May 20, 2025 • 31 mins
Perinatal mental health is often overlooked, yet it plays a crucial role in the well-being of families during a vulnerable time. Join us for an insightful conversation with Dr. Celeste Poe, Clinical Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Stanford University, as we delve into the hidden challenges faced by parents during the perinatal period. Explore the emotional complexities of NICU journeys, the importance of fostering attachment despite physical barriers, and the often-neglected mental health needs of fathers and non-birth partners. Learn strategies for integrating trauma-informed care in high-stress environments, shedding light on how we can better support families during this critical time.
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Episode Transcript
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(00:00):
(light upbeat music)
- Welcome to Stanford Medcast,the podcast from Stanford CME
that brings you the latest insights
from the world's leadingphysicians and scientists.
If you're joining us for the first time,
be sure to subscribe onApple Podcast, Amazon Music,
(00:20):
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to stay updated with our newest episodes.
I am your host, Dr. Ruth Adewuya.
Today I am joined by Dr. Celeste Poe,
who is a licensed clinical psychologist
and perinatal mental health specialist
with deep expertise in supporting families
through high risk pregnancies,
NICU stays and earlychildhood development.
(00:42):
She is a clinical assistant professor
in the Department of Psychiatryand Behavioral Sciences
at Stanford University School of Medicine
and directs the NICU psychology program
at the Lucile Packard Children's Hospital.
Dr. Poe's works centerson the emotional lives
of parents navigating medical complexity,
especially those copingwith trauma, grief,
(01:03):
and bonding disruptionsduring the perinatal period.
Her clinical practice and research
explore family-centeredcare, early interventions
and the mental healthneeds of both birthing
and non-birthing parents.
Dr. Poe offers trauma-informed therapy
through her private practice
and speaks nationally onperinatal mental health,
infant-parent attachmentand NICU psychology.
(01:25):
Thank you so much forbeing here with me today.
- Really excited to be here.
Thank you so much for the invitation.
- Let's start with your journey.
What first inspired your focuson perinatal mental health,
particularly within high riskpregnancy and NICU settings?
- Even as a little girl,I was the child who loved
to pretend to be a mommy.
(01:45):
I was always a little bitmystified by the magic
of mothers and babies.
When I was getting my masters
in marriage and family therapy,
I had the opportunity to see it in action.
Some of the theories thatwe're learning in school,
just seeing it play outright in front of my eyes
was absolutely incredible.
I knew from that point on Ididn't wanna do anything else.
As I continued to do that work,
(02:07):
I recognized how many barriers
and life challenges getin the way of that magic
during that period of time.
I've dedicated my workto supporting families
who are navigating the perinatal period,
but in ways that areunexpected or traumatic.
That has led me into workingwith more high risk populations
and the NICU families.
(02:27):
- It's really movingto see how you've taken
that early sense of wonder
and turned it into realsupport for families
facing some of the hardest moments.
The perinatal period can be so complex.
What are some of the most common
but often under-recognizedmental health challenges
that patients face during this time?
(02:47):
- We often tend to focus on depression,
that's what people tendto recognize the most,
but what we tend to seeis that biologically
and psychologically,this is a period of time
when parents are reallymotivated to protect
and care for their children.
Oftentimes, parents who are depressed
are also experiencing alot of anxiety and worries
(03:09):
related to their roleas a parent or the baby.
This can show up inworries that are intrusive
and persistent and in waysthat impact their functioning
and can get in the wayof their everyday life.
This is something that Ithink is under assessed,
but happening just as frequently,
if not more frequently than depression.
And the other thing we don't really assess
(03:31):
because it's more of ahuman experience, is grief.
Typically in thistransition into parenthood,
whether you're a first time parent or not,
the change in identity
and the shift in your familydynamics is really significant
because we think of it as normal
or you wanted to become a parent.
It's just something that you'resupposed to be okay with.
Oftentimes, especiallywith high risk pregnancies
(03:52):
and NICU experiences, thereis a lot of unspoken grief,
unresolved issues, uncertainties,
things that parentstypically find really helpful
to speak to
because it's not somethingthat's spoken about enough.
- It's definitely an important reminder
that it's not just about depression,
but also about what you callpersistent intrusive anxieties
(04:13):
and even the grief
that can come from such amassive life transition.
I really liked how youframed it when you talk about
the fact that it is alayered emotional experience
and not just the single diagnosis.
I imagine that there are still
a lot of misconceptions out there.
What are some of the misunderstandings
that you often encountereither among families
(04:35):
or healthcare providers aboutperinatal mental health?
- Because this time periodis so complex and layered,
it is sometimes difficult to determine
what is typical adjustment
and what is actually something
where the parent couldutilize some support.
We see a lot of common stressorsin the perinatal period
for families.
(04:55):
As healthcare providers,but also as parents,
you might think that it's normal.
The distinction between normal
and common is really important.
Just because something isexpected to be difficult,
you shouldn't be suffering through it
or having to drag yourself through it.
That's something that I like to correct
not only in healthcare providers
who are doing some of the assessments
and working with these families,
(05:16):
but also in helping families to determine
when it's time for themto seek some support.
Another major piece isthis idea that depression
is not the only thing that can happen
after having a baby.
There are several otherperinatal mental health disorders
that can come up duringthis period of time.
It's not just mothers orbirthing parents who are at risk
(05:37):
for experiencing some of thosemental health difficulties
or are impacted by thosemental health difficulties.
We know that fathers
and non-birth parents can also experience
the majority of these disorders as well.
I think that even justsaying the perinatal period,
technically that's a veryspecific period of time.
The time from conceptionto a baby's first birthday.
(05:58):
It's also easy to onlythink about these issues
as being impactful duringthis period of time,
but we know that a lot of parentsenter the perinatal period
already having mental health difficulties.
Just because your babyturns one doesn't mean
that you automatically don't feel
depressed or anxious anymore.
Thinking about the longer termimpact as well is something
that's helpful to changein terms of misconceptions.
(06:20):
- What I heard from you there is
that the duration isunspecific for each person
and that it is a uniqueexperience for every patient
that's going through it.
I also heard thedistinction when you said,
just because something iscommon doesn't mean it's normal,
and I thought that was areally powerful statement.
I also really appreciate you pointing out
(06:41):
that depression is notonly an emotional challenge
that can arise in birthingparents, but also in partners
and fathers and everyone that is impacted.
Shifting gears a little bit,
I wanna talk specificallyabout NICU families
because their journeyadds even more layers
of emotional strain.
For parents of NICU babies,
how does the trauma that they experience
(07:02):
differ from other typesof perinatal stress?
