What compassionate care for mothers in recovery looks like | Sara Hobgood

[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 perspectives and, tell us more about their work. Connecting around research and experiences is key for implementing more meaningful support for families and those who care for them. I'm so excited to be with Sara Hobgood. Sara brings over twenty years of experience in perinatal nursing and fifteen years as an International Board Certified Lactation Consultant. As an IBCLC, Sara has supported and encouraged mothers who desire to breastfeed, to help build their confidence and promote positive maternal and infant outcomes. During her time as a bedside nurse, Sara's developed a passion for working with mothers affected by substance use disorder, and she's recognized significant gaps in the support that they receive.

[00:01:02] Kristin Tully: Sara, welcome. Will

[00:01:05] Sara Hobgood: Thank you.

[00:01:06] Kristin Tully: And will you

[00:01:07] Sara Hobgood: Happy to be here

[00:01:10] Kristin Tully: This is so great. Will you please share a little bit more about you and what drives your work?

[00:01:16] Sara Hobgood: Absolutely. Well, I have been a nurse for about twenty-nine years, and I started out in pediatrics, and then I transitioned over to mom baby after I had, my first child, twenty... almost twenty-four years ago, and just really fell in love with all things moms and babies. And, through that time period, I-- we had a lot of moms that struggled with substance use disorder, and we were caring for them and their infants, and I just developed just a heart and, a love for them.

[00:01:53] Sara Hobgood: And, the more that I sp-- more time I spent with them, I could see similarities, like in their background and my background as far as like childhood trauma. I've never had struggled with a substance use disorder, but I, have struggled with like mental health, things like anxiety, depression, PTSD.

[00:02:15] Sara Hobgood: And just getting to know them a little bit better, I just could, understand them in ways that I think other people couldn't understand them. Like what that means to not, like, have transportation or, enough money to get some food to eat, or having your electricity or water cut off, like things like that.

[00:02:36] Sara Hobgood: And just, you know, being affected by, you know, childhood trauma. I just, just developed this love for them, and the more time I've spent with them, just really could see where they struggle. And we've really come a long way, I feel like, in the support for this population, and that's just something to be absolutely celebrated.

[00:03:00] Sara Hobgood: But we still have so much work to do. We're not anywhere close to being done. And, and I, I just have to say that these women, honestly, are some of the people that I admire most in the world. Absolutely.

[00:03:22] Kristin Tully: That's really beautiful and powerful, Sara. Thank you for sharing how our, know, your personal experience, and I said our because, you know, so many of us, like, we feel this deeply, and we sort of with different aspects, of what, you know, matters most for folks. So thank you for being, you know, open a- and sharing that, which is, which is so special

[00:03:50] Sara Hobgood: Oh, yeah, of course.

[00:03:52] Kristin Tully: And so will you tell us more about what you're, what, what are you up to now? And, you know, what, what a lot of things, and so tell us about your moving parts and what, you know, excites you

[00:04:06] Sara Hobgood: Absolutely. Absolutely. So like I said earlier, I've been a nurse for, 29 years, and I never really had any, dreams or goals to go back to school or do anything in, the psych world. And you just never know where you're gonna, where you're gonna be, 'cause right now I am, close to completing, my nursing doctorate and psychiatric mental health nurse practitioner degree.

[00:04:31] Sara Hobgood: I, just through personal experience, professional experience, have seen, just where, our mental health system has a lot of opportunity to grow and improve, and, it's just something that I felt very strongly that, like, I absolutely needed to do, just because I... Just because of the experiences that I have, and, like, I, I don't know, like I can just understand, and see barriers, that people who struggle with mental health issues, I can see the barriers that other people, really can't see or don't...

[00:05:04] Sara Hobgood: it doesn't make sense to them, you know, why somebody would do that or not do that. It makes sense to me. And, and I just have, like, a special heart and, have gone through a lot myself and really want to do what I can do for, people and families just when they're at that, At that point where they're needing help.

[00:05:25] Sara Hobgood: I mean, 'cause it's, it's just so hard, and there's just so much, like shame, associated with that, which is I've- I'm finding is just like probably one of the most powerful, emotions that there is. And, so, so yeah, so I'm at, UNCW. I graduate in May of 2027, so I'm counting down months now, not years.

