Addressing a broken system: How to prioritize your mental and physical health during complicated pregnancies with high-risk OB/GYN Dr. Tracy Shevell

May is Mental Health Awareness Month and I want to highlight the importance of finding trusted resources women can turn to for maternal mental health support through pre-pregnancy, pregnancy and postpartum.

Joining me today is Dr. Tracy Shevell. We'll discuss her almost 20 years of experience in a hospital setting that led her to believe the system is broken and the how she's working to change this by creating Blue Moon Perinatal. We'll also review her 3-step process to help expecting parents feel informed and confident going into their OB-GYN appointments, whether they are having a typical or high risk pregnancy.

Dr. Tracy (00:00):

And I realized that most of my doctoring was being done outside of really being a doctor in some ways. It was more helping women just navigate their experience.

Dr. Sarah (00:19):

May is Mental Health Awareness Month. And last week was Maternal Mental Health Awareness Week. While it's necessary to dedicate a period of time to really highlight this need. It's also so important to carry on these conversations and offer women's support throughout the entire year. And that is exactly what my next guest is doing. Dr. Tracy Shevell is a maternal-fetal medicine specialist with almost 20 years of experience. And she's the founder of Blue Moon Perinatal. No matter who you are, where you live, or where you fall on your maternal health journey. There are some universal takeaways that we can all benefit from and use to find appropriate sources for support, and we're gonna cover them all.

Dr. Sarah (00:58):

Hi, I'm Dr. Sarah Bren, a clinical psychologist and mom of two. In this podcast, I've taken all of my clinical experience, current research on brain science and child psychology and the insights I've gained on my own parenting journey and distilled everything down into easy to understand and actionable parenting insights. So you can tune out the noise and tune into your own authentic parenting voice with confidence and calm. This is Securely Attached.

Dr. Sarah (01:31):

Hi, we have a very special guest on today's podcast. I'm so excited to introduce you guys to Dr. Tracy Shevell. She is a maternal-fetal medicine specialist, and she specialized specifically in high risk OB-GYN. And she is the founder of Blue Moon Perinatal, which is an amazing resource for women who are experiencing any type of high risk pregnancy or postpartum. So I'm just so excited to have you on today. Thank you for being here.

Dr. Tracy (01:59):

Thank you. I'm so happy to be on. I'm really looking forward to, to talking about a lot of things that need to be talked about. So thank you for bringing me in here.

Dr. Sarah (02:10):

Yeah. This is gonna be, this is gonna be a little heavy of an episode, but I think it's gonna be very, very juicy in a, in a kind of messed up way. And I'll explain, but like, cuz we're gonna talk about a broken system is what we're really gonna talk about today, which is unfortunate. But there are disruptors trying to fix this broken system and I feel like that's kind of what you're doing.

Dr. Tracy (02:33):

Yeah. I completely agree. I mean, one thing I wanna point out before we talk about the broken system is that the system is not broken and I want women that are listening to this to understand this, the system is not broken because your doctors don't care about you. The system is broken, not because your doctors are disengaged or aren't interested. It's something is beyond that. It's something that's out of most doctors' control and we'll get a little bit into sort of why. But you know, I think that it's, it's a much larger picture, like you said, and it's a system error, not a physician error because your doctors care and they're struggling as well. And so that's, you know, I just wanted to make sure that I said that before we said anything else. Because again, it's really important for moms to know, like their doctors care. And that's not the disconnect, it's, it's a much bigger issue it's bureaucratic and it's systemwide and that's really frustrating and I'm not much of a disruptor. I've been a good girl my whole life, but I've had to become a disruptor because I can't handle systems being broken and failing women.

Dr. Sarah (03:47):

Yes. So let's talk about like what, what you do and how you got to this.