- Just because your baby's in the NICU
doesn't mean you're somehowsaved from the general risk
that parents have for perinatalmental health disorders.
Stressors like financial difficulties
and understanding when to return to work
or childcare issues with older siblings,
those things are also stillimpacting NICU parents.
(07:24):
The psychologicaladjustment to being a parent
and bringing an additionalbaby into your family means
that you're gonna have toshift things around a bit,
and that period is typically
what we hear about in terms of stress.
When we think about trauma specifically,
trauma is defined as anexperience, an event,
or a set of circumstances
(07:44):
that are well beyond your ability to cope.
It's also very subjective.
What one person experiences astraumatic is not necessarily
what someone else wouldexperience as traumatic.
First to start is that notall families necessarily
would describe their NICUexperience as traumatic,
though many of them do.
For example, it could be afamily whose baby was born
(08:07):
at term and it was a verytraumatic birth experience,
or it was very unexpectedthat they had a NICU journey.
For other families, it could be
that the birth experienceitself was traumatic in the fact
that the baby was born early
and needed to be inthe hospital for months
and months at a time, receiveprocedures, things like that.
It's important to hear what families say
in terms of how they'reexperiencing things,
(08:29):
but certainly some symptoms
that we see also really help us understand
and indicate is thisjust a normal stressor
versus is this beingexperienced as traumatic
for the family?
So some of those include the feeling
as if you are re-experiencing past events
in the present moment.
For example, likenightmares about past events
(08:49):
like the birth experienceor the first time
you saw the baby in the NICU.
We certainly see physicalreactions of the trauma,
so hyper vigilance.
Parents may be pacing in the room
or constantly looking at the monitors
to see if their baby's okay.
Sometimes an increased startle response,
that sense of being on edge and irritable,
difficulty sleeping.
(09:10):
Some of the things that cansound similar to depression,
just feeling really negativeabout their experience
or having really negativefeelings like anger,
even sometimes guilt, difficultybeing happy about the fact
that their baby's here.
Some important ones thatsometimes we take for granted
as healthcare providers areavoidance and dissociation.
(09:30):
So avoidance, it's notthat a parent is intending
to avoid their baby or comingin to visit at the hospital,
but because the hospitalis a stressful place,
sometimes parents havea hard time coming in
or being able to toleratebeing at bedside.
We can easily judge a parentwho may not want to spend
a lot of time with their baby,
but that can be really difficult.
(09:51):
A piece around dissociation is hard
because we don't always know
when it's happening for a parent.
Many of our NICU parents describe feeling
as if their experiences are not real.
They're really high stress moments,
it could be in conversationswith a healthcare provider
where they're learning about a diagnosis
or long-term developmental trajectories
where they almost are not present.
(10:12):
That can be really difficult
'cause when you're sharinga lot of information
of a healthcare provider,you don't really know
if they're really taking it in.
Pausing and asking for moreunderstanding and clarity
and things like that can make sure
that you're helping the parents.
But those are some of the signsthat we would see that show
that this is above and beyondjust a typical stressor.
- That paints a vividand empathetic picture
(10:33):
of what families can be going through.
It's not just about theemotional but also the physical
and neurological aspects as well.
It makes so much sensewhen you describe trauma
by hyper vigilance andnightmares and flashbacks
and also highlighting behaviors
like avoidance or disassociation
and affirming that it's notabout the parents not caring,
(10:56):
but often that the hospitalenvironment itself has become
so overwhelming that beingpresent feels unbearable.
Given all of those layers,
I imagine early interventioncan make a real difference.
What are some early steps or approaches
that can help mitigate thelong-term mental health effects
for NICU parents?
- When talking with NICU parentsabout this exact question,
(11:20):
a lot of them talk aboutinformation being so helpful.
From a medical perspective,
when we think aboutpreparation and information,
especially if we know a baby is likely
to end up in the NICU, thatmeans talking about development
and the baby born at this gestation
is likely to have these issues.
And while that is absolutelyimportant for parents
(11:40):
to understand, a lot ofthe psychosocial pieces
get left behind.
Thinking about whatsome of the barriers are
in terms of what visitation looks like,
how long they're able to be there,
can they sleep at bedside?
Do they have privacy?
Those sorts of thingsthat sometimes parents
are not thinking about at the time
of knowing that their babymight end up in the NICU.
(12:00):
So I think really thinking about
how do we help prepare them for that.
That also includeshelping them feel prepared
with how to collaboratewith the medical team.
Recognizing that althoughthis is your baby,
there will likely feellike there are times
when this is not your baby.
A lot of parents describethis as the hospital's baby
and what that can feel likewhen you have to make decisions
(12:22):
and if you disagree with themedical team's perspective,
how to navigate that.
Then also how to lean intotheir role as a parent.
Depending on thelimitations of the babies,
medically, the baby cannot be held.
Thinking with the parent about ways
that they can stillengage and feel important
and valued during this time.
Additionally, just helping them feel like
(12:43):
there are coping skillsat their availability
so that they can use a relaxation exercise
in a moment of high intensity
or they know how to reachout for social support.
Finally, I think the other piece actually
has to do mostly about staffand what staff can be doing.
We recognize that parents feel like clear
and compassionatecommunication is helpful,
(13:03):
so being as transparent andopen as possible with parents.
Like I said before, liftup the parents' role
in this setting to help them feel valued
and part of the team.
Those sorts of things I think are things
that we could be thinking about
even before a baby is admitted
and how to just create an environment
that feels empowering for parents.
- That's a crucial point.
(13:25):
Beyond just givingparents medical updates,
it's really about empoweringthem to collaborate
with the healthcareteam, to voice concerns,
and even to disagree when needed.
Ultimately, it's not just
so that they can survive the experience,
but it's so that they canreclaim their role in it.
Speaking of that strength and growth,
(13:45):
I'd love to hear an example
if you can share a story,anonymized of course,
of a family you worked with
who really shaped your understanding
of what perinatal resilience looks like.
- The family that I justfinished working with
comes to mind for me.
It started off with areferral for the mother
and she was not expecting to need therapy
(14:07):
or psychological support whilethe baby was in the middle.
In these moments, the mom was finding
that she was having panic attacks
and struggling with feelinglike she could navigate this
successfully, knowing that it was going
to be several more weeks
before the baby was ready to go home.
Just really doubting herself.
I think there was a lotof feelings of guilt
around, I wish I could bedoing more for my baby,
(14:29):
which we see a lot in that setting.
Through the trajectoryof our work together,
I think she got more and more open
to receiving psychological support.
