Meaningful support for new families in the first postpartum days | Veronica Kemeny

[00:00:00] Kristin Tully: Welcome to the Advancing Maternity Care podcast. I'm Kristin Tully, founder and chief scientist. In this podcast, we invite maternal, infant, and family health thought leaders to share their perspectives and work. Connecting around research and lived experiences is key to implementing more meaningful support for families and those who care for them.

[00:00:23] Kristin Tully: I am delighted to welcome Veronica Kemeny. Veronica is a licensed clinical social worker with over 15 years of experience and is certified in perinatal mental health. She joined our team at Couplet Care as the director of clinical success, supporting healthcare team members as they install and use the bassinet in practice.

[00:00:45] Kristin Tully: As a national leader in perinatal mental health, Veronica has a unique perspective on parents' experiences as they navigate pregnancy, birth, and postpartum. I'm so happy for this opportunity to learn more about you and your work, Veronica.

[00:01:01] Veronica: Thank you for having me, Kristin. It's a pleasure to chat with you. I'm excited.

[00:01:06] Kristin Tully: Would you tell us a bit more about you and your background?

[00:01:11] Veronica: Sure. I'm a clinical social worker, and it's been my career for over 15 years. I am bilingual and bicultural as well. My dad is from Argentina, so I've worked much of my career with Latino families and Latino immigrants. That's a huge component I like to bring in, the cultural perspective, as I work in the perinatal space. I'm a mom to two daughters, 11 and two and a half, so I'm navigating different seasons of life with them, and pretty recently being postpartum myself. That's been a really fun experience to go through now that I'm in the perinatal space myself.

[00:01:48] Veronica: I've been thrilled to join the Couplet Care team recently and bring my perspective and my passion for perinatal mental health. In learning about the bassinet, I immediately became convinced that every person needed it, every room needed it, and that it can really change the experience of being postpartum. There are lots of areas where we can improve that experience and that environment, and I think the Couplet Care Bassinet is something I feel excited to be alongside you and the rest of the team to make sure everyone knows about, and hopefully as many people get access to it as possible.

[00:02:25] Kristin Tully: Thank you so much. This is wonderful, to be a team and to bring in expertise on these different aspects of becoming a new family, and postpartum care as an important part of that.

[00:02:49] Kristin Tully: Can you share more about your understanding of what matters most to families in the transition to postpartum and their new season?

[00:02:54] Veronica: For sure. Having provided psychotherapy to families for many years, and heard the intimate details of birth experiences, I would say having a respectful environment and a respectful team. It's really hard in a medical environment, things go so fast. It's very easy to feel lost in it. So how do you have birth preferences while being flexible?

[00:03:27] Veronica: I honestly think it's about slowing down when possible and empowering families to have choice and get questions answered, even when things do need to go fast for medical emergencies. I think mostly of what to expect during pregnancy, birth, and postpartum, while being honest and not just glazing over with the niceties of "It's so joyful and it's so natural." All those things are true, and it can be scary, and it can feel lonely. So how can the medical environment, the medical team, doulas, midwives, whoever else is integrated, how can we as providers slow down, answer questions, and be grounded in what they want that experience to be? Because it is a very unique experience. No birth is the same.

[00:04:29] Kristin Tully: And as part of that meaningful communication, can you share more about people who speak a language other than English, or Spanish, or others?

[00:04:37] Veronica: I think access to live interpretation is always ideal. I know that's hard, especially for languages that are less common, but most hospitals do a really good job offering translation services. The more pamphlets, information, and tours can be provided in alternate languages, or translation be available, the better. Having staff that looks like our patients is really important, whether it be the social workers, the nurses, the lactation consultants, or the midwives. Whenever we can culturally align a provider with a patient, they feel there are some things they don't have to explain about what they want, maybe a part of the birth experience that's really important to them that here in American culture is less so. So that representation, seeing themselves in the marketing, seeing themselves through their language and with providers, and again, slowing down and asking them what is most important to them. Regardless of a person's cultural background, they want to be heard, seen, and valued.

[00:05:45] Kristin Tully: I really love this importance of pace, going at an appropriate pace for comprehension.

[00:05:59] Kristin Tully: It's something I think a lot about and want to be helpful with in the future. Especially after birth, having time and space to be invited to share whatever you like about how that was for you. I really think that would be so helpful to better integrate as part of supportive, respectful services in the birthing facility, and then ongoing as people like. So many folks don't feel heard, or don't understand what happened, so being able to share, and then, as makes sense, have appropriate referrals, including more universal education on mental health support.