[00:05:45] Sara Hobgood: And, and so just doing a couple different things. You know, I still work a little bit as a bedside nurse on the antepartum unit. And I am-- I volun- like I work a little bit at, an organization called Tides, which, supports women in r- recovery, like who are pregnant or newly postpartum, and they are just some of my favorite people to be around.

[00:06:07] Sara Hobgood: And, and just in my experience, I, you know, had wanted to, I'm like, gosh, we, you know, we really need to increase the education that we give these moms that come into the hospital, particularly the moms that, struggle with opioid use disorder because their infants have to stay, a longer period of time and can go through withdrawal, and it can be very challenging to manage, that process.

[00:06:29] Sara Hobgood: There's just a lot of, emotions, a lot of guilt, and just a lot of just being overwhelmed and exhausted going through that. And I started to see, some ways that we could educate them and get them better prepared, emotionally and just educationally wise. And just through that, this whole project called, I named it the HOPE, Recovery Project, and HOPE stands for Holistic Ongoing Patient Engagement.

[00:06:54] Sara Hobgood: And the best, for lack of a better term for, some people, to try to like process or figure out what, what, what this is, it's sort of like a case management type of thing, but I really don't even want to use that, that verbiage, but it's sort of like that. But it's not like any other, like case management that you have ever seen.

[00:07:14] Sara Hobgood: It's, it's wraparound care for the womens that struggle with substance use disorder. It starts at the prenatal, visits, and it's, it's just very different. It's built upon relationship building, getting to know them, initially because they have to build trust with you. And, you can try to teach them things, but if you don't-- if they don't trust you and feel comfortable and safe with you, it's just not gonna stick.

[00:07:40] Sara Hobgood: And so it's a lot about relationship building and a lot about asking them like what, what would be helpful to you? What is important to you during this pregnancy? You know, when you have this baby and postpartum, like what, what would be helpful for you? 'Cause I feel like there are a lot of resources out there for this population, but, there's a lot of gaps, and they're not really hitting the actual needs.

[00:08:08] Sara Hobgood: And, it's interesting that I'm learning that this population, particularly mothers with substance use disorder, are not ones to really speak up for themselves, very much or complain very much because there's just such fear of, like, retribution and the, potential of losing, their child or their infant.

[00:08:29] Sara Hobgood: And so they don't really speak up, for themselves, and so that's really, very unique to them. And so-- And I really want to, to be their voice. And so Hope Recovery is about, advocacy, education, and healthcare navigation. And basically that same advocate stays with them from that prenatal visit all the way, at least, until their first year postpartum, and helping them just learn everything that they need to do so that when they walk into the hospital to have their baby, they are prepared.

[00:09:02] Sara Hobgood: Like, they know how to swaddle their baby. They know how to do the five S's of soothing. They know how to do some basic infant massage, and they know about skin-to-skin. And, and with all of these... These are things that are good for all babies, but especially if, a baby is going through opioid withdrawal syndrome, it can be just completely overwhelming and paralyzing to know how to help, help your child, and they are riddled with a lot of guilt.

[00:09:29] Sara Hobgood: And, with this project, I Want to do anticipatory guidance and, you know, kind of having them picture that moment where the baby is crying and they're like, "Gosh, you know, I did this." And, but then also helping them to reframe that into like what can we do right now, and putting that baby on their chest and helping them to see and like kind of be in the voice for that baby.

[00:09:54] Sara Hobgood: Like, this feels so good to them. Like they're hearing your heartbeat, your warmth, your smell. Like you are doing this for them. And just really helping them to feel empowered just even with their like physical bodies and the things that their body is doing really well and the things that they are doing well, and just trying to point out things that others might take for granted, that they're doing so that they can be encouraged and know that they are doing a good job, taking care of their infants.

[00:10:22] Sara Hobgood: And, and, and just a little bit of encouragement goes a long way for them. And so yeah, so I'm working on that. I'm trying to get funding to be able to implement that. I, I have places where I'm implementing pieces of that, but I would love to have it put all together, to do it because I, I think it would really change things.

[00:10:42] Sara Hobgood: You know, there's a, a new initiative where we, before the, women leave, the hospital, we do a postpartum depression scale And which is great that we're doing that. You know, I think we're, just it brings awareness to postpartum, depression and mood disorders, and it helps us, talk about it a little bit more.