Over time, that ended up inus doing individual sessions
with the mom, as well as couple sessions
because we recognize that thiswill likely have an impact
on your relationship as parents as well.
They were also navigating alot of social things at home
(14:52):
that had nothing to do with the NICU,
but as we navigated the experiences
that they were having inthe hospital over time,
mom was also starting to recognize
that she felt unconfidentin her ability to ask for
what she needed from the medical team.
There would be times when she needed help
with something from a nurse,but she wouldn't speak up
(15:12):
because she wanted to be thegood parent in that setting.
A lot of our work includedher feeling more empowered
to not only navigate theups and downs emotionally
and feeling like she was strong enough
to be the parent she wantedto be in this setting,
but also how to show upwith the medical team.
I remember there was acare conference that we had
with several providerswhere she was in the front
(15:35):
of the room and she was speakingup and she led the meeting
and her social worker andI were just so impressed
because we remember hownervous she was to ask
some of these questions.
So by the end of their hospital stay,
she was feeling so much more confident
with expressing concerns,feeling like she was a part
of the medical team, but I thinkalso feeling more confident
(15:55):
that even after the hospital experience
with knowing that therewould be some challenges
after discharge, shejust felt more confident
and empowered to be ableto navigate that as a mom.
- Thank you for sharing that story.
It's really heartwarmingand a powerful reminder
that NICU journeys are rarelyjust about the baby's health,
(16:17):
but that they stir up so muchwithin the parents themselves.
I love how you describethe work as evolving
and supporting not justthe immediate panic attacks
and self-doubt, but also inthis case helping her build
the confidence to advocate forherself and for her family.
It's really incredible howmuch healing can happen
when families are givenpermission to seek support,
(16:39):
even for challenges thataren't just about the NICU.
Given all the barriers thatcan come with a NICU stay,
how do you help promoteattachment and bonding
when physical closeness might be limited?
- That is a great question.
It's something we aspsychologists can focus on
because it can be somethingthat tends to slip under the rug
(16:59):
because so much focus ison medical intervention
and the baby feeling healthy.
First step is to identifywhat barriers there are
to the attachmentrelationship and bonding.
This can differ from family to family.
There are some families
who live five minutesaway from the hospital
or who were staying atthe Ronald McDonald House
and have access to the baby frequently.
(17:20):
There are other familieswho live hours away
and have other children andcan only come on the weekends.
There's also certain medical complications
that create certain barriers,
if one child is able to doskin to skin versus another.
We really wanna work witheach parent-child dyad
to understand what is available to us
and what are the barriers.
After we identify that, thenwe can provide the education
(17:43):
around the importance in making sure
that there is this relationship
between the parent and child.
And sort of thinking creativelyabout how to do that.
Sometimes a barrier caneven be anxiety and fear
in the parents, so thinking about
how small this baby isand the wires and tubes
and every time we do skin to skin,
it takes an additional nurseto come in and help us.
(18:05):
Sometimes all of that seems like too much,
so parents don't even try it.
It can be talking about their anxieties
and their worries thatthey're not harming their baby
when they hold their babyand all of the benefits.
We even talk about some ofthe things that they can do
that aren't as maybe major a skin to skin,
like providing positivetouch just with a few fingers
(18:26):
or leaving a cloth that smellslike them in the baby's crib
even when they're not there.
Thinking about how impactfulit can be to read to your baby
or talk to your baby
because your baby recognizes your voice,
your baby knows you.
I know that a lot of NICU parents,
when babies are agitatedor really struggling,
they can feel like they're notgood at soothing their baby
(18:49):
or that the baby's better with the nurses.
Reframing some of thatthinking and supporting parents
and understanding again,
their important valueat the most basic level,
teaching and supporting parentsand how to read baby's cues,
how to understand what stagedevelopmentally their baby's at
and according to that stage,what their baby can tolerate,
(19:11):
what their baby needs,
and how to be responsive to those needs.
Those are the small littlebuilding box that over time helps
with attachment and bonding,
- A practical response
and a compassionate approach for parents.
Instead of forcing thisone size fits all solution,
you're really meeting eachfamily where they are,
whether the barrier isphysical, medical or emotional.
(19:33):
When you talked about thinkingcreatively about connection,
it shows that even small gestures can have
such a profound impact on bonding
during such an overwhelming time.
You mentioned earlier thatit's not just birthing parents
who are affected, and I'dlove to explore that more.
What mental health needsdo you see in NICU fathers
(19:53):
or non-birth parents or partnersthat often gets overlooked?
And how can clinicians better engage them
as well as extended family members
as part of the caregiving team?
- It's important to recognize that
the same sort of mentalhealth difficulties
that we see in mothers andbirthing parents like depression,
(20:13):
anxiety, traumatic stress,
those things can happen in fathers
and non-birth parents as well.
And we actually often see thatparents are at increased risk
of experiencing their ownmental health difficulties
during this time when the mother
or birthing parent isexperiencing some difficulties.
So understanding some of thepressures and expectations
(20:34):
that fathers have in supportingthe emotional wellbeing
of the mother and the birthingparent while also navigating
their own mental healthduring this period of time.
Oftentimes, fathers are also expected
and needed to support oldersiblings or go back to work
because of financial difficulties.
(20:54):
We often see that fathersare bouncing back and forth
among different settings
and really have a lot ofresponsibility on their plate.
This is really difficult becauseour mental health system,
but as well as society at large,
doesn't always give parentsthe equal amount of space
and attention around the perinatal period.
When we're checking in on a new parent,
(21:16):
it's usually the new mother.
What this means is that fathers feel that
and they recognize that itfeels like there is a priority
for the mother or the birthing parent.
Sometimes fathers strugglewith knowing what their role is
or how they fit in general,
but certainly when they're struggling,
do they have space to express that?
(21:36):
Is there resources andsupport out there for them?
Oftentimes, the baby is the patient,
and so what that means isthat we're providing support
to the entire family.
That sort of approach is important
even before babies are born,how we think about them
as a pregnant family or apostpartum family and support them
and invite fathers in
and helping them tounderstand what their role is,
(21:59):
encouraging them, andthen providing resources
specifically for fathers andknowing how to go back to work
while your baby's still in the NICU.
Or financial supports,things like that could allev
some of the stressors that they have.
- What I'm hearing from you is
that mental health challengesdon't really discriminate
by gender or role,
and yet our systems stilltend to center the mother
(22:21):
or the birthing parent whileunintentionally perhaps
shielding or sideliningsome of the partners.
I appreciate how younamed this emotional load
that fathers or partners can carry,
and I think it's such a callto action for clinicians
and healthcare systems to reallyshift from parent-centered
to truly family-centered care.
