Posted on October 21st, 2021by RMANY

Ep 77: Mental Health and Conception and Pregnancy with Dr. Emily Watts

Fertility Forward Episode 77

Mental health struggles are stigmatized and when women are pregnant or become mothers, these issues are almost completely overlooked. Dr. Emily Watts specializes in women's mental health and perinatal psychiatry and applies a holistic approach to the care of her patients. She sees the interplay between the physical, mental and social wellbeing of her patients as vital to their overall health. In today's episode, Emily explains how those on medication for their mental health can navigate conception and pregnancy. There is a not a universal answer and it depends on individual factors and circumstances. We talk about the prevalence of mood and anxiety changes during all stages of pregnancy and Emily walks us through some of the lifestyle changes she typically recommends. Our conversation also touches on the importance of sleep, challenging the idea that moms need to do it all, and normalizing speaking about mental health during pregnancy. Tune in to hear it all!

Transcript of Episode 77

Rena: Hi everyone. We're Rena and Dara, and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York city. Our Fertility Forward podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients, because knowledge is power and you are your own best advocate.
Dara: Dr. Watts, a reproductive psychiatrist, specializes in women's mental health and perinatal psychiatry. She has a New York based private practice where she applies a holistic approach to the care of her patients and sees the interplay between the physical, mental, and social wellbeing of her patients as a vital to their overall health. She specializes in psychotherapy, psychopharmacology, sleep, nutrition, exercise, and mindfulness based practices. She also teaches residents and fellows at the NYU School of Medicine in the Department of Psychiatry. Dr. Watts is passionate about women's mental and physical health and advocates for women and children worldwide. Dr. Watts, so happy to have you today. Thanks for having me. It's great to be here.
Dr. Emily Watts: Thanks for having me. I’m happy to be here.
Rena: Yay! You sound like such a super woman in your intro, like Jack of all trades
Dr. Emily Watts: You’re kind. So, so do you guys.
Rena: We’re so psyched to have you on such an important topic and something that patients ask all the time, you know, depression, anxiety, medication, pregnancy, trying to conceive what is okay? What isn't okay? I think there's so much out there and it can be super overwhelming. So let's dive in. I think the one question I always get asked is, you know, I've been on X medication for years for anxiety. Can I keep taking it while I'm trying to conceive or while I'm pregnant? Is it safe?
Dr. Emily Watts: So that's a great question. This is a question I obviously get a lot too, especially during the preconception consultation, but also during pregnancy and postpartum during lactation. So when thinking about the risk of medication, we also have to weigh that with the risk of untreated illness. And those two things are both thought of as exposures in both the pregnancy and postpartum. When talking to an individual client or patient about their individual risk we consider both the current illness severity, their past history, both with medications and psychotherapy and otherwise and we weigh that with sort of the individual risk of continuing medications versus not. Typically when people have a mild illness, if they're not on anything and have been doing well on that, we would just consider psychotherapy and lifestyle modifications. If they are on medications and have had multiple trials on and off medications in the past and have not done well and have done well on medications, again, weighing their past history would often suggest staying on medication because the risk of relapse during that period of pregnancy is quite high. It used to be thought of as a sort of a protective time, but we now know that it's quite the opposite. And if once a woman does relapse and let's say, a woman says, you know, why don't I try being off medications? And when symptoms present, then maybe I'd consider going back on medications. It's much harder to actually treat later during the pregnancy and postpartum once you've come off the medication. It's a much more severe illness and much more protracted in time and it's harder to reach remission with the medication, even if that medication helped them in the past. So often, you know, we counsel on continuing to, to prevent that relapse during pregnancy.
Dara: There's a lot of different types of medications to that peak that can be given. To be honest with you, I'm familiar more with, with SSRIs, but I know there's a wide spectrum. Are there ones that are typically more likely to be less harmful or another way of saying that, are there, are there more risks in certain medications over others?
Dr. Emily Watts: Yeah, this is also another great question. SSRIs are one of the most commonly prescribed antidepressants at this point, and that's not just for depression, but we also use it for anxiety. They're incredibly safe and about a million women who are pregnant each year are exposed to antidepressants during pregnancy to give you a perspective about seven and a half million women are pregnant each year and give birth to live babies. So that's about 13% and in some cities and states, that's about 15% of women who are on SSRIs during pregnancy.
Dara: It’s common?
Dr. Emily Watts: Very common, very common, very common, and the data and the media often shows sort of the, unfortunately, so the mixed data, especially the older data and, and that's, you know, a little bit it's unfortunate. And so a lot of our job is, is psychoeducation and informed consent about what we know in the literature and what are some areas of, some gray areas essentially.