[00:11:00] Sara Hobgood: But for this population, you know, they're, they're not going to, again, in fear of, what is gonna happen, are they gonna lose their child? You know, I think that, survey is done sometimes in childhood, infant checkups and things like that, but they're never gonna say, "Oh, I don't feel like I can take care of my baby."

[00:11:18] Sara Hobgood: They're never gonna say that. But if you have established a relationship with them and you've talked about if this happens to you, this is what we're gonna do about it. This is what-- how we're gonna support you, this is what's gonna happen with your baby, and those types of things so that if they are feeling really overwhelmed, they are feeling, like they might be getting close to relapsing, they're gonna be able to verbalize that and feel safe to do that rather than, you know, just pushing and pushing, and then they just can't keep going, and then they relapse.

[00:11:50] Sara Hobgood: And then, you know, babies and children have to go into foster care and, and then you start more trauma, and it's just to break that cycle. And so the whole idea of this project is to essentially keep these families together and help them live a healthy and joyful life and, just-- and then use that, you know, their experiences to help others.

[00:12:17] Sara Hobgood: And so I'm, I'm working on that and, you know, I think, it's, it's interesting to see-- It'll be interesting to see what I do when I graduate. Like, I definitely want to work with this population and be a prescriber for them. And as a nurse practitioner, I can do, I can prescribe medication, but I also, am trained in therapy too.

[00:12:35] Sara Hobgood: So I can, weave a lot of that together, to get to the heart of a lot of the issues that they're, they're facing. So, so I'm working on that. And, and right now I'm starting my doctorate project And so, I-- it took a while to figure out and narrow down what I wanted to do because I have so much passion for this population.

[00:12:55] Sara Hobgood: There's so many great things that we can be doing to, increase the support that we give them. And so what, the thing that we identified was, there's a huge knowledge gap, in knowing how to-- the best practice for caring for not just people with substance use disorder, but mothers that are affected with substance use disorder, 'cause there are a lot of things that are unique to that.

[00:13:20] Sara Hobgood: And so, and then infusing that education with trauma-informed care because, even those we, we are coming along really nicely, we are advancing, for that population, there still is a lot of stigma, a lot of judgment, there's a lot of emotion tied to, you know, when you see like an infant struggling or things like that, there's a lot of like frustration towards that mom.

[00:13:45] Sara Hobgood: And, you know, and just learning how to... And I think a lot of people, you know, when they are kind of being judgmental or, punitive or harsh, they sometimes almost feel like that's their duty, that they need to be like that to maybe help that person to do better. But, but research tells us that's like not effective at all.

[00:14:07] Sara Hobgood: And, just really helping to equip them to be able to show compassion, show kindness and with understanding. I mean, you still have to... I mean, they're still hold accountable for everything that's happening, but just helping them along and, encouraging them in a way that they can respond to, that they can keep going.

[00:14:27] Sara Hobgood: 'Cause, I mean, it just takes one discouraging comment to just have it fall apart. You would think just one little comment, it does. It can just be-- it can send them down, it just can send them down. But then on the positive side of that, you know, being a person that is encouraging them, any kind word that you say is, I mean, it means everything to them.

[00:14:51] Sara Hobgood: It means everything to them. And, they are a very, you know, misunderstood, population, I feel like. A couple little things that I want to, you know, just share, that things that I didn't know, coming along, but I've learned, in the past few years, just about the brain. Like people, who struggle with substance use disorder, their whole reward system, their neurotransmitters, like there's a lot of rewiring that's done, And it is definitely something that we need to look at more as a chronic disease rather than a moral failing.

[00:15:28] Sara Hobgood: Like I have this, let me see if I can find it easily. I have this quote, the Surgeon General and National Academy, of Sciences, Engineering, and Medicine have underscored the need to address societal views that substance use disorder is a moral failing or a character flaw versus a treatable chronic medical condition.

[00:15:50] Sara Hobgood: And, I think we just need to, to understand that. And I think if we understand that, we're gonna be better equipped to actually help them and use language that is going to support them in their efforts in recovery. The maternal reward system, for them specifically, they have a amplified stress activation.

[00:16:12] Sara Hobgood: So like when their, their infants are crying, they experience more stress, than a mom who hasn't struggled with substance use disorder, and they have decreased sensitivity to that natural reward system. So when they see their infant smiling and cooing at them, I mean, they do have a sense of pleasure and reward, but it's, it's, it's muted some.