Dr. Tracy (03:52):

Sure. so I, you know, as I just sort of alluded to, I sort of followed the very traditional good girl path for a long time. I grew up wanting to be a doctor, went to, you know, medical school fell in love with OB and really had a tremendously satisfying career for a very long time. I trained in the city, I worked in our community hospital and I I was at a local hospital for my entire career for 16 years and I dealt with two things. I dealt primarily with prenatal diagnosis. So I saw a lot of women where we discussed, you know, ultrasound findings. And we got referrals for patients who had abnormal findings. And we would often do, you know, tests, amniocentesis or CVS and talk about complicated issues and scary things. And then on the other side, I would help doctors whose patients had complications come up and I would help them care for their own patients to maintain that relationship that we, you know, alluded to earlier and help them manage their patients when they got sick. So if a woman had preeclampsia or diabetes of pregnancy or something else really scary going on on the labor floor or postpartum, I would get involved as a specialist and I would become that patient's team provider. So their doctor was still in the loop and was still taking care of them, but I was helping manage the situation. And, you know, I dealt with some very, very intense things and it was an incredibly, incredibly rewarding job. But you know, over the last five to 10 years, things changed dramatically and that's how blue moon perinatal came about. I started to see patients coming into my office who understood less and less why they were there, who had a more and more difficult time reaching their doctor because their doctor was now in a 10 person practice and they had to call a call center. Someone would answer the phone in, I don't know, you know, Chicago and it would take, you know, 10 layers of bureaucracy to get through to their doctor to discuss their results or discuss what we had talked about doing. And that became more and more frustrating because I wanted to make sure that the women that I saw were informed that they understood what was going on and we'd spend half our time talking about logistics.

Dr. Sarah (06:12):

Yeah. And these women are being diagnosed with things that are not typical. Like, you know, oh, this is my regular 30 week checkup. This is like, we're dealing with things that are scary. That can cause a tremendous amount of anxiety and fear and other types of mood issues in women because this isn't this, you know, these are very vulnerable patients that you're dealing with.

Dr. Tracy (06:36):

Absolutely right, Sarah. And you know, when you add to the mix, the fact that, this was a main driver for me. I started to realize that like the whole system in place for getting your care was starting to break doctors. Weren't doing solo practice anymore. They were joining larger groups. So now you'd have, you know, instead of your one doctor that was probably gonna deliver, you you'd have bigger groups of doctors. Those doctors were then being kind of encouraged. And I use that word very gently were being encouraged to, for their own, you know, sort of ability to keep up, see more and more patients. The larger groups of OB-GYNs were then being encouraged to join multi-specialty groups because the larger the group, the more pull you had with insurance companies. And now all of a sudden your relationship is so diluted that, you know, it makes it even harder. And when you combine that with the fact that we about, you know, 10 years ago, started to be tasked with really paying attention to the fact that one in seven women during pregnancy will be diagnosed with a mood or anxiety disorder. Now, I don't wanna, you know, curse on your podcast, but now we've really got like a crap storm. Right. So we're in this system now supposed to also check to make sure if by the way, are you depressed or anxious about the news you've been given or just about your pregnancy, and we're not really prepared to answer the questions. So you put those two things together and you've really got a perfect storm. So I, you know, I started working in the system where I wanted to do more and more. I had a huge toolbox of mental health resources and holistic resources, and it just was becoming impossible to use them within the system.

Dr. Sarah (08:29):

Yeah. Because, so what you have like 15 minutes with a patient.

Dr. Tracy (08:33):

It's, you know, and I even had the luxury of having more time. I worked for a hospital, so I didn't have to see 50 patients in a day, but the patients that I saw just needed so much education and so much more than I was able to give, you know, I just was giving out my phone number, constantly talking to patients, you know, all the time. And it was about things that just, you know, were super basic. Like just having an empathetic listener or having someone re-explain what had been explained in lay terms one more time. And I realized that most of my doctoring was being done outside of really being a doctor in some ways. It was more helping women just navigate their experience. Yes. And then I realized, why not make this, you know, COVID hit, we went online, the mental health system went online. And I thought to myself, this could really be an opportunity to change the system really from the inside out.

Dr. Sarah (09:37):

Yes. And it's, it's interesting cuz like you and I both treat perinatal mood and anxiety disorders, but we come at it from such a different place. And even just the people who come to us are probably slightly different. And I'm so curious, like I wanna know about Blue Moon Perinatal and like what, because you are this amazing hybrid of, you know, you are an OB GYN with a tremendous knowledge, like field knowledge of like some of the scariest stuff that can happen in pregnancy and in postpartum. But you also, like, we both did the Postpartum Support International like intensive training in perinatal mood and anxiety disorders. And I was like, it's so nice to met an OB-GYN who is trained in that because it's very rare.