Rena: I just wanna recap also what you said for our listeners to make sure they really understand. So it sounds like you're saying like the mother's mental health is the most important, so that's first and foremost. So if you are on medication and you go off it, and now all of a sudden, you know, you have severe symptoms, depression, anxiety, you know, other mood disorders that is not recommended. It is not recommended that you take yourself off medication and then you suffer because you think it's going to be safer not to be on medication while you're pregnant or trying to conceive. The recommendation is that it's yourself first as the mother, because if you can't take care of yourself, how are you going to take care of a pregnancy and then a child?
Dr. Emily Watts: Totally. We always say healthy mother, healthy baby. The risk of perinatal mood and anxiety disorders is not just like, you know, a mother white knuckling it through it and suffering, which is still an enormous risk, but it's also higher rates of miscarriage, preterm delivery, C-section, lower birth weight, increased rates of smoking and alcohol use, poor physical health, preeclampsia, impaired bonding, lower rates of breastfeeding and later neurodevelopmental outcomes. We also know that even within the city of New York, there was a study that was done that 20% of maternal deaths are secondary to suicide, which is just awful. And again, we know that the maintenance of antidepressant medication is significantly associated with reduced risk of relapse.
Dara: Wow. I'm happy that you mentioned all of those potential potentials for people who get off, off their medication. I mean, I only thought of a couple of them, but I didn't realize that those, there’s a lot to think about.
Dr. Emily Watts: I mean, in addition to that you have, again, the suffering of the mother, a poor sense of efficacy in the mothering role, elevated risk of abuse and violence, lower rates of breastfeeding, the effects on the family system and social supports, unfortunately infanticide fairly rare cases, but still it's a risk and abuse and neglect of the infant. Again, none of this is intentional, but if illness gets severe enough and if we have a hard time treating them after a certain point, these are risks that present themselves.
Rena: And what about also for patients who have a history of anxiety, depression, and mood disorder? Is that, say, it's been dormant though. So say you had, maybe you were diagnosed with depression or anxiety in high school, and then it's, you know, been dormant, whatever, but now you're looking to conceive, are you at a higher risk then of it recurring during pregnancy or postpartum pregnancy?
Dr. Emily Watts: Yeah, I mean, I think if it's been 10, 15 years without an episode, the risk is probably lower than if you cycle through every year or two, if you weren't taking medications, which is the normal, natural history of depression and anxiety. You might be doing well for a period of time off medications, usually six months to a year, but then usually you have another relapse and that's like major depressive disorder what we're talking about. And generalized anxiety and anxiety disorders are often also really high during this period. Again, preconception during fertility and fertility treatments can be very high. Pregnancy, about 70% of women are shown to have increased quarries during this period. And then postpartum at least 85% of women undergo the postpartum blues. So this is not, this is not uncommon to have new changes during this period. So if you had one isolated episode when you were in high school, are you potentially at a higher risk because you had a history of it? Yeah, but all women, parents just in general are at risk during this period of time, especially postpartum because of all of the life transitions that you're going through. People don't talk about it now.
Dara: And for me also, I feel like it's when your hormones are changing, especially when it comes to fertility treatments whether you are on a specific protocol for hormone injections, and then actually during your pregnancy, your hormones change again. Would that contribute also to perhaps a change in your mood and anxiety and other hormones that may contribute to perhaps depression or anxiety?
Dr. Emily Watts: A hundred percent. We know that some women are more vulnerable to hormone sensitive mood states, whether that's during their menstrual cycle, peri-menopausal and definitely, you know, fertility treatments, pregnancy, and postpartum we have this huge, massive drop off of progesterone and estrogen. So there's definitely some neuro-biological factors that go into motherhood specifically. That said, challenges during this transition period often present also for partners and that's often under recognized as well. But there is something about hormonal mood states and perinatal mood and anxiety disorders are thought to be not just hormonally driven, but also multifactorial with other things such as an inflammation, genetic and epigenetic causes and personal history and environmental factors, psychosocial stressors. And those are, you know, there's a lot of psychosocial stressors that happen, especially if you have to undergo, you know, the stress of the fertility treatments before.
Rena: So what would you say, what would you recommend best support someone going through this? You know, I always say it takes a village and certainly something I talk about with patients either, you know, trying to conceive or patients that are postpartum, is how to set yourself up for success. What would be your recommendations as to how to set yourself up for success as you navigate, you know, both the fertility journey and then postpartum in terms of mental health?