[00:06:44] Veronica: Yes, for sure. It's hard in our current system, understandably. There are maternal care deserts. There are not enough beds for deliveries and postpartum. We need to make room. We want to honor that time, and when people are ready for discharge, that room is getting cleaned and used very fast. So I want to honor that as a truth we need to navigate. And I agree with you completely. I have so many clients I've worked with in individual psychotherapy where it's "What happened?" Whether something went well or something didn't go as planned, or something was really emergent and scary or traumatic, there's often a need to process, to slow down and say, "Wait, what led to what?" Because it can happen in a way that can feel overwhelming, even if it's not necessarily something negative. Nothing went wrong, but it can feel overwhelming to our bodies.

[00:07:51] Veronica: That can feel sometimes even traumatic when things are just happening to you rather than feeling empowered throughout the process. So yes, I agree. Does that happen in the healthcare setting? Not often. And is that something realistically to expect? Possibly, and possibly not.

[00:08:10] Veronica: I've even had families access nurse providers who, on a consultation basis, will review your medical record and talk to you about it. It takes time, and it brings up so many emotions. So whether there can be components within social work, myself being a social worker, or case management, or lactation, how do we make sure folks have guidance and those referrals out in the community, so that if they want ongoing support, they know exactly where to go that's accessible to them geographically, financially, and linguistically.

[00:08:47] Kristin Tully: Thank you. Just to recap as I take notes and listen, you've offered the importance of being prepared, for the healthcare team to better prepare expecting families, to communicate well throughout that process, and then to have opportunities to process that together.

[00:09:11] Kristin Tully: And at Couplet Care, your work is around clinical success. Would you share more about what that means to you?

[00:09:19] Veronica: Sure. It's similar to other technology products or companies, where customer success is a very common title. But with clinical success, we at Couplet Care are working with healthcare systems, so this is really a clinical relationship. How do you, as a team, not only get excited about this new opportunity coming to your hospital, for your patients and your workflow, but also understand what it is? What is this bassinet? What makes it special? Why has our hospital chosen to invest in this? And also the nitty-gritty: How do I move it? How do I orient patients to it? How do I make sure I feel oriented, so that I can be as natural as possible, both in using the bassinet and in helping my patients understand?

[00:10:09] Veronica: Because most people will say, "This wasn't around when I gave birth a few years ago," whether at that hospital or another. So it's something new, and with newness, there needs to be orientation and support. I work with hospital systems that are integrating the Couplet Care Bassinet. We work around initial training and ongoing training as they have new hires, and troubleshooting if they're having struggles with a particular feature or feeling a little lost in what to highlight for patients. So I am that social worker to the nurse, midwife, lactation consultant, or doctor. I am their point of contact, clinically, to discuss, "How do I integrate this into my care?"

[00:10:52] Kristin Tully: That's so wonderful. It's so exciting to be able to talk through and signpost to resources too, like videos and materials. And all humans need a knowledgeable, empathetic, and encouraging person to talk through it with.

[00:11:11] Veronica: It's been exciting to see how any change in the hospital environment has this ripple effect, within the hospital room and within the workflow. It's been exciting to talk with hospital leaders and say, "Do we integrate this into our nursing orientation? Do we integrate training around this bassinet at every annual training opportunity? What does it look like to orient patients during a labor and delivery tour?" Again, so that they are empowered and there are no surprises about what is available to them. I was speaking with a colleague and thinking about the tours, which hopefully people are able to engage in, so they know where to show up. It's an exciting moment, it's overwhelming, but also, what does the space look like?

[00:12:01] Veronica: Being able to know there's this bassinet that I've never seen before, but I can really understand it, so I can get the best use out of it during that short time they're inpatient, because really it is just for the hospital stay. So it's been fun to think about, with the hospital leaders, how do we support the nursing teams as they support the patients? There's a lot of creativity in what works for every hospital system and how they want to do that education.

[00:12:31] Kristin Tully: That's great. I remember my younger daughter, she's nine now, was born, I think, in the early morning. I'm not sure, I should look, whether it was one or two AM. Even though that was our second, when you're moved into a postpartum room, you've just been through something intense.