Dr. Tracy (10:26):

Thank you. Yeah, I think so. So to that point, you know, there are places in the country where they have reproductive psychiatrists and a lot of OB GYNs, you know, have had a special interest in mood and anxiety disorders. However, for me, it was a very natural extension of 20 years of giving bad news or being there in a scary time or, you know, just being part of a very emotionally intense situation. And I found that, you know, my, the hybrid of sort of information that I've gained over the years, both about psychology and about medicine is, is something that allows me and, and I too am a mother and have gone through some really scary times myself. And so knowing that I had sort of that hybrid, I felt that blue moon perinatal really had a special niche. And there are going to be many things that come in to try to disrupt the system that are app based that will help patients kind of try to navigate the system. But Blue Moon Perinatal is something that is very unique, I think. And I hope because it's so intimate and it's really woman to woman or woman to partner. I always say, if you wanna bring your partner online, like that's one of the benefits of having a practice like I do. And my practice is not one or the other. It's both, you know, I offer women, the clients that I am looking to engage are women who really just feel lost. You know, whether they've received a diagnosis or they really just want extra support to kind of say, okay, let's let's center, you know, what do I need to look at at the next visit? What do I need to ask my doctor? What does this test mean? How do I handle feeling anxious right now? It doesn't necessarily mean that I'll do your therapy but I'm gonna be your cruise director. You know, I'm gonna, I'm gonna be your high class, overly trained cruise director who can really speak to your medical fears, your medical concerns, but also help you with your emotional needs too. And I think you're right. I think it's a unique combination of interests, but it's why I feel like this is such a passion project for me.

Dr. Sarah (12:50):

Yeah. So let's get clear on what exactly that you do. So if people are listening, they can like look, cuz this does not exist really at all, what you do. And so like my understanding and correct me if I'm wrong is that women who are experiencing some type of diagnosis in their pregnancy that they need help understanding whether it's mundane or very, very scary, and that's subjective, frankly, but who feel like they need more, you know, medical advisement than they can get with their doctor, who they would still continue to see. Right. You still, they still have their OB who's gonna be, you know, managing the pregnancy from a medical perspective, but you are like this adjunctive support that can, that basically consults and helps people process what's going on and then connect them to the resources that they need. Is that, am I getting that right?

Dr. Tracy (13:48):

That's a great, absolutely right. So the way that I work is I offer either one session, if somebody has a directed question or I offer five hour packages of time where, you know, a client can use those five hours, however, they wish to spread them out into 15, 30 minutes, 45 minutes. And then I offer a larger 10 hour package where if somebody wants me to be involved for the whole pregnancy or they have a really intense issue and that time is yours to use. And I want women to sort of think of me as you know, there, what if, what if your best friend happened to also be a doctor, that's really what I want to be viewed as. I know it sounds weird to become best friends with strangers, but in the era of social media, you make relationships with people that you never even sort of meet. And now zoom has added a crazy element to that. So, just to give you an example, I've had clients call me who have who are struggling through infertility treatments and just need an ear. They need someone to help them sort of oversee sort of what they're going through and what are they missing, or maybe they just need to vent, or maybe they need help finding a therapist or someone who's seen the big picture. Some of my clients have medical issues. They've had either complex pregnancies in the past, or they have a preexisting mood disorder. I'm not afraid of any of that or I have a lot of people are. And I love people who do the work that you do, Sarah, because it's so important. And it's so, so, so needed right now. I also have clients who struggle with with situations, for example, you know, I have a client who I'm, I'm working with right now who is dealing with sort of decision making about how to pursue a next pregnancy, or how to pursue family planning, because she's had some complications in the past. So when a client signs up to work with me, we, I will not be their doctor. I go completely based on the patient's history, if they need to show me a lab result or, or show me something on a portal, I will look at it, but I do not provide medical recommendations. I'm not really like a second opinion service, but I will give you an overview of sort of recapping your care and asking sort of you to tell me how you understand your situation. And then within that framework, we'll talk about, okay, these are the things that I'd like you to read instead of going blindly on Google, let's look together at what the American college of OB-GYN says about treating preterm labor. And we will look together and look at the language and go from there. And sometimes we'll strategize. These are the things I'm gonna ask my doctor at our next visit. And these are the things that I need to walk away with this information, that information, this is the type of support person I need in my life. I need a social worker, I need a psychologist. I need an acupuncturist. This is gonna make me feel better. I need to be walking for 10 minutes a day. I need to be journaling, or I need something totally off the beaten path. You know, a healer, a someone who works with energy medicine you know, I can talk about all of that. And then we try to really brainstorm about how to make your experience better and easier and clearer.

