we have seen only rise, and especially through the last couple of years, overall mental health struggles have been so pervasive for a myriad of very understandable reasons. You know, I think we really need to I think systems we need to be internalizing all of what is happening reading the room in a really broad sense to recognize that we really need to build a design systems differently, that integrate mental health support. As an assumption, I think that does so much for breaking, like you said, breaking that stigma like this is for everyone, everyone gets mental health support, just like we expected, everyone who's pregnant, or the vast majority people who are pregnant, want someone, some sort of provider midwife OB to kind of walk alongside them with on their journey and to kind of check in make sure things are going with a plan that is just as valid and accepted to have a mental health guide there along walking alongside that, and I want that score. I want that versus Well, you know, like I think it's just it's something we have to be really conscious of. So I wonder too, then if you know, when you I don't know if there's an instance you can think of when you maybe come across with leadership, either you know, your present role or anywhere else along your journey where you have found someone what are kind of talking tips you've had, maybe for sharing the impact of perinatal mental health for someone who is just, perhaps through no fault of their own but oblivious to how pervasive it is how needed it is to address it.

Dr. Erin Sadler, PsyD  34:42  
I may just have been fortunate enough right now to be in spaces where everyone is at least recognizing the importance. I am appreciative that a lot of the medical organizations have had an extra push even though there's ACOG. I always forget the acronym the It stands for, but the American Medical Association, that they're also at least, announcing and making these initiatives, as part of their guidelines for the future of just medical care in general, that I think has been really helpful. Where I find maybe running into the most difficulty is, is thinking about what that looks like, and how we implemented because it does require re envisioning what the system of care looks like. And so saying, you know, this is great. We need I've worked previously in a maternal fetal medicine clinic, where we were embedded in and it's our own kind of way, though, I will say it's kind of early on. So this was more about we were tacked on the end, versus woven in when we were weaving. But helping the care providers and truth recognize that once families were able to connect with us, that it really did shift a little bit of what the the medical care looked like. And so by connecting with our mental health team, caregivers were maybe I'm thinking one, in particular instance, were just focused on even just healthy nutrition. And so what the mother was eating, that looked quite different, just based on some of the conversations we were able to have, outside of a 30 minute visit that was happening with the medical team that we were able to then spend more time do more planning with the parent. And I think seeing that helped, at least as I'm thinking about it now, one particular medical team that I've worked with before, recognize, like, while we didn't necessarily speak about it, there's a change that's happening. And it's working well for the medical lens that they are looking through, yes, but the impact came from the other individuals who are able to spend time on, you know, sleeping, eating, sleep, eat and exercise, or just some sort of physical activity, those big helpful for mental health, which we know is very well connected with our physical health and works really well and bodes well for our pregnant women, or pregnant people in general.

Maggie, RNC-OB  37:05  
Yeah. Oh, yeah. I love that. I think that's great. Yeah, seeing how it's all connected, you know, because, like, you I like, it's the hitch there together, they all interact, we can't pretend that, you know, mind and body are the two separate entities. So you know, realizing how that that support goes back and forth and impacts, you know, each other's work is really important, right? And then, you know, as we wrap this up, could you just share a little bit of kind of what your if you got to spend your vision for what kind of the future of community birth care community perineal care could look like?

Dr. Erin Sadler, PsyD  37:33  
What would it be? My true vision, personally, would be, when I think about comprehensive care, we know that everything kind of moves in a cycle and all the generations are really connected. And I would love for there to be a space in time where everybody has a care team that is well connected together, whether that is we have our perinatal specialists who are with birthing people all through pregnancy delivery, postpartum, and could ideally just stay with them for the duration of whatever happens next. And then as needed, and of our infant mental health specialists who are able to stay with young children through their childhood into adolescence. And my hope is way down the line somewhere, we'll hit a space where everything has kind of re shifted, where we've grabbed enough caregivers, that the generations that they're raising kind of the parents, the children that they're raising, had had a generation of parents who have had all the support and care that they need. So that way, we can reduce all the ACEs as much as we can. And then we have a generation of children who are raised in a space where their aces are so low that they can really just just go off into the world. And then we reshift the cycle. It's an it's just a lot of positive experiences. And said, just simply based on the care that people were able to get both in early childhood or into adulthood, as they're becoming caregivers and raising children. So there's that piece of it, but how that looks is weaving us into everything is weaving this type of support and care knowing that it's also level that it doesn't require psychologists to be everywhere, but there are multiple levels. We have our doulas our really kind of anybody, any therapist, any person who is connecting with birthing people, or new caregivers could have the ability to to know what's helpful and and be able to have their one touch because if everybody's able to connect and have a role in adding one beautiful positive experience with the family, that that can certainly outweigh a lot of the the adverse ones.

Maggie, RNC-OB  39:42  
 Ah, that is a beautiful vision. I am sharing it with you. I trust that and yeah, I mean, ultimately, gosh, like you don't want to see yourself out of a job right like every time well if these if there was just not as much of a need for dealing with the trauma and the backlash that comes For not having well integrated care so well thank you so much for coming on and sharing with us. Is there a good way for folks to connect with you if they want to kind of follow along or with with you and your work?

Dr. Erin Sadler, PsyD  40:12  
Sure thing I guess email wise if anyone wants to connect with me there it's esadler@cnnc.org. Then also, our children's hospitals has their own both Twitter and Instagram. And I believe Facebook as well. You guys want to find us there and then my Twitter and Instagram are erinsadlerpsyd.

Maggie, RNC-OB  40:38  
I will link all those in the show notes for everyone who wants to keep in touch with you. Thank you so much for coming on and spending the time with us today. And I appreciate it.

Dr. Erin Sadler, PsyD  40:45  
Thank you so much for having me. It's been a pleasure.

Maggie, RNC-OB  40:49  
Well, just a huge thank you to Dr. Sadler for coming on and sharing so much of her knowledge and wisdom about how we can really increase and make a standard of supporting folks mental health parents mental health, perinatal mental health throughout the course of their postpartum and parenting journey. I am so inspired by everything that she shared today, and I'm sure you are too we would love to hear from you about what struck you about this while you'll be taking back to your own community. You can reach us across social media at your birth partners. Feel free to share snippet on your Instagram stories and tag us there. Till next time.