[00:12:55] Kristin Tully: There are so many forms of that, and so many different experiences, but it's a lot. I remember shaking a bit just from all the hormones and things, who knows. And then to have something be so straightforward. We've strived and continue to improve processes for things to be very straightforward and clear, and to have a demonstration and be able to refer to materials to go deeper as you like. So that's just so critical. I'm so excited for your work.

[00:13:32] Veronica: Thank you. One of the things I'm most excited about with the bassinet is, of course, it's supportive of the mother who's gone through the birth experience, is recovering, and navigating all her emotions and hormones, as well as the nursing team. But I really love the aspect of the ability to move the bassinet toward the loved ones as well, whether it be the partner, a grandma, or a sibling who's visiting.

[00:14:01] Veronica: I love that it can seamlessly move from being above mom's lap, as she's in the bed and she just changed a diaper or set the baby down after nursing, and it can be passed over to that other loved one who also wants to connect. I love that additional layer. The benefits to mom are more obvious, and even to the nurses and the environment, but the family connection, the partner connection, the dad connection, the sibling connection, that's the piece I really like to highlight. Very rarely do we think about anyone beyond the mom, but it is such an intimate, exciting, and overwhelming time for everybody. So the more everyone can connect with the baby. Babies need attachment. They need connection. They need skin-to-skin. They're already oriented to some voices through being in utero. So building that connection across the family system is one of my favorite things, and I always make sure to highlight that.

[00:15:03] Kristin Tully: Oh, thank you. That's wonderful. It's beautiful, isn't it, being a part of it.

[00:15:12] Kristin Tully: And if you could share more around your insights and experience with mental health: how do we know when things are going well? We've done some work on the research side, and in the literature there's a lot of deficit-based writing. We want less stress, less depression, less anxiety, of course. But what we all want is for people to feel well, to be thriving, and to be able to navigate as they desire. So what are your thoughts around knowing when support is sufficient and structured well?

[00:16:06] Veronica: I think definitely, reinforcing what we talked about earlier, it's that slowing down and being attuned. I want to highlight that because it's hard to do in a busy hospital environment. Even as a psychotherapist, part of my training is that, depending on people's affect and how they're feeling, I have to slow down, and I have to be mindful, because I can be a more passionate person who talks with her hands. So thinking about that presence is really important. Being able to answer those questions, and with no judgment, bring in resources, whether it be social work or lactation, because they're struggling around those initial contacts and latch. Accessing donor milk if needed, if there are struggles and they really want to be working toward breastfeeding. There's a lot of mom-shaming in the culture, not at a hospital, but just in culture. So the more we can say there's no right way to be a postpartum mom, there's no right way to access certain services, really making sure they're at the helm of those decisions, and that they feel every decision they make is the right one because it's their decision.

[00:17:49] Veronica: And fostering connection, and them leaning, over time, on their own instincts, being able to reach for the baby when they want to, or when they feel they should because there are some cues with the baby. That's why I especially love that the bassinet allows that connection. Through those connections, through the reinforcement, support, guidance, and cheering on from family members and the birthing team, their confidence builds. It's very hard to trust yourself, especially when it's your first time. But every baby is different, so it happens every subsequent time too. So really hyping them up: "You're doing great. We're right here. What do you need? How can we support? Do you just want space?" Asking lots of questions, sitting in the silence with them, and letting them ask for what they want and honoring that request. It might be, "I am so exhausted, can I get a bit of a break?" Whether a partner steps in, or the baby goes to the nursery for a little bit because there's nonstop crying and they need a sensory break.

[00:18:44] Veronica: These are things they're sometimes afraid to ask for, like, "I'm afraid to be away from my baby for any moment." So making sure they rest. It's a huge thing they've gone through, whether it was a vaginal birth, unmedicated, medicated, C-section, or emergent. Regardless, even in the best of circumstances, it's overwhelming and draining, physically and emotionally. So honoring that that's what's going on too, amidst the logistics of "I'm bonding, I'm holding, we're latching, I'm changing a diaper."

[00:19:20] Veronica: So it's this web of support we can provide at that time. A lot of it shows up in our pacing, in our demeanor, our non-judgmental language, and empowering them to make decisions in that timeframe they're at the hospital.