Dr. Sarah (17:27):

Clearer. It sounds like you're this, like this targeted educational guide.

Dr. Tracy (17:33):

Correct. And, and a support system. I mean, you know, I got very used to, when I, when I was working in the hospital, I had two boxes of tissues on my desk. And people, people used to joke. People would always walk outta my office crying, but that's not necessarily a bad thing. Right. Like, you know, there's so much that we hold in during pregnancy. There's so much, we don't express there's so much. I don't want that to be the case. Women need to feel their feelings, especially when they're pregnant or trying to get pregnant or dealing with, like you said, a scary diagnosis or scary piece of information. And I will say, Sarah, I just wanna add one more thing. You know, this, this does make, my goal is also to make your OB-GYNs job easier. Right. Because if your OB-GYN has 15 minutes, and you ask the four important questions and you leave, and that doctor gets to write a note in their chart, that you reviewed all the relevant points. Well, that doctor just did a really great job with your 15 minutes, and everybody's gonna be happier.

Dr. Sarah (18:39):

Yes. I mean, I'm like in this field and know a lot about pregnancy, and I remember going into my doctor, I'm like, I don't even know what I'm supposed to ask right now. They'll be like, do you have any questions? I'm like, I don't know, should I have questions? Like you tell me? And it would be, I think it would be nice to feel more educated. And I certainly, if I was in a situation where part of my pregnant was higher risk, I would feel, I would feel really nervous about not knowing what to ask and wasting that time. The very limited time that I had. So like, I like this idea of being able to have like this place outside of those limited timed appointments to be able to figure out, okay, how do I use that 15 minutes with my doctor as wisely as I possibly can maximize that time with them. And to your point, that's helpful for the doctor too.

Dr. Tracy (19:29):

Yes. Absolutely.

Dr. Sarah (19:30):

And, and, and so that feels so valuable and, you know, it makes me think too, like, okay, so if someone is listening to this podcast and they're like, okay, I have, I know what you're talking about. This scary news resonates with me and I feel anxiety. And I'm, you know, like what are things that we can kind of help people walk away from this episode today with like some tools or some strategies, you know, for knowing how to do this kind of research on their own? Like, let's say they, you know, they're DIYing this for right now.

Dr. Tracy (20:09):

Yes.

Dr. Sarah (20:10):

What can people do? What are the things that you would recommend a woman who's received a scary diagnosis? You know, at some point early in their pregnancy, or or has maybe gone through a lot of, you know, attempts to get pregnant and is really struggling. And what are some things that they can do to, you know, inform themselves so that when they do have an opportunity to meet with their doctor, they are using that time as wisely as they possibly can.

Dr. Tracy (20:37):

That is a great question. And before I answer that, I just wanna make clear that my goal with Blue Moon is to help as many women as I can. And while right now it's going, it's, I have a private practice model. This is something that I want to be successful to take to the next level, because this service needs to exist for women at a bigger level. And I believe that it will. And to answer your question, I think it's really important for women to do three things on their own, with support, whatever, but to answer your question, what can they do on their own? Number one is always educate. So the question is rather than going to Google, if you don't have someone to go over the, you know, recent ACOG guidelines with you, which is totally okay. And what everybody probably is dealing with, ask your doctor when I leave your office, where do you want me to find information about thing X that you just mentioned? Do you have a resource? Do you have a recommendation for what I should be reading? That's number one. So how do you educate yourself? Ask your doctor how they'd like you to learn more. You can acknowledge to the doctor. I know we don't have a lot of time, and I'd like to educate myself a little bit more outside. What do you want me to do? How should I do that? And that's a fair and easy answer. Maybe it's a pamphlet they'll give you, and then you go out with what they want you to know. So again, number one is educate. Number two is to feel empowered, really important. Please do not ever say to your doctor. I'm sorry, but. We tend to do that a lot as women. We tend to apologize for asking questions. Like you're growing a human that's a huge job, right? So please don't say, I'm sorry, but I have one more question. Come in ahead of time, empowered with the questions that you know that you have, or Sarah, to your point, come in and say, I don't know what questions I should be asking you. What are the five things you want me to leave here knowing today?