Dr. Emily Watts: So behavioral interventions are our first line defense, and that's also critical during the preconception phase, during pregnancy and again, postpartum. And that's engaging in psychotherapy, whether that's individual or group or peer support, lifestyle modifications, yoga, exercise, stretching, mindfulness-based practice, acupuncture, massage, light therapy, sleep is huge, a balanced diet as you guys know, and social supports. And I would say also healthy boundaries. We have a culture that is focused on, you know, women and mothers being able to accomplish it all, both in their professional lives and their personal lives. You know, this whole idea of being perfect is unattainable and often leads to these feelings of guilt and shame, which then make people feel isolated. So learning how to say no, learning how to create boundaries learning when, you know, to acknowledge these feelings of guilt or these negative feelings as just this ambivalence and these tensions that exist within this period of time about self care versus caring for the baby or caring for, you know, some other factor here. So some of those would be the large things that I would identify as coping strategies.
Dara: I think that’s great that you're, you're listing such a wide variety of options, you know, especially at one thing that I, I'm not familiar with light therapy. Does that mean, like, turning on like a blue light in the morning, which I do it definitely in the winter time.
Dr. Emily Watts: So you already do it?
Dara: I do, because I definitely, I was actually an old patient of mine who was like, yeah, I use this like blue light therapy in the winter. So I don't, you know, get the blue case, the blues and it helps I've started doing that. And it's
Rena: And I got the same light that Dara has.
Dr. Emily Watts: Good! Yeah. So exactly all of these things contribute.
Dara: I never would've even thought about that to recommend that to my patients. I mean, you know, but it really does, you know, it's such a small change that can really cumulatively have a, have an effect. And I love that. You also, you know, you do mention nutrition, you do mention, you know, mindfulness practices, but I love that you also mentioned sleep. Cause I feel like sleep really can play a role with, with hormone imbalances and so much more.
Dr. Emily Watts: Oh yeah. I mean, half of what we do as psychiatrists is sleep. Sleep is just as important as medications in people who need it. Without enough sleep, you can feel almost manic and with too much sleep, you can feel suppressed even in a healthy person. So regulating sleep, not only does, you know, anxiety and depression and other, symptoms impair sleep, but then the impaired sleep continues to create this cycle of worsening symptoms. And so controlling sleep is a huge factor.
Rena: I’ve always heard that lack of sleep is the number one trigger for postpartum?
Dr. Emily Watts: Yeah. I mean, again, this is a, this is a big, physiological change that happens postpartum. And even during pregnancy, you see first trimester and third trimester, a lot of insomnia and that can trigger sort of the start of a mood or anxiety symptoms emerging. And so yeah, I saw that for some patients and especially those that are breastfeeding, this becomes a huge issue at the beginning and often we need to elicit support from partners and, you know, other people who may be helping with the family during that period of time.
Rena: I think that's so important to, to note, I think so many people feel like they have to struggle or power through, but lack of sleep is, you know, they say it's really the same level of danger as drunk driving. You don't have your faculties about you. It's super dangerous. And so I think it is so important, you know, if you're able to have support from, you know, outside help or family or whatever your partner, to really, really figure out a plan so that you can get consecutive sleep because it's extremely dangerous,
Dr. Emily Watts: And for some women where sleep is, you know, like if you have bipolar disorder, for instance, sleep becomes hugely crucial, even more so than in other areas. And for some women, breastfeeding in those scenarios may not even be an option. That's how important sleep is or at least, you know, cutting out the nighttime feeds. So yeah, I mean, it's, it's a huge factor.
Dara: I think it's also important, you know, you, you touched upon, I think as women when there's a lot of expectations and pressures on us and you know, the idea of being perfect, whatever that means. And, you know, I think it's, it's great to have support in that to let people know that, you know, there's no such thing as perfection and also, you know, you do the best that you can and you can kind of, you know, tap into that and realize that you are doing the best that you can. It can be, I'm assuming a little bit easier to be able to say, you know, I'm okay if I can't, you know, I, I tried breastfeeding, but it, it, you know, it's taken up too much of my time and I think it's great to have that support to, to remind people that it's okay not to, to do things exactly the way you think you need to.
Dr. Emily Watts: Totally, totally.
Rena: Yeah. Dara, I love that you said that I think that's so important or, you know, even as Emily said, you know, it might be about reframing, so maybe you went in and you're, you know, you really want to do breastfeeding. It's, you know, something you don't want to give up, but you realize, okay, I have to prioritize sleep. So someone else gives a bottle at night, right? So I can have consecutive hours. And so sometimes it's about maybe reframing your picture and pivoting and adapting to your situation.