(22:42):
I'd love to hear more about the tools
you've found most helpful.
What therapeuticapproaches or interventions
have you seen work well
in supporting perinatal mental health,
especially in high acuitymedical settings like the NICU?
- First and foremost, having the approach
of a culturally responsive,
flexible intervention is really important.
(23:05):
Understanding that there'sno one size fits all
and that we need to be takingit one family at a time.
The other piece is being trauma-informed
and grief sensitive, sounderstanding the impact of trauma
and grief and how thatcan show up differently
in different families.
In terms of actualtherapeutic interventions,
things that I tend to lean on the most
(23:26):
include child parent psychotherapy,
which is an evidence-based treatment
that is a diadic treatment.
Speaking to the whole family approach,
this intervention wascreated to support families
of young children who are goingthrough some sort of trauma
or high stress momentat the core of what do,
but certainly as far asactual everyday tools,
(23:49):
cognitive behavioral therapy
with a trauma-informedapproach is really helpful.
So thinking about theways that our thoughts
and our feelings andbehaviors are all connected
in a traumatic situation,the way that shows up
that can actually exacerbate our distress
and make it more challengingfor us to show up how we want.
So that's educating the parentson what's coming up for them
(24:12):
and how all of that works,and then giving them skills
and tools to navigate theiremotions during that time.
- I truly appreciate howyou center this flexibility
and cultural responsivenessin these moments.
There's no one right way forfamilies to show up emotionally
and all of the tools that you mentioned
can really be adapted to meeteach family's unique needs.
(24:34):
Not just about treating the symptoms,
but really restoringconnection and agency.
How do you approach integratingtrauma-informed care
into the fast-paced, highstress environment of a NICU?
- This is a major part ofour role, so most broadly,
it's really thinking about unit culture.
When we tell families thatthere is a psychologist
(24:57):
and that this is availableto you, we're telling them
that we care about howyou're doing as parents
and we have a resourcehere available to you.
Thinking about therelationships that we have
with staff members, withthe families we work with,
the partnerships, how wecollaborate on care with families,
all of that demonstrates thissense of trauma-informed care,
(25:19):
whether you are the neonatologist,
whether you're the socialworker, whether you're the OT,
that all of us are on the same page,
and that also translates to the policies
and everyday practices thatwe demonstrate with families.
It shows up in the ways thatwe interact with families.
The other piece is modeling that,
asking to pause when a familyseems a little overwhelmed,
(25:41):
making sure that there is space
and demonstrating how to make space
for that kind of traumaresponsiveness that we wanna see
as professionals in this setting.
Is also providing educationto staff, as we talked about
with the different symptomsof traumatic stress.
This is not always at the top of mind,
especially in an intensive care unit
where we're so focusedon the child's wellbeing,
(26:04):
providing education andthinking about how as a nurse
or how as a physicaltherapist, you can demonstrate
that trauma-informed care.
That's part of our role.
The third piece is being ableto support staff wellbeing,
recognizing and havingthe humility to note
that this traumatic settingcan impact us as providers
(26:25):
as well, and creatinga safe space for staff
to debrief if they've had areally difficult situation,
if they've lost a baby,if they're navigating how
to support a family, being aspace that they can come to
and receive thatpsychological support as well.
- Let's talk bigger picture.
What of structural changes would you like
to see across hospital systems
(26:47):
to better support thepsychological needs of new parents?
- One thing that we'veactually been able to do
now that we are doing some construction
and upgrading our NICU is provide families
with individual rooms.
So having a truly privatespace is important.
Not only are they ableto be less stimulated,
they might be more comfortablewith actually seeking support
(27:11):
or having emotional conversationsbecause they feel safe.
The other things around logistics
that we see getting in the way of parents
include transportation difficulties,
getting into the hospital, childcare.
It would be incredible if wehad childcare at the hospital.
I know we're probablya long way from that,
but I think that is sucha challenge for families.
(27:32):
One of the things that aswe worked with families
before the baby's bornto after the baby's born
to after the baby discharges,for our NICU families,
we recognize how siloed our systems are.
So whether it is OB and the NICU
and the pediatrician's office,
I feel like really integratingthose systems much better
(27:53):
and making sure that familiesdon't feel the responsibility
to carry over informationand concerns and all of that
throughout thosedifferent systems of care.
On that note, just the continuity of care,
so not only being able
to provide psychologicalsupport in the NICU,
but if we know that a baby is likely
to end up in the NICU, can we start early?
Can we start as soon as afetal diagnosis is given
(28:15):
or as soon as a motherneeds to be hospitalized?
And then can we certainlyfollow them after discharge
because we know thatmental health difficulties
for NICU families do not stop
after they discharge from the hospital.
Finally, I think greateraccess to medication support.
Oftentimes in general,
most NICUs do not havepsychological support,
(28:35):
even a psychologist, butcertainly for families
who are really suffering
and could benefit from medication
just to kind of take the edge off
and then be able to workon some of the things
that they'd like to work on
that can be truly alifesaving intervention.
- It's quite a long wishlist,
but every one of those changes reflects
(28:56):
such a deep understanding ofwhat families actually need,
and it's really aboutreducing barriers to care.
I'm glad that you mentionedaccess to medication
because even short-term support
for those families cantruly be life changing.
It's about giving parentsevery possible tool to cope,
to be able to connect and also to heal.
(29:16):
With all of that in mind
and the wishlist that you just mentioned,
if you could implementjust one policy tomorrow
to better protect perinatalmental health, what would it be?
- One of the biggest barriers I see
is just not enough paidfamily leave for parents.
NICU families have to makethe impossible decision
(29:36):
about when and how to take time off
when their baby's not even home yet,
and really trying to playTetris with paid family leave
and baby bonding time and disability
and all of that is not something
that they should have ontheir shoulders on top of
wondering if their babyis going to be okay.
And really also making thatequally available to fathers
and partners as well.
(29:58):
So many times families areforced to go back to work
in the middle of theirbaby being in the hospital,
and it just adds anadditional layer of stress
and difficulty for themto actually take care
of their emotional andpsychological health.
- What a critical callout on paid family leave.
It's not just a policy issue,and I think you'll agree.
It's really about a mentalhealth intervention.
(30:20):
And as you have referredthroughout this conversation,
for NICU families especially,
that pressure to time their leave
around unpredictable medicalneeds is just so heartbreaking
and no parent should have to choose
between their baby's care andtheir financial stability.
And making that leaveequitable for all parents
is essential if we arereally serious about
(30:40):
supporting the entire family system.
Dr. Poe, thank you so muchfor sharing your wisdom,
your compassion, and also yourdeep expertise on this topic.