[00:16:37] Sara Hobgood: And, a lot of people don't realize that. So, that was interesting to find out, and mothers who struggle with depression, their infants sleep about ninety-seven fewer minutes a night and wake up a lot more during the night than mothers who don't struggle with depression. And, and I thought that was, Also really interesting, which kind of, leads me into talking a little bit about, my absolute love for the Couplet Care, bassinet.

[00:17:09] Sara Hobgood: I just happened to find a little bit of something written about it when I was-- when I initially started school four years ago, I think, and was just completely mind blown by this, this bassinet. And when I saw it, I immediately thought of these women who, just to kinda give you a visual, I'm gonna do my best to kinda give you a visual.

[00:17:31] Sara Hobgood: You know, you-- maybe you guys can picture, a hospital room, the hospital bed, like a mom wearing like a hospital gown, and you see a room, you know, maybe you can picture a little bedside bassinet in there. And their infants, the moms, who, have struggled with opioid use disorder specifically, even when they are, have been like in a treatment program and doing very well in a very healthy place, they are-- they have that need to stay on that, that infant, can withdraw from that.

[00:18:03] Sara Hobgood: Which is a big, misunderstanding, a lot of times even in healthcare, that if the mom has been on something that's prescribed, that the baby isn't gonna have withdrawal, but they, they absolutely can. And it's very difficult to predict because we're all so different and have different metabolic, you know, rates of processing medications.

[00:18:20] Sara Hobgood: But All the infants will withdraw to some extent, and some are fussier than others, and they, they cry a lot, they tremor, and even if they fall asleep for a second, they're, like, woken back up, like, every five minutes. And, and so we've started... One of the progress-- some of the progress that we've made is this new scoring system we call Eat, Sleep, and Console, and it's really designed to, keep that mom and baby together.

[00:18:48] Sara Hobgood: It has shown that infants have needed a lot less, medication management, while they're going through that withdrawal. They, don't have to stay in the hospital, as long, and it's really-- it's very-- it's wonderful. However, that mom, you know, one of the things that we're like, "Oh, do skin-to-skin," and the infant, you know, they love being up on their mom's chest.

[00:19:10] Sara Hobgood: However, that mom has gotta have s-some time to sleep, and she can't keep that baby on her chest, twenty-four hours. And what happens is they fall asleep in the bed with their infant, and which isn't safe sleep, and they, you know, get in trouble for that and reprimanded, more so than other moms without substance use disorder.

[00:19:35] Sara Hobgood: I mean, 'cause all moms fall asleep in the bed with their babies. I'm just gonna tell you as a bedside mother-baby nurse, this happens to pretty much every mom. And, but when it happens to this population, they're held to a higher standard. But yet, they're not really given many tools to help with that.

[00:19:51] Sara Hobgood: And so then if they try to be compliant and put their baby in the bassinet, that baby can jolt and wake themselves up in, like, five minutes, and they can't really reach into the bassinet. It's too high. They can't reach their baby, and so then they have to try to get up out of the bed to get the baby, and even in those seconds, that baby is starting to escalate.

[00:20:12] Sara Hobgood: And then it's harder to get them to calm down and all of that. And so then the, the mom's sleep is so, interrupted And when I found out about the Couplet Care Bassinet and got to play with it myself, last summer, I was like, just like, "Hallelujah. This is just perfect and amazing, and is just gonna give them the chance to do what they want to do."

[00:20:38] Sara Hobgood: And so it's, it's so beautiful because you can just pull it over, the mom's lap, and, their baby, if they're, they've gotten their baby to sleep, and they're in the bassinet and, and they kind of jolt to wake up, they can very easily just pat their little bum, and 'cause they love that, and they go right back to sleep.

[00:20:56] Sara Hobgood: That mom can actually sleep in her own safe sleep space. That baby is in their own safe sleep space. And, just having that mom's hand nearby, the, the warmth, the smell, keeps them calmer. And if they do need to eat, mom can just reach in, feed them, and when they calm down, and are done, they can just put them back in there.

[00:21:16] Sara Hobgood: It's just, I mean, it's just a completely different postpartum experience. And because they haven't had to get up and, and, and then increase their pain in moving around and things like that, they're able to go back to sleep a lot better, them and the babies. And that is important because for two reasons for the mom, the more sleep that she can get, the more that that reduces her risk of postpartum depression.