Dr. Sarah (22:45):

Oh, I love that.

Dr. Tracy (22:46):

What what's coming up at my next visit, be empowered. Walk into that room as a colleague, as a peer, right? Your doctor wants to work with you as a team for the best interest of you and your baby as a unit. So number two is empowered. Try to be empowered, however you best can and then the third thing that women should really try to do. If they get a scary diagnosis is advocate, but not only advocate for themselves, but to look specifically for areas where other women have advocated for themselves. I think we don't use each other enough as a resource. Women don't use each other enough. I'm not suggesting, you know, going on Google and finding like a chat page about whatever the diagnosis is. Cuz that can be really scary. But there are other places that are helpful. There are, you know, Lamaze groups where there are women at the same point in pregnancies, you are try to find a tribe. If you have a diagnosis, let's say, God forbid, you've just had an amniocentesis come back and you've got an abnormality. Your baby has down syndrome. Let's say, go on Facebook. Not on to the main, big world at large, the world wide web. Right? Go on Facebook and find a group of women who moms with diagnosis of down syndrome. See if you can find women dealing with your situation mm-hmm and then talk to them. The other, the other piece, you know, that, that I think is very underutilized is the opportunity to potentially ask your doctor. Do you have any patients that have gone through what I'm going through that might be willing to talk to me? You know, that's, that's another way to get support. Peer support is so, so important.

Dr. Sarah (24:35):

Yes.

Dr. Tracy (24:36):

So those three things are people that, there are things that everybody can do, right? Education, empowerment, and advocacy. And I think that we're so sort of digitalized now that if you can find someone one or two women kind of to talk to, to relate to that's so important, we've lost our communities. Yes. Right. Pregnant women used to be cared for and taken care of postpartum for, you know, 40 days in most cultures by a community. And we don't have that. And you know, I think that our doctors can't give us everything. So let's look to the people who can, who we may be, you know, completely overlooking.

Dr. Sarah (25:21):

Yeah. And I think it's interesting, like, you know, you, you said to, I'm thinking also of a potential like resource. Like if you, for example, you find out your child is diagnosed with down syndrome. I like the idea of going to like a targeted space, like a Facebook group. But I also wonder there are probably like foundations, like, like institutions. Like I keep thinking about Postpartum Support International. Cause I know they have very specific free support groups for parents postpartum parents who have different diagnoses. So that's a resource postpartum.net.

Dr. Tracy (25:59):

Huge. Yep.

Dr. Sarah (26:00):

And they also have support groups, free support groups for perinatal mood and anxiety disorder. So like, if you are finding that you have postpartum anxiety or postpartum depression or antinatal depression. Absolutely. Which is a thing that I don't think I've ever talked about on this podcast, which is what you were saying, like this is depression during your pregnancy. We often talk about postpartum depression or postpartum mood disorders because that's very common, but you can also have a antinatal depression which is a depression that happens while you are pregnant. And there are support groups for that as well. And that's also often happens when you're in a higher risk pregnancy or have gotten some scary news because we do that can make somebody depressed or very anxious.

Dr. Tracy (26:48):

And, and to your point, not only that, first of all, if you have a young child you're anxious when you're pregnant again, right. I mean, let's be honest, you know, we talk about the pandemic and its effect on teens and how it's damaged them in terms of, you know, the need for mental health. So what about women of childbearing age? The incidence in general of depression and anxiety is so much higher now that you're gonna have so many more women that have issues during pregnancy and also a big contributor to that is think about all the women that are struggling with infertility. They all have, you know, a component of depression and anxiety going through that process and just being pregnant doesn't necessarily make that magically go away. There are, there are so many women who have the need for support during pregnancy. And to your point, if the need is identified and met in any way during pregnancy, they're a lot less likely to have a postpartum issue. So absolutely we really need to focus on identification of risk factors before and during pregnancy and getting women a support network. Because quite frankly, that's the time to build your support structure.

Dr. Sarah (28:06):

Yes. Yes. Because once the baby comes, you're, you're kind of, you're, you're thrown into the deep end. It would be nice to already have a life raft waiting for you there. You know what I mean?