This has been such a powerful reminder
that supporting perinatalmental health means more than
just treating symptoms.
It's about changing systems.
It's about listening deeply
and creating spaces for families to heal.
(31:02):
This episode was broughtto you by Stanford CME.
To claim CME forlistening to this episode,
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to Stanford Medcast whereveryou listen to podcasts.
(light calming music)
(light upbeat music)
- Welcome to Stanford Medcast,the podcast from Stanford CME
that brings you the latest insights
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If you're joining us for the first time,
be sure to subscribe onApple Podcast, Amazon Music,
(00:20):
Spotify, or YouTube
to stay updated with our newest episodes.
I am your host, Dr. Ruth Adewuya.
Today I am joined by Dr. Celeste Poe,
who is a licensed clinical psychologist
and perinatal mental health specialist
with deep expertise in supporting families
through high risk pregnancies,
NICU stays and earlychildhood development.
(00:42):
She is a clinical assistant professor
in the Department of Psychiatryand Behavioral Sciences
at Stanford University School of Medicine
and directs the NICU psychology program
at the Lucile Packard Children's Hospital.
Dr. Poe's works centerson the emotional lives
of parents navigating medical complexity,
especially those copingwith trauma, grief,
(01:03):
and bonding disruptionsduring the perinatal period.
Her clinical practice and research
explore family-centeredcare, early interventions
and the mental healthneeds of both birthing
and non-birthing parents.
Dr. Poe offers trauma-informed therapy
through her private practice
and speaks nationally onperinatal mental health,
infant-parent attachmentand NICU psychology.
(01:25):
Thank you so much forbeing here with me today.
- Really excited to be here.
Thank you so much for the invitation.
- Let's start with your journey.
What first inspired your focuson perinatal mental health,
particularly within high riskpregnancy and NICU settings?
- Even as a little girl,I was the child who loved
to pretend to be a mommy.
(01:45):
I was always a little bitmystified by the magic
of mothers and babies.
When I was getting my masters
in marriage and family therapy,
I had the opportunity to see it in action.
Some of the theories thatwe're learning in school,
just seeing it play outright in front of my eyes
was absolutely incredible.
I knew from that point on Ididn't wanna do anything else.
As I continued to do that work,
(02:07):
I recognized how many barriers
and life challenges getin the way of that magic
during that period of time.
I've dedicated my workto supporting families
who are navigating the perinatal period,
but in ways that areunexpected or traumatic.
That has led me into workingwith more high risk populations
and the NICU families.
(02:27):
- It's really movingto see how you've taken
that early sense of wonder
and turned it into realsupport for families
facing some of the hardest moments.
The perinatal period can be so complex.
What are some of the most common
but often under-recognizedmental health challenges
that patients face during this time?
(02:47):
- We often tend to focus on depression,
that's what people tendto recognize the most,
but what we tend to seeis that biologically
and psychologically,this is a period of time
when parents are reallymotivated to protect
and care for their children.
Oftentimes, parents who are depressed
are also experiencing alot of anxiety and worries
(03:09):
related to their roleas a parent or the baby.
This can show up inworries that are intrusive
and persistent and in waysthat impact their functioning
and can get in the wayof their everyday life.
This is something that Ithink is under assessed,
but happening just as frequently,
if not more frequently than depression.
And the other thing we don't really assess
(03:31):
because it's more of ahuman experience, is grief.
Typically in thistransition into parenthood,
whether you're a first time parent or not,
the change in identity
and the shift in your familydynamics is really significant
because we think of it as normal
or you wanted to become a parent.
It's just something that you'resupposed to be okay with.
Oftentimes, especiallywith high risk pregnancies
(03:52):
and NICU experiences, thereis a lot of unspoken grief,
unresolved issues, uncertainties,
things that parentstypically find really helpful
to speak to
because it's not somethingthat's spoken about enough.
- It's definitely an important reminder
that it's not just about depression,
but also about what you callpersistent intrusive anxieties
(04:13):
and even the grief
that can come from such amassive life transition.
I really liked how youframed it when you talk about
the fact that it is alayered emotional experience
and not just the single diagnosis.
I imagine that there are still
a lot of misconceptions out there.
What are some of the misunderstandings
that you often encountereither among families
(04:35):
or healthcare providers aboutperinatal mental health?
- Because this time periodis so complex and layered,
it is sometimes difficult to determine
what is typical adjustment
and what is actually something
where the parent couldutilize some support.
We see a lot of common stressorsin the perinatal period
for families.
(04:55):
As healthcare providers,but also as parents,
you might think that it's normal.
The distinction between normal
and common is really important.
Just because something isexpected to be difficult,
you shouldn't be suffering through it
or having to drag yourself through it.
That's something that I like to correct
not only in healthcare providers
who are doing some of the assessments
and working with these families,
(05:16):
but also in helping families to determine
when it's time for themto seek some support.
Another major piece isthis idea that depression
is not the only thing that can happen
after having a baby.
There are several otherperinatal mental health disorders
that can come up duringthis period of time.
It's not just mothers orbirthing parents who are at risk
(05:37):
for experiencing some of thosemental health difficulties
or are impacted by thosemental health difficulties.
We know that fathers
and non-birth parents can also experience
the majority of these disorders as well.
I think that even justsaying the perinatal period,
technically that's a veryspecific period of time.
The time from conceptionto a baby's first birthday.
(05:58):
It's also easy to onlythink about these issues
as being impactful duringthis period of time,
but we know that a lot of parentsenter the perinatal period
already having mental health difficulties.
Just because your babyturns one doesn't mean
that you automatically don't feel
depressed or anxious anymore.
Thinking about the longer termimpact as well is something
that's helpful to changein terms of misconceptions.
(06:20):
- What I heard from you there is
that the duration isunspecific for each person
and that it is a uniqueexperience for every patient
that's going through it.
I also heard thedistinction when you said,
just because something iscommon doesn't mean it's normal,
and I thought that was areally powerful statement.
I also really appreciate you pointing out
(06:41):
that depression is notonly an emotional challenge
that can arise in birthingparents, but also in partners
and fathers and everyone that is impacted.
Shifting gears a little bit,
I wanna talk specificallyabout NICU families
because their journeyadds even more layers
of emotional strain.
For parents of NICU babies,
how does the trauma that they experience
(07:02):
differ from other typesof perinatal stress?
- Just because your baby's in the NICU
doesn't mean you're somehowsaved from the general risk
that parents have for perinatalmental health disorders.
Stressors like financial difficulties
and understanding when to return to work
or childcare issues with older siblings,
those things are also stillimpacting NICU parents.