[00:21:42] Sara Hobgood: And these women, the ones with the babies that have to stay, extended for at least five days, if you could imagine being in the hospital, trying to sleep in a hospital for five days, even if you haven't given birth, is just exhausting. And then postpartum depression, you know, that's gonna increase their risk for relapse.

[00:22:01] Sara Hobgood: So the more that these moms can sleep That's great, and then they can feel good about themselves that they're being compliant. They're doing safe sleep. They're, able to do it. And, and then the infants, because they're not crying as much, they're able to be calmed down. Infants that are going through withdrawal have a much higher metabolic rate.

[00:22:21] Sara Hobgood: They require more calories, and the more that they're crying, they're burning more calories, and so the more that they can sleep, they're saving those calories and are able to spend that time growing. And so that just affects them, you know, in all sorts of ways. And so it is just-- it's actually very, very, just practical and, and it just makes that postpartum experience so much more, enjoyable.

[00:22:46] Sara Hobgood: You know, you've worked so hard. You've prep-- they've prepared this nursery. They've gone to all their prenatal appointments, and then they've had this baby. And then, you know, with traditional bassinets, they, they can't get to their baby, and, they feel really bad about bothering you, and some of the moms will raise their beds up so that they can reach into the bassinet, which is very unsafe because then they're at a higher, distance to fall themselves or their infants.

[00:23:10] Sara Hobgood: A lot of hospitals will put the babies in, a mamaRoo, which is like a swing that kinda goes around, to kinda help keep them calm. And it can be very helpful. However, its intended use is to be for an hour or so while a, an adult is monitoring them because their, neck, they can, you know, kink their neck, and, it can be a risk for, SIDS if they're in there.

[00:23:36] Sara Hobgood: And so sometimes these infants, just because there's nothing-- no other way to get these infants calm and to get these moms to be able to have, like, even an hour's worth of sleep, you know, they spend a very long time in these, mamaRoos, and so they're getting used to sleeping in a, motion-like way.

[00:23:52] Sara Hobgood: They're not used to sleeping in a stationary bed. And so then when we send them home, they-- I mean, we can-- I always kinda say this, it's kind of like, I don't know, silly to say, but these moms, I mean, we could have them complete a PhD in safe sleep, but it, it doesn't matter at all if they are at home, and they cannot get that baby to sleep, and the baby is screaming and screaming and screaming.

[00:24:16] Sara Hobgood: That baby is absolutely gonna go into the bed with them, which for this population, you know, they, babies that have been exposed to opioids, are at high risk for SIDS, just from that exposure. And, so yeah, it just, it just creates a way for nurses to model safe sleep in the hospital and creates a way for these moms to be compliant with safe sleep and feel good about what they're doing.

[00:24:41] Sara Hobgood: And, it's just, it's just a beautiful thing

[00:24:46] Kristin Tully: Sara, this is amazing. You're in, you know... And thank you so much for sharing how the Couplet Care bassinet, you know, is a piece of this story about respectful supportive care and just, better equipping people to navigate as they need to. And I loved your talk and your counseling and this whole program and standard o- of care that I think should be with all populations about how... what wonderful, you know, things that our bodies and our, and our voices and, you know, like, and our feeding, like, just everything that we're doing is, is just so beautiful when it can work well. And so that's why we wanna remove barriers so that people, as you just described, so that they know that, you know, so that they're equipped with that knowledge. And then we want the environment to be, supportive so that they can actually, interact with their baby as they need to. And, and with these sort of high acuity circumstances, that's just, that's just everything, so

[00:25:59] Sara Hobgood: It is. It is. And it's, so much needed, you know, because we've started, you know, baby-friendly and, you know, we encourage rooming in. And, we, just moms in general, we are not giving them, the way to do that. We are saying these things but then not giving them a way to do that, and it can be really frustrating.

[00:26:20] Sara Hobgood: But this is just opens them, just provides that avenue to do it, do all the, the wonderful natural things and stay safe at the same time

[00:26:29] Kristin Tully: yeah. this is so great. And so Sara, maybe taking a step back, do you have reflections around, you know, respectful care and what conditions, help that? You, you mentioned some about when clinicians, you know, that they can experience some judgment and then they're, they're wanting to be, promoting, you know, positive health outcomes and so. some- sometimes we don't have that, that knowledge or support maybe to be able to be aware and then to be trauma-informed.. Yeah. Anything else that helps with the healthcare team?