[00:19:42] Kristin Tully: That's so awesome, Veronica. Part of what I heard is the many forms of rest. We need sleep, we need sensory sensitivity, and we need people to sit with us, to sit in silence and just be present. And when you talked about how the bassinet can go over mom and they can see and have their hand on their baby, that peace of actively seeing and having your hand on your baby and knowing that things are great right now, or otherwise being together. That is just what we're here for, really.

[00:20:33] Veronica: Exactly. Moms who have gone through pregnancy have already begun the bonding process, and that identity shift, because they've had that shared space. And it's going to shift once baby is outside of their body. They're trying to reconcile that "this thing I've kept safe this entire time is now outside of me." So there's that time, space, and connection that is really important, and I think the capacity to fall asleep touching your baby is so beautiful, so needed, and very much aligned with being respectful. They are two beings that have just separated. They need each other. Babies too are searching. And even for dads or partners, their transition to becoming a parent, or to that baby, is also through connection. So getting dads and partners as involved as possible, with holding, with feeding if there are bottles being provided, with changing diapers, the connections that foster attachment. The more people are involved in the caretaking, they are going to fumble their way through it, but that's okay. This bassinet is one piece of how we can create a space that really complements this huge adjustment.

[00:22:03] Kristin Tully: Yeah. At the University of North Carolina at Chapel Hill, we have something called the Fourth Trimester Project. Through that work, we talk about how newborns, and parents, are born too, and grandparents. So it's a multi-component transition for everyone involved, and siblings too, to your point. It's so wonderful to have them be able to be at eye level and see and touch their little brother or sister.

[00:22:46] Veronica: Exactly. There's the relationship to this little being, and the logistics of it all, whether it be the breastfeeding journey, changing diapers, holding them when they feel so fragile, and how do I bathe them. There are all those logistics we make sure they have. But also, how do I orient to there being this being in my orbit that is now top of mind, that I am keeping safe?

[00:23:13] Veronica: So there's that huge emotional component, which is going to take a lot longer than just those first couple of days at the hospital, but those are crucial days. As much as we can do to create an environment that feels really respectful and attuned to all of those adaptations and adjustments, that's the direction we need to be heading.

[00:23:35] Veronica: And it's beautiful to watch, anytime I watch it happen. I'm excited to maybe see a baby when I'm at the hospital orienting the bassinet, and I say congratulations to the parents as I walk by. It's a beautiful space. It reminds me of how people talk about watching someone die. It is beautiful to watch someone be born. Even in the most scary moments, it's still really beautiful and worth honoring. Let's stop and realize that even though this happens a lot here, each one is different, and each one is beautiful.

[00:24:19] Kristin Tully: Well, thank you so much, Veronica. That was wonderful. Anything else on your mind that you'd like to share? That was just lovely.

[00:24:29] Veronica: Thank you. I'm just really glad we're having more conversations about empowering parents in general. Thinking about this time, post-COVID, there's been more conversation around parenting, and what parents, myself included, went through, as you did as well. I think it's really great that we're slowing down and saying, "There's a lot going on for families. It's really hard." So I'm glad to have spaces like this where we have these open conversations and really think about the things we can be grateful for and want to continue, and the things we want to tweak and improve, to support families.

[00:25:07] Veronica: And to support children, their development, as families, adults, and humans. So, to more conversations. The more conversations, the better. I'm very grateful for this time, and to be part of the team. It's been such a joy in my short time here.

[00:25:28] Kristin Tully: Thank you again. As a part of this, I'm so glad that resources like Postpartum Support International exist, offering free virtual support and a whole network of healthcare providers and people to actively support people being well, in addition to processing experiences and getting connected with mental health care services.

[00:25:56] Kristin Tully: So just reiterating that during pregnancy, birth, and postpartum, and postpartum is forever as well, Postpartum Support International and the National Maternal Mental Health Hotline are such critical resources that I hope everyone knows about and uses, to benefit them. They help you heal faster.

[00:26:22] Veronica: Yes, for sure. Thank you for highlighting Postpartum Support International. They are the embodiment of so many resources that are free and accessible virtually, in lots of different languages. There are support groups, they have state coordinators that connect you to resources, and the maternal mental health hotline. So thank you. You touched upon really important resources that are always the first recommendation I give. People are in really great hands when they reach out to them, and their website is postpartum.net.

[00:26:58] Kristin Tully: Thank you very much.

[00:27:01] Veronica: My pleasure. Thanks for having me.