(07:24):
The psychologicaladjustment to being a parent
and bringing an additionalbaby into your family means
that you're gonna have toshift things around a bit,
and that period is typically
what we hear about in terms of stress.
When we think about trauma specifically,
trauma is defined as anexperience, an event,
or a set of circumstances
(07:44):
that are well beyond your ability to cope.
It's also very subjective.
What one person experiences astraumatic is not necessarily
what someone else wouldexperience as traumatic.
First to start is that notall families necessarily
would describe their NICUexperience as traumatic,
though many of them do.
For example, it could be afamily whose baby was born
(08:07):
at term and it was a verytraumatic birth experience,
or it was very unexpectedthat they had a NICU journey.
For other families, it could be
that the birth experienceitself was traumatic in the fact
that the baby was born early
and needed to be inthe hospital for months
and months at a time, receiveprocedures, things like that.
It's important to hear what families say
in terms of how they'reexperiencing things,
(08:29):
but certainly some symptoms
that we see also really help us understand
and indicate is thisjust a normal stressor
versus is this beingexperienced as traumatic
for the family?
So some of those include the feeling
as if you are re-experiencing past events
in the present moment.
For example, likenightmares about past events
(08:49):
like the birth experienceor the first time
you saw the baby in the NICU.
We certainly see physicalreactions of the trauma,
so hyper vigilance.
Parents may be pacing in the room
or constantly looking at the monitors
to see if their baby's okay.
Sometimes an increased startle response,
that sense of being on edge and irritable,
difficulty sleeping.
(09:10):
Some of the things that cansound similar to depression,
just feeling really negativeabout their experience
or having really negativefeelings like anger,
even sometimes guilt, difficultybeing happy about the fact
that their baby's here.
Some important ones thatsometimes we take for granted
as healthcare providers areavoidance and dissociation.
(09:30):
So avoidance, it's notthat a parent is intending
to avoid their baby or comingin to visit at the hospital,
but because the hospitalis a stressful place,
sometimes parents havea hard time coming in
or being able to toleratebeing at bedside.
We can easily judge a parentwho may not want to spend
a lot of time with their baby,
but that can be really difficult.
(09:51):
A piece around dissociation is hard
because we don't always know
when it's happening for a parent.
Many of our NICU parents describe feeling
as if their experiences are not real.
They're really high stress moments,
it could be in conversationswith a healthcare provider
where they're learning about a diagnosis
or long-term developmental trajectories
where they almost are not present.
(10:12):
That can be really difficult
'cause when you're sharinga lot of information
of a healthcare provider,you don't really know
if they're really taking it in.
Pausing and asking for moreunderstanding and clarity
and things like that can make sure
that you're helping the parents.
But those are some of the signsthat we would see that show
that this is above and beyondjust a typical stressor.
- That paints a vividand empathetic picture
(10:33):
of what families can be going through.
It's not just about theemotional but also the physical
and neurological aspects as well.
It makes so much sensewhen you describe trauma
by hyper vigilance andnightmares and flashbacks
and also highlighting behaviors
like avoidance or disassociation
and affirming that it's notabout the parents not caring,
(10:56):
but often that the hospitalenvironment itself has become
so overwhelming that beingpresent feels unbearable.
Given all of those layers,
I imagine early interventioncan make a real difference.
What are some early steps or approaches
that can help mitigate thelong-term mental health effects
for NICU parents?
- When talking with NICU parentsabout this exact question,
(11:20):
a lot of them talk aboutinformation being so helpful.
From a medical perspective,
when we think aboutpreparation and information,
especially if we know a baby is likely
to end up in the NICU, thatmeans talking about development
and the baby born at this gestation
is likely to have these issues.
And while that is absolutelyimportant for parents
(11:40):
to understand, a lot ofthe psychosocial pieces
get left behind.
Thinking about whatsome of the barriers are
in terms of what visitation looks like,
how long they're able to be there,
can they sleep at bedside?
Do they have privacy?
Those sorts of thingsthat sometimes parents
are not thinking about at the time
of knowing that their babymight end up in the NICU.
(12:00):
So I think really thinking about
how do we help prepare them for that.
That also includeshelping them feel prepared
with how to collaboratewith the medical team.
Recognizing that althoughthis is your baby,
there will likely feellike there are times
when this is not your baby.
A lot of parents describethis as the hospital's baby
and what that can feel likewhen you have to make decisions
(12:22):
and if you disagree with themedical team's perspective,
how to navigate that.
Then also how to lean intotheir role as a parent.
Depending on thelimitations of the babies,
medically, the baby cannot be held.
Thinking with the parent about ways
that they can stillengage and feel important
and valued during this time.
Additionally, just helping them feel like
(12:43):
there are coping skillsat their availability
so that they can use a relaxation exercise
in a moment of high intensity
or they know how to reachout for social support.
Finally, I think the other piece actually
has to do mostly about staffand what staff can be doing.
We recognize that parents feel like clear
and compassionatecommunication is helpful,
(13:03):
so being as transparent andopen as possible with parents.
Like I said before, liftup the parents' role
in this setting to help them feel valued
and part of the team.
Those sorts of things I think are things
that we could be thinking about
even before a baby is admitted
and how to just create an environment
that feels empowering for parents.
- That's a crucial point.
(13:25):
Beyond just givingparents medical updates,
it's really about empoweringthem to collaborate
with the healthcareteam, to voice concerns,
and even to disagree when needed.
Ultimately, it's not just
so that they can survive the experience,
but it's so that they canreclaim their role in it.
Speaking of that strength and growth,
(13:45):
I'd love to hear an example
if you can share a story,anonymized of course,
of a family you worked with
who really shaped your understanding
of what perinatal resilience looks like.
- The family that I justfinished working with
comes to mind for me.
It started off with areferral for the mother
and she was not expecting to need therapy
(14:07):
or psychological support whilethe baby was in the middle.
In these moments, the mom was finding
that she was having panic attacks
and struggling with feelinglike she could navigate this
successfully, knowing that it was going
to be several more weeks
before the baby was ready to go home.
Just really doubting herself.
I think there was a lotof feelings of guilt
around, I wish I could bedoing more for my baby,
(14:29):
which we see a lot in that setting.
Through the trajectoryof our work together,
I think she got more and more open
to receiving psychological support.
Over time, that ended up inus doing individual sessions
with the mom, as well as couple sessions
because we recognize that thiswill likely have an impact
on your relationship as parents as well.
They were also navigating alot of social things at home
(14:52):
that had nothing to do with the NICU,
but as we navigated the experiences
that they were having inthe hospital over time,
mom was also starting to recognize
that she felt unconfidentin her ability to ask for
what she needed from the medical team.