[00:27:11] Sara Hobgood: So just really, my plan, for like I was talking about my DNP project is to provide, just very comprehensive education on, mothers who struggle with substance use disorder. Just like the just neurobiology, just addiction as a chronic disease and, language that's helpful to use.. In general. And, and it's interesting 'cause a lot of, people who struggle with substance use disorder still use some of this, stigmatizing language, but talking about like clean is one that always stands out to me, is, you know, when I was clean or, you know, that kind of thing. But then if you're not clean, then what are you? Dirty. And so, you know, you want to, you know, just use different terminology. Just you're, you know, in, in recovery you are, or you have, had a return to use instead of like, you know, dirty, that kind of thing. Just, just saying like what it is, you know. You don't have to describe it, you just say what it is, you know, if someone is relapsing or returning to use and, and just understanding that that's part of the recovery process.

[00:28:19] Sara Hobgood: That, that, you know, is very-- that can happen to them and kind of, you know, prepare for that yourself mentally to... You know, I think a lot of people worry that if they, invest in this population, what if they relapse and, you know, all of that. And, you know, so if you've shown them empathy and compassion and kindness.

[00:28:41] Sara Hobgood: And, you know, say, okay, they are, you know, they have been manipulating you, or they are lying or something like that, you know, what does it really matter? What have you lost? Because your investment in making them feel cared for and treating them with kindness, it still stands, because their story isn't finished yet.

[00:29:01] Sara Hobgood: And you want to, do everything you can. Every touchpoint that a mom has with a healthcare provider is an opportunity to, to help them in that journey, to give them, you know, help re-motivate them, help them, you know, I can do it. 'Cause they do get really, discouraged and really wanting, And then in that education, I want to infuse, stories of women that I know and to tell their stories of what it was like for them to help, you know, nursing staff, healthcare staff to be able to step in their shoes.

[00:29:39] Sara Hobgood: 'Cause it really is hard if you haven't experienced certain things. It's really hard to feel empathy and, but just giving healthcare staff a way that they can do that because we also, you know, can get frustrated with healthcare staff about not doing that, but let's also give them a tool and a way to be able to provide the care that is needed and use the language.

[00:30:03] Sara Hobgood: And you know, I look forward to the day that when You know, all patient, you know, all people in healthcare know sometimes when you work with patients it can be frustrating and, and things like that with different instances. But I, I look forward to the day when behind closed doors, the healthcare staff that work with this population are, are not saying judgmental and negative things against them.

[00:30:26] Sara Hobgood: They're just saying, you know, "Hey, this is a challenge. This is a problem. What can we do to work together to help them?" And just, yeah, because even if you think that, you're being in front of that patient, if you actually feel that way down deep, it actually comes through. They can tell. You think you can't, you think you're hiding it, but they can tell.

[00:30:46] Sara Hobgood: And, and what that does, just to put it into... It's not just making, when people talk to them like that, it's not like, "Oh, well, you know, I just was discouraging to them," or, "I made them feel bad," or something like that. It's so much bigger than that. The impact is, and the literature is very clear.

[00:31:04] Sara Hobgood: Research shows that, moms when they have a history of substance use disorder or are currently, using, they... there's so much stigma, they, are very late to seek prenatal care because of how bad that that looks on them. You know, if you're a real mom or if you're a good mom, you wouldn't do this. And so they delay their access to care, which can be lifesaving for them or their baby.

[00:31:29] Sara Hobgood: And that, that's like a huge thing, that delay in care. And one thing that I just found out, you know, in just doing some research for my project that is, is really astounding, it comes from the North Carolina Maternal Mortality, Review Committee. The most recent numbers, 'cause it takes a while to compile and analyze this, analyze it.

[00:31:50] Sara Hobgood: But from the most recent, report that's been put out has been from 2018 to 2019. And the, as far as pregnancy related deaths, the majority, the leading cause of death was, related to mental health conditions leading to suicide and fatal overdose. So in North Carolina, the leading cause of death for the years 2018 to 2019, associated with pregnancy was mental health conditions.

[00:32:24] Sara Hobgood: And You know, that's just something to keep in mind. You know, if you took care of that person and you found out that, you know, that happened to them, you know, would you wish that you had said anything more encouraging? And so just think about those words, which you would want to say to them to, you know, in, in truthful words, but things that you can do to build them up that they are doing well, and to, to look at them and look, make eye contact and, sit down.

