00:00First up, I just want to do the macro, if I may, and your thoughts about global birth rates
00:04here in the US. What have you seen in your practice about what's going on and what you
00:09see as kind of some of the main reasons? Is it complications in getting pregnant? Is it older
00:13age? What do you see from your vantage point? I think it's a variety of things that we're
00:19dealing with. Part of it is young people feeling less certain about the world and less certain
00:25about their financial futures and being more reluctant to have children. Part of it is being
00:31in a place where in much of the world, we do have choice about whether or not to have children.
00:37I think a lot of it is financial though, unfortunately.
00:39Well, yeah. I mean, we can open up a whole discussion about what different governments
00:47could be doing or should be doing in your view to help encourage this. But I feel like at least
00:53in
00:53the United States, the idea of a dad or a mom being able to spend an extended period of time
01:00with a newborn is still a luxury. And I wonder to what extent that is something that holds people
01:08back. I think that's a huge factor, especially here in the US. We are one of the very few industrialized
01:15countries that doesn't have a standard set of parental leave. You still have to ask it as a favor in
01:23a lot
01:23of places. And even though we do have FMLA and people are obligated to give that leave,
01:29it's only certain companies. It's not necessarily paid leave. And that makes a huge difference in
01:34people feeling whether or not they can afford it, both in terms of finances, but also in terms of
01:39their ability to connect with their child and their emotional bonding with the child.
01:43Okay. Again, here's another thing that people aren't going to get hate mail. But if guys were having
01:48babies, do you think this would be different and that we would have figured this out?
01:53Oh, you've asked a great question. I'm sorry to say I do think it would be different if guys were
01:58having babies. I think a lot of the place we're in has to do with just a lot of preconceived
02:04ideas
02:05about what motherhood is and the self-sacrifice that mothers have to make and the fact that half the
02:10population isn't going through that experience. So let's go to that. Having had a child and just
02:18loving actually the whole process and being very lucky, because I know it's not always so easy.
02:25And I know it can be difficult just getting pregnant. It can be difficult through the process. It can also
02:30be difficult afterwards. We know women get postpartum depression. Give me an idea of how common that is.
02:41So it's surprisingly common. It's about 15 to 20 percent of the population in countries like the
02:47U.S. and other industrialized countries. So when you think about it, it's much more common than a lot
02:52of other relatively common disorders. And yet it's very little talked about, studied, or recognized.
03:00Why? Or is it just because we're women?
03:05A part of it is because we're women, and I think we don't prioritize women's health. You know, it was
03:10only in 2014 that the National Institutes of Health required science that is doing research in animals
03:18to use female animals in addition to male animals. So we're really far behind in terms of the research
03:24we have in women's health. We're far behind in terms of the advocacy that we need to get to the
03:30answers of why people develop postpartum depression and what kind of supports we need.
03:35One of the statistics that I find so shocking is that there's that 15 to 20 percent rate of
03:40postpartum depression, but the rate of women that we actually diagnose and treat is much,
03:45much lower than that, with only about 3 percent of women with postpartum depression are actually
03:50treated to remission, so treated until they get better.
03:54How does that treatment typically work, doctor?
03:57So there's a variety of things that we can use. Fortunately, we have a lot of good and
04:01evidence-based treatments. We just don't always put them in place where we need to. So there are a
04:07couple of different types of psychotherapy that are evidence-based for depression, in particular,
04:11cognitive behavioral therapy and interpersonal therapy. We also know that traditional antidepressants
04:17are efficacious in postpartum depression. And then we also have some relatively new drugs that are
04:23based on hormonal mechanisms that also have some good evidence for treatment in postpartum
04:27depression. So we have the treatments. We're just not getting the moms to the place where they can
04:31access them. And I guess in an ideal world, right, you could, it would be great if you could predict
04:35if
04:35someone is going to likely have it. Is there something to it? And my understanding is that you're
04:40researching biological markers that could help predict postpartum depression. What are folks looking
04:46for? And I'm just wondering how this could maybe be a game changer for a lot of women.
04:51Yeah, I do think it is a game changer because as I said, we have good treatments. We just don't
04:55get
04:55women to the place where they need to get them. And part of that is that we're not sure who's
05:00at
05:00risk. Postpartum depression is something that can be caused by many different factors, both
05:06psychosocial factors and biological factors. But if we had a blood test or something that could really
05:11predict who's at risk, we'd be able to target the resources we have towards those moms who need them
05:17the most. Yeah, look, I think this is something too, increasingly that that partners are understanding
05:25and in a world where, you know, dads, the non birthing partners have an understanding of this,
05:34they can increasingly be a supporter or play a role of support. How does that partnership factor in,
05:41in your work and in recovery? You know, I think that's a huge factor. One of the things that we
05:48know is a huge contributor to postpartum depression is sleep deprivation, which is common with a
05:54newborn. But I increasingly am seeing partners and non birthing partners who are really willing to
06:00invest that time to get up in the middle of the night and help the baby. And that can be
06:03such a
06:04support and can really can be a prevention of postpartum depression for the mom. We also,
06:08unfortunately, can see postpartum depression in the non birthing partner. So it's really a situation
06:13where the two partners have to support each other. It gets us back to the idea, Carol, of having that
06:18flexibility and being lucky enough to have a job where you can actually, you know, be away from work
06:23to spend that time at home. I just got to do a shout out for my husband because he on
06:28that and
06:29getting sleep would do a nighttime feeding at midnight so that I could at least kind of get four or
06:35five hours of straight sleep. And that that was part of our routine. And he still cooks dinner
06:40for you every night, too. We can't forget. He does cook dinner.
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