Dr. Tracy (28:18):

That is what I, that is what I always tell patients. You know, I say to them, if there's an issue that we discuss, I know you don't think you need it now, but you're gonna need it. So let's put together your team because I'm telling you when you're, you know, dripping milk all over the place and bleeding and the baby's screaming and you haven't slept really tough to do anything for yourself that is productive at that stage of the game. Even if you have help. And at the end of the day, unless you're the one going through it, it's really, really hard to, even your closest support person. They can be amazing. But when it's your body and your hormones are all over the place and your a mess, it's really tough to get it together enough to find the right kind of support.

Dr. Sarah (29:05):

Right. And it could feel so overwhelming that you can't start.

Dr. Tracy (29:10):

Absolutely right.

Dr. Sarah (29:11):

So I always tell people, in fact, I even have like a free download on my website. I'll link to it in the show notes, but it's a mental health postpartum checklist. And the whole idea is it's like a crib sheet, like just like we have our birth plan and everyone does their birth plan. And there's like a million free downloadable forms to like check off all the birth plan things you want. Like, this is like a mental health checklist, like who find the resources, think of it as an insurance plan. Maybe you'll never have to use it. It'd be great if you, if this gathered dust in a drawer one day, but fill it out. Like who is a physical therapist, you know pelvic floor specialist that you can vet, you know, put a number down on there who is a mental health professional, put a number down on there who is a lactation consultant, put a number down. Like, so I have people fill it out and like basically create a mental health plan, should they need it? Because once they're in it, it's so hard. You need to have it's it's obviously, if you're in it right now and you don't have a plan, like we're here, you can do this. But if you are ahead of that, this would be the better time, the easier time to make this, to do this research.

Dr. Tracy (30:28):

Oh Sarah. You're so spot on there. And if you think about it, you know, for any woman or anyone who's ever been in therapy, you know, think about, you know, you go, you go to therapy and this is not even being pregnant. Let's just say, right. You go to therapy, you meet your therapist, you talk to them. Okay. What if you don't like them? Most people stop because they're like, Ugh, I don't feel like going and sharing my story again. And then I've gotta talk again. I've gotta pay for three visits and then it's awkward to leave. And, you know, just finding a good relationship with a therapist when you have time and financial resources and no baby crying and you've slept, it's hard enough then. So you're gonna be talking to someone that you don't know in this vulnerable, critical time. It's really hard. It's really hard. And so to your point, to just even be aware of the opportunity to make a checklist before problem strike is, is half of the key to success.

Dr. Sarah (31:30):

Yeah. Yeah. And so now they can add Blue Moon Perinatal to that list. Cause it sounds like a good resource to be thinking about.

Dr. Tracy (31:37):

I hope so. And if I'm not the right resource...

Dr. Sarah (31:40):

And do you work with people outside of New York state or is it only New York state?

Dr. Tracy (31:43):

So right now I, so it's interesting because I am really doing mostly what's considered coaching, it's sort of. I can talk to patients in 50 states. But for right now, starting my practice, I'm working primarily with patients where I'm licensed in New York and Connecticut. I'm in the process of getting a California state license as well. But through the platform that I use the platform, the platform is called Sesame Care. I do a virtual, it's a video platform. But I'm primarily seeing patients in New York and Connecticut. That said, I have a client in Wisconsin, I have a client in the Netherlands. So I'm open and able to do sort of all.

Dr. Sarah (32:24):

Got it good. Because I think that's another like kind of funny little challenge that has emerged kind of, because of COVID. Because, you know, before COVID, it was like, well, if you can't physically walk into my office, then I can't see you. So you being out of state was not really like, it just, it didn't really, it was like a non starter, but now that everything's telemedicine and telehealth, I'm, you know, we are licensed in the states in which we are licensed and we can't practice outside of those states. And so navigating that has challenging. And I think it's created an interesting puzzle to solve for in our industries, in our fields, because we want, I mean, I believe that people listen to this podcast from all over the world, actually. Like we have people from like many other countries than America listening and, you know, people do reach out to me. I just had a session with someone who is in Abu Dhabi, like, you know, but I do it as coaching outside of my license. And I'm very clear, like if we're doing parent coaching, I cannot diagnose and I cannot treat anything clinical, but I can provide psychoeducation. I can help you identify and work towards very specific goals. And if you or your child actually need clinical care, I can help you find those resources.