There would be times when she needed help
with something from a nurse,but she wouldn't speak up
(15:12):
because she wanted to be thegood parent in that setting.
A lot of our work includedher feeling more empowered
to not only navigate theups and downs emotionally
and feeling like she was strong enough
to be the parent she wantedto be in this setting,
but also how to show upwith the medical team.
I remember there was acare conference that we had
with several providerswhere she was in the front
(15:35):
of the room and she was speakingup and she led the meeting
and her social worker andI were just so impressed
because we remember hownervous she was to ask
some of these questions.
So by the end of their hospital stay,
she was feeling so much more confident
with expressing concerns,feeling like she was a part
of the medical team, but I thinkalso feeling more confident
(15:55):
that even after the hospital experience
with knowing that therewould be some challenges
after discharge, shejust felt more confident
and empowered to be ableto navigate that as a mom.
- Thank you for sharing that story.
It's really heartwarmingand a powerful reminder
that NICU journeys are rarelyjust about the baby's health,
(16:17):
but that they stir up so muchwithin the parents themselves.
I love how you describethe work as evolving
and supporting not justthe immediate panic attacks
and self-doubt, but also inthis case helping her build
the confidence to advocate forherself and for her family.
It's really incredible howmuch healing can happen
when families are givenpermission to seek support,
(16:39):
even for challenges thataren't just about the NICU.
Given all the barriers thatcan come with a NICU stay,
how do you help promoteattachment and bonding
when physical closeness might be limited?
- That is a great question.
It's something we aspsychologists can focus on
because it can be somethingthat tends to slip under the rug
(16:59):
because so much focus ison medical intervention
and the baby feeling healthy.
First step is to identifywhat barriers there are
to the attachmentrelationship and bonding.
This can differ from family to family.
There are some families
who live five minutesaway from the hospital
or who were staying atthe Ronald McDonald House
and have access to the baby frequently.
(17:20):
There are other familieswho live hours away
and have other children andcan only come on the weekends.
There's also certain medical complications
that create certain barriers,
if one child is able to doskin to skin versus another.
We really wanna work witheach parent-child dyad
to understand what is available to us
and what are the barriers.
After we identify that, thenwe can provide the education
(17:43):
around the importance in making sure
that there is this relationship
between the parent and child.
And sort of thinking creativelyabout how to do that.
Sometimes a barrier caneven be anxiety and fear
in the parents, so thinking about
how small this baby isand the wires and tubes
and every time we do skin to skin,
it takes an additional nurseto come in and help us.
(18:05):
Sometimes all of that seems like too much,
so parents don't even try it.
It can be talking about their anxieties
and their worries thatthey're not harming their baby
when they hold their babyand all of the benefits.
We even talk about some ofthe things that they can do
that aren't as maybe major a skin to skin,
like providing positivetouch just with a few fingers
(18:26):
or leaving a cloth that smellslike them in the baby's crib
even when they're not there.
Thinking about how impactfulit can be to read to your baby
or talk to your baby
because your baby recognizes your voice,
your baby knows you.
I know that a lot of NICU parents,
when babies are agitatedor really struggling,
they can feel like they're notgood at soothing their baby
(18:49):
or that the baby's better with the nurses.
Reframing some of thatthinking and supporting parents
and understanding again,
their important valueat the most basic level,
teaching and supporting parentsand how to read baby's cues,
how to understand what stagedevelopmentally their baby's at
and according to that stage,what their baby can tolerate,
(19:11):
what their baby needs,
and how to be responsive to those needs.
Those are the small littlebuilding box that over time helps
with attachment and bonding,
- A practical response
and a compassionate approach for parents.
Instead of forcing thisone size fits all solution,
you're really meeting eachfamily where they are,
whether the barrier isphysical, medical or emotional.
(19:33):
When you talked about thinkingcreatively about connection,
it shows that even small gestures can have
such a profound impact on bonding
during such an overwhelming time.
You mentioned earlier thatit's not just birthing parents
who are affected, and I'dlove to explore that more.
What mental health needsdo you see in NICU fathers
(19:53):
or non-birth parents or partnersthat often gets overlooked?
And how can clinicians better engage them
as well as extended family members
as part of the caregiving team?
- It's important to recognize that
the same sort of mentalhealth difficulties
that we see in mothers andbirthing parents like depression,
(20:13):
anxiety, traumatic stress,
those things can happen in fathers
and non-birth parents as well.
And we actually often see thatparents are at increased risk
of experiencing their ownmental health difficulties
during this time when the mother
or birthing parent isexperiencing some difficulties.
So understanding some of thepressures and expectations
(20:34):
that fathers have in supportingthe emotional wellbeing
of the mother and the birthingparent while also navigating
their own mental healthduring this period of time.
Oftentimes, fathers are also expected
and needed to support oldersiblings or go back to work
because of financial difficulties.
(20:54):
We often see that fathersare bouncing back and forth
among different settings
and really have a lot ofresponsibility on their plate.
This is really difficult becauseour mental health system,
but as well as society at large,
doesn't always give parentsthe equal amount of space
and attention around the perinatal period.
When we're checking in on a new parent,
(21:16):
it's usually the new mother.
What this means is that fathers feel that
and they recognize that itfeels like there is a priority
for the mother or the birthing parent.
Sometimes fathers strugglewith knowing what their role is
or how they fit in general,
but certainly when they're struggling,
do they have space to express that?
(21:36):
Is there resources andsupport out there for them?
Oftentimes, the baby is the patient,
and so what that means isthat we're providing support
to the entire family.
That sort of approach is important
even before babies are born,how we think about them
as a pregnant family or apostpartum family and support them
and invite fathers in
and helping them tounderstand what their role is,
(21:59):
encouraging them, andthen providing resources
specifically for fathers andknowing how to go back to work
while your baby's still in the NICU.
Or financial supports,things like that could allev
some of the stressors that they have.
- What I'm hearing from you is
that mental health challengesdon't really discriminate
by gender or role,
and yet our systems stilltend to center the mother
(22:21):
or the birthing parent whileunintentionally perhaps
shielding or sideliningsome of the partners.
I appreciate how younamed this emotional load
that fathers or partners can carry,
and I think it's such a callto action for clinicians
and healthcare systems to reallyshift from parent-centered
to truly family-centered care.
(22:42):
I'd love to hear more about the tools
you've found most helpful.
What therapeuticapproaches or interventions
have you seen work well
in supporting perinatal mental health,
especially in high acuitymedical settings like the NICU?