[00:32:56] Sara Hobgood: Like, don't be rushed. Spend time with them. Let them talk a little bit. Make them feel like they matter. It really makes so much more of an impact, than you realize because not only is you impacting, are you impacting the moms, you're impacting their infants and their children too. They're keeping... you're helping keep those families together

[00:33:17] Kristin Tully: Wow, Sara, so important and so exciting. I can't wait to see what you continue and increasingly do, and I, I'm really cheering you on with this, with your work and this program and

[00:33:31] Sara Hobgood: Thank you

[00:33:32] Kristin Tully: that, as you said, holistic and ongoing and, like, because hard things i- in different ways, they will come up for everyone. And,. So being there, know, being an ongoing resource and offering... I love the part too where you shared about, you know, being proactive and, and sort of giving people the m- maybe not the whole story, but like outlining what this means, you know, when this comes up and sort of sharing that because power dynamics with anyone, let alone, you know, with, with this population, those are always hard.

[00:34:13] Kristin Tully: You know, like we... here, as you've just described, you know, the, consequences are immense.

[00:34:20] Sara Hobgood: And just having, just in all ways with all, I mean, all people in general. But, just I have found that educating moms, whether it be about breastfeeding or, you know, diaper changing or swaddling, I mean, just all these, little th- things that might, people might think are little, just education and learning about, like, what's normal and what's, you know, what's okay and, you know, those kinda things can help, be so empowering to moms and decrease anxiety.

[00:34:50] Sara Hobgood: I mean, they're gonna have anxiety, they're a new mom, but that can help decrease anxiety, a lot of the fear of the unknown, when they understand and see what's happening before them. And it just brings, it just builds them, just builds their confidence that, you know, maybe I can do this. I can be a good mom that I wanna be

[00:35:08] Kristin Tully: Yeah. And as, as you shared, you know, patient and quality care, that includes psychological You know, we need to be able to be vulnerable. I mean, gosh, what is more vulnerable than giving birth in, in,

[00:35:25] Sara Hobgood: Yes. Yes

[00:35:27] Kristin Tully: way? In every way. And so you, you need that, and so I'm so, I'm so in awe, you know, of, of, of the work that you're leading.

[00:35:36] Kristin Tully: Thank you so much for sharing a little bit about that.

[00:35:40] Sara Hobgood: Well, thank you, and thank you for your work. It's just, it's amazing. It's, it's provided a way to, you know, help these moms, and it's just so meticulously thought out and, yeah. Thank you so much for your work

[00:35:52] Kristin Tully: Well, and I appreciate your ongoing... you know, you're an advisor to Couplet Care, and, you know, it's because of you and so many others where we've been able to listen about these things that really matter, and then to be responsive to that, to offer something that fits and is helpful. So, you know, it's good to be in community with you, Sara

[00:36:16] Sara Hobgood: Awesome. Thank you

[00:36:18] Kristin Tully: Great. I think wonderful. If you, you know, if, unless there's anything else that you'd like to, to share, Sara

[00:36:28] Sara Hobgood: No, no. I, I think that's it. You know, I very much just wanted to share a little bit about, you know, my passion and just how amazing these women are. And I just, encourage anybody who, you know, is hearing this or, that just to, you know, be patient, you know, with someone who might be struggling with that.

[00:36:49] Sara Hobgood: And then as far as like moms, with substance use disorder, I mean, look at your local organizations. They always can use volunteers. Meals, help with childcare, just... or even like just different activities, the things that they can do to, to learn a skill, tutoring, those kinds of things.

[00:37:07] Sara Hobgood: Just spending time with them, you know, is, is just such a huge thing, that you would, you know, give an hour of your time. I mean, that, that means something to them and it makes they-- makes them feel like, you know, "I do matter. I am worth something." So those are some ways that people can, volunteer.

[00:37:23] Sara Hobgood: In Wilmington, we have, the TIDES program, that I definitely recommend. You can go on their website and look. There's lots of, opportunities to volunteer. And I promise you that if you do, you will be, you will definitely bless these women, but you will come away even more blessed and, you know, on cloud nine and so excited.

[00:37:43] Kristin Tully: That's great, and we'll link to that. Thank you.