Dr. Tracy (33:42):

That is absolutely 100% spot on and it allows you to extend your reach. There are second opinion medical consulting forums that operate under the same principles as well. So as long as you are really is it as you and the client are on board in terms of what services you are actually providing and your client understands that this is really a guidance educational type of service. It opens up the world, I think about, you know, the expat community and, you know, all of the women who are stationed overseas, either for military reasons or for, you know, their husband's work takes them or their own work, takes them to Hong Kong or to London or to Abu Dhabi. You are in a different, you know, the medical system is different, your doctoring is different. Wouldn't it be nice to speak to, you know, a provider from home? We have those opportunities now. So it's time to it's time to make those opportunities available to as many people as can use them.

Dr. Sarah (34:47):

Right. And there's something kind of empowering because it gives people a little bit more choice.

Dr. Tracy (34:52):

Totally.

Dr. Sarah (34:52):

You know, I'm thinking of people in like very rural communities where access to mental healthcare and the kind of guided like high risk OB-GYN support that you offer is hard to come by, you know? And so if you're in a rural area and you can't have, it's just, there's not really anybody around that can meet a specific diagnosis or a specific need. Obviously it still doesn't cover the issue of having the treatment for that diagnosis, which is the tricky part, but the support can be found.

Dr. Tracy (35:26):

Yes, the support can be found. And truly a lot of, there are a lot of things, you know, that fall under the sort of umbrella of high risk pregnancy that are just really about asking the right questions and having, you know, the right sort of assessment and the right sort of interval between assessments. You know, it's, it's being, it's being able to say to your doctor, can we check the baby's growth every month since I have mild high blood pressure? I mean, just knowing to ask that question is the care. So if the patient, you know, sort of has that education behind them, they're able to potentially get the care that they need even without really having it.

Dr. Sarah (36:11):

Or going to medical school.

Dr. Tracy (36:13):

That's exactly right. Yeah. That's exactly right. Yeah, it's something that I hope will continue to grow and, you know, like you said, to get to the right resources, you know, to get to the right places. That's my goal.

Dr. Sarah (36:30):

Yeah. Cause I feel like feeling educated, feeling like you have someone in your corner makes it easier to ask those questions to your doctor. Like you said, you know, your number two thing to do is to like, try to step into that feeling of empowerment so that you can advocate for yourself and like ask the questions. It's hard to ask the questions if you're really like, I don't know where to begin. And so when we feel educated, like it's a cascading effect. Like the more educated you feel, the more empowered you feel, the more you can advocate for yourself. So your 1, 2, 3 step process really starts with education and everything really flows from there. So I love that as kind of a takeaway for people like everybody can get educated. And sometimes we go to Google cause we think that's education and really that just scares the crap out of us. And it makes us stop right there, at step one and we just shut the computer and we walk away cuz we're like, I don't wanna do this anymore.

Dr. Tracy (37:24):

And you just lie awake all night thinking about it anyway.

Dr. Sarah (37:27):

Right. So it's like, we need to put like a big asterisk by education. And it's really not Dr. Google. Like we really want your education to be coming from targeted vetted sources. Correct. So that you know, that you can trust this information and you also know that you're not gonna get like terrified by the like whatever results show up in your search. Like these like extreme situations. Like we want you to be looking at things that are medically reviewed or peer reviewed, or if, if that feels too jargony and too confusing and hard to process that it's then digested for you by a professional that's writing this content.

Dr. Tracy (38:03):

I wanna just add that another really excellent source for sort of peer to peer support is Instagram, actually. You can find through searching hashtags. You know, a lot of our sort of targeted marketing is done via hashtags for certain terms. Right.

Dr. Sarah (38:22):

Okay, so what are some terms that you feel like are like secret code for like, this is a real doctor putting this information out.