- First and foremost, having the approach
of a culturally responsive,
flexible intervention is really important.
(23:05):
Understanding that there'sno one size fits all
and that we need to be takingit one family at a time.
The other piece is being trauma-informed
and grief sensitive, sounderstanding the impact of trauma
and grief and how thatcan show up differently
in different families.
In terms of actualtherapeutic interventions,
things that I tend to lean on the most
(23:26):
include child parent psychotherapy,
which is an evidence-based treatment
that is a diadic treatment.
Speaking to the whole family approach,
this intervention wascreated to support families
of young children who are goingthrough some sort of trauma
or high stress momentat the core of what do,
but certainly as far asactual everyday tools,
(23:49):
cognitive behavioral therapy
with a trauma-informedapproach is really helpful.
So thinking about theways that our thoughts
and our feelings andbehaviors are all connected
in a traumatic situation,the way that shows up
that can actually exacerbate our distress
and make it more challengingfor us to show up how we want.
So that's educating the parentson what's coming up for them
(24:12):
and how all of that works,and then giving them skills
and tools to navigate theiremotions during that time.
- I truly appreciate howyou center this flexibility
and cultural responsivenessin these moments.
There's no one right way forfamilies to show up emotionally
and all of the tools that you mentioned
can really be adapted to meeteach family's unique needs.
(24:34):
Not just about treating the symptoms,
but really restoringconnection and agency.
How do you approach integratingtrauma-informed care
into the fast-paced, highstress environment of a NICU?
- This is a major part ofour role, so most broadly,
it's really thinking about unit culture.
When we tell families thatthere is a psychologist
(24:57):
and that this is availableto you, we're telling them
that we care about howyou're doing as parents
and we have a resourcehere available to you.
Thinking about therelationships that we have
with staff members, withthe families we work with,
the partnerships, how wecollaborate on care with families,
all of that demonstrates thissense of trauma-informed care,
(25:19):
whether you are the neonatologist,
whether you're the socialworker, whether you're the OT,
that all of us are on the same page,
and that also translates to the policies
and everyday practices thatwe demonstrate with families.
It shows up in the ways thatwe interact with families.
The other piece is modeling that,
asking to pause when a familyseems a little overwhelmed,
(25:41):
making sure that there is space
and demonstrating how to make space
for that kind of traumaresponsiveness that we wanna see
as professionals in this setting.
Is also providing educationto staff, as we talked about
with the different symptomsof traumatic stress.
This is not always at the top of mind,
especially in an intensive care unit
where we're so focusedon the child's wellbeing,
(26:04):
providing education andthinking about how as a nurse
or how as a physicaltherapist, you can demonstrate
that trauma-informed care.
That's part of our role.
The third piece is being ableto support staff wellbeing,
recognizing and havingthe humility to note
that this traumatic settingcan impact us as providers
(26:25):
as well, and creatinga safe space for staff
to debrief if they've had areally difficult situation,
if they've lost a baby,if they're navigating how
to support a family, being aspace that they can come to
and receive thatpsychological support as well.
- Let's talk bigger picture.
What of structural changes would you like
to see across hospital systems
(26:47):
to better support thepsychological needs of new parents?
- One thing that we'veactually been able to do
now that we are doing some construction
and upgrading our NICU is provide families
with individual rooms.
So having a truly privatespace is important.
Not only are they ableto be less stimulated,
they might be more comfortablewith actually seeking support
(27:11):
or having emotional conversationsbecause they feel safe.
The other things around logistics
that we see getting in the way of parents
include transportation difficulties,
getting into the hospital, childcare.
It would be incredible if wehad childcare at the hospital.
I know we're probablya long way from that,
but I think that is sucha challenge for families.
(27:32):
One of the things that aswe worked with families
before the baby's bornto after the baby's born
to after the baby discharges,for our NICU families,
we recognize how siloed our systems are.
So whether it is OB and the NICU
and the pediatrician's office,
I feel like really integratingthose systems much better
(27:53):
and making sure that familiesdon't feel the responsibility
to carry over informationand concerns and all of that
throughout thosedifferent systems of care.
On that note, just the continuity of care,
so not only being able
to provide psychologicalsupport in the NICU,
but if we know that a baby is likely
to end up in the NICU, can we start early?
Can we start as soon as afetal diagnosis is given
(28:15):
or as soon as a motherneeds to be hospitalized?
And then can we certainlyfollow them after discharge
because we know thatmental health difficulties
for NICU families do not stop
after they discharge from the hospital.
Finally, I think greateraccess to medication support.
Oftentimes in general,
most NICUs do not havepsychological support,
(28:35):
even a psychologist, butcertainly for families
who are really suffering
and could benefit from medication
just to kind of take the edge off
and then be able to workon some of the things
that they'd like to work on
that can be truly alifesaving intervention.
- It's quite a long wishlist,
but every one of those changes reflects
(28:56):
such a deep understanding ofwhat families actually need,
and it's really aboutreducing barriers to care.
I'm glad that you mentionedaccess to medication
because even short-term support
for those families cantruly be life changing.
It's about giving parentsevery possible tool to cope,
to be able to connect and also to heal.
(29:16):
With all of that in mind
and the wishlist that you just mentioned,
if you could implementjust one policy tomorrow
to better protect perinatalmental health, what would it be?
- One of the biggest barriers I see
is just not enough paidfamily leave for parents.
NICU families have to makethe impossible decision
(29:36):
about when and how to take time off
when their baby's not even home yet,
and really trying to playTetris with paid family leave
and baby bonding time and disability
and all of that is not something
that they should have ontheir shoulders on top of
wondering if their babyis going to be okay.
And really also making thatequally available to fathers
and partners as well.
(29:58):
So many times families areforced to go back to work
in the middle of theirbaby being in the hospital,
and it just adds anadditional layer of stress
and difficulty for themto actually take care
of their emotional andpsychological health.
- What a critical callout on paid family leave.
It's not just a policy issue,and I think you'll agree.
It's really about a mentalhealth intervention.
(30:20):
And as you have referredthroughout this conversation,
for NICU families especially,
that pressure to time their leave
around unpredictable medicalneeds is just so heartbreaking
and no parent should have to choose
between their baby's care andtheir financial stability.
And making that leaveequitable for all parents
is essential if we arereally serious about
(30:40):
supporting the entire family system.
Dr. Poe, thank you so muchfor sharing your wisdom,
your compassion, and also yourdeep expertise on this topic.
This has been such a powerful reminder
that supporting perinatalmental health means more than
just treating symptoms.
It's about changing systems.
It's about listening deeply
and creating spaces for families to heal.
(31:02):
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