Dr. Tracy (38:30):

Right. So here, so just to give you an idea, I mean, there is a hashtag that you can use pregnancy after loss. And if you're lucky that will direct you, there is an unbelievable group of women that I have been fortunate enough to encounter and work with. And their organization is called Push for Empowered Pregnancy. And they have together with a hospital in New York city launched the first rainbow clinic, which is a clinic for dealing with a pregnancy after stillbirth. So just by searching that hashtag you may find out that you land on the Instagram page of Push for Empowered Pregnancy. So if you actually search by your hashtag by your search term, if you search hashtag preeclampsia, there's an organization on Instagram very much like postpartum support international, where there are resources within those organizations. So it's important to know that there are marketing strategies happening on Instagram, via the use of a hashtag where women may be able to find the right support groups.

Dr. Sarah (39:36):

Right. They might be able to find a lot of other stuff too. So I say that with like go in there being like, scan for like, this is my whole thing about being an educated consumer of like parenting content and the same thing for being an educated consumer of pregnancy content. Like if you search the hashtag preeclampsia, make sure you're really checking it out. Who are the accounts that feel legitimate, who feel authoritative in the work that they're doing? Like who you feel like have vetted resources because there's a bunch of people out there talking about this stuff that, you know, it's good that they're bringing awareness to certain things, but they might not be the source. You wanna get your medical information from. So I say that with like, yes, go use those hashtags and find, but be mindful as you're searching through that space because there's wonderful stuff out there and it's a great way to find it. And there's a lot of noise

Dr. Tracy (40:32):

To your point 100%. Don't watch reels, don't watch TikTok. But when you find your hashtag exactly to that point, if you land on an organization, make sure there's doctors involved in the organization. You know. Make sure this is, exactly right. Make sure you are being an educated consumer and use the resources wisely.

Dr. Sarah (40:55):

Yes. But it is a great way to find something very targeted that might be hard to actually Google for, you know.

Dr. Tracy (41:01):

Of course.

Dr. Sarah (41:01):

Cause these, some of these organizations are very small, very grassroots. They don't, they don't come up to the top of a Google search, but they're in there and it's like, you sometimes have to look very hard for it, but it they're there.

Dr. Tracy (41:14):

This was one of my big obstacles starting Blue Moon. I worked with someone in terms of doing, you know, advertising and getting the word out from Google. And he was like, okay, let's come together with some search terms. What are the most common search terms people will need to find you I'm like there aren't any, so you've gotta sort of create, you know, you've gotta sort of work within those constraints because what you may need may not be a hashtag yet.

Dr. Sarah (41:45):

But it is a good way to start. And I think that's really helpful for people to take away from this is like this isn't easy. It is hard to find this kind of targeted support and this sort of vetted information. You are trying to make that a lot easier for people. And you know, it's good that there are people doing the kind of work that you're doing because it can feel overwhelming. And it can feel like just such a hard to know where to begin. Especially when you get a scary diagnosis. You, you know, the whole world feels a lot scarier and you're not, you know, you wanna, you kind of wanna go in and cocoon a bit because you're trying to kind of navigate this really difficult. You know, whatever it might be, it's gonna be difficult. And so I think this is good to know that there are resources out there you're not alone. And there are some very specific things that you can start to do and in, and work with your doctor to do to help you feel less hopeless and helpless and alone. When you get scary news when you're pregnant or when you're trying to get pregnant,

Dr. Tracy (42:54):

Absolutely use your community, educate yourself. And women are lucky that you, that you're around Sarah and doing the work that you're doing.

Dr. Sarah (43:04):

Same to you. I think that it's, I'm so glad I met you because I feel like you're a resource that I'm happy to know about for people that I work with.

Dr. Tracy (43:13):

Likewise, likewise.

Dr. Sarah (43:15):

Thank you for so much for coming on. And I hope you have a wonderful rest of your day and we'll talk soon.

Dr. Tracy (43:20):

Thanks so much. Thanks everybody for listening.

Dr. Sarah (43:27):There is a lot of noise out there. It is so important to me that women feel supported and have the resources. They need to focus on their mental health from a trusted and reliable resource. And that's exactly why I created a mental health postpartum checklist and made it completely free because I want all new and expecting parents to have access to it. This interactive checklist and workbook will walk you through everything you need for establishing your personalized physical and emotional support systems throughout your postpartum. You can feel more confident and relaxed knowing you have all your ducks in a row and have a game plan for whatever your new little duckling brings. To download this and many other free workbooks and guides go to my website, drsarahbren.com and click the resources tab. That's drsarahbren.com. Thanks for listening. And don't be a stranger.

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