Dr. Emily Watts: Yeah. That's a huge thing that happens during the early days. And actually onwards is reconciling this fantasy that is often created either, again, before you have the baby, before you're pregnant and then during pregnancy to what is reality. And sometimes that can draw tensions, but it's important to remember that some of these things are fantasies and where are these fantasies based off of? Social media, you know, and what we see in the media at large, but also our own pictures of people that we knew, or we thought they were doing as when we were children, either mothers that we had ourself or other people's mothers and where all of this is driven from basically.
Dara: For sure. I'm happy to read that you mentioned reframing because I do feel like, you know, we often have a vision of how we want things to go. And especially in the fertility world, we, we know that's often the first time we realized, oh, wow. Like I thought it would be very easy to conceive. And, you know, I didn't expect to have to go through fertility treatments and, and just the idea of, you know, looking at things differently and, of course getting support and getting the tools and the support to really realize that you can create a new narrative and change that perception.
Rena: Yeah. And I think a great support system is super important. And also, you know, as we sort of mentioned at the beginning boundaries and sometimes like too many cooks, it might not be helpful to hear what your mom and your mother-in-law and your friend and your sister and your, whatever your doorman have to say about this. You need to surround yourself with a great team, whether it's a therapist and a psychiatrist, or just a therapist or whatever, and then those are your voices and those are your supports. And then it's really important to own your choice and set boundaries. And if you can own them and honor them, other people will too.
Dr. Emily Watts: Totally. And also the partner and the friends and the community of mothers and, you know, these mom groups are hugely important to people and it doesn't have to be a mental health specialist. It can be, you know, part of the support system. But, I think the community of mothers is hugely important.
Dara: For sure. But for me, I wish I wish this there's more of a discussion, you know, when someone's trying, you know, thinking about starting a family, you know, going to see their OBGYN, going to see their reproductive endocrinologist, I wish this was a discussion like day one, by the way, these are resources, whether you need them or not, you know, just letting people know, because I mean, I don't think that was something that I was really spoken about when I was starting my, my path to motherhood.
Dr. Emily Watts: Totally. People don't talk about it enough. There's a term called [inaudible]. I don't know if you guys have heard about it or read about it. It sort of sounds like adolescents. It is this, you know, it's an anthropological term that's basically coined to, to think about this as like, huge life transition and I think it's, you know, it is that.
Rena: Yeah, it's so hard. And I think, you know, how about the screening, you know, you're at your, GYN or your pediatrician for postpartum, you know, it's, it's such a joke. And I think so many people are really scared to speak up because, you know, then they're afraid to be looked at as a bad mom or, you know, especially my patients that have gone through fertility treatment often feel as though they're not allowed to verbalize or feel that motherhood is hard because they should just be so grateful because of everything they went through. And I always say no way, you know, you're so entitled to these feelings, you know, being a parent is really hard. Being a new mom is hard. It can be super lonely isolating. You know, if you're in a couple, can totally change your dynamic if you haven't really prepped for it and it's so important to reach out and seek help and not go through it alone.
Dara: Especially in this day and age, I feel like, you know, in the past year and a half with COVID, I think now more than ever, we need the support. I would, I love my, you know, when I go to my GP for my annual physical or, or I go to my GP to get a, a COVID test, every single time I go there, they always ask, how has your mental health, and would you like to speak with a therapist? And I think that's wonderful.
Dr. Emily Watts: Perfect. All practitioners are doing that more. OBs and pediatricians, there's a huge need for that to be increased. Obviously we only have that, you know, one postpartum visit and within the OB, and that's a hard, that's, that's difficult. Like how do you reach women more broadly if there's only one postpartum visit six weeks later when a lot of these symptoms emerge sooner or later and then also the OBs and pediatricians don't have as much time. So yeah, it is a, it's a huge problem.
Dara: Yeah. I mean, it's one quick question, but yeah, I think when there's a lot of things to cover, sometimes it gets lost in conversation.
Rena: I love that you're so aligned and that, you know, all three of us I think are speaking out and hopefully this is helping other people and educating, you know, I think, you know, again, medication and that's already kind of, you know, can be looked down upon, you know, with trying to conceive or pregnancy. And I think it's so important to talk about this habit out in the open and really support people.
Dr. Emily Watts: Medications, like psychiatric medications, you mean?
Rena: Mental health medications .
Dr. Emily Watts: Yeah. I would say it's, you know, mental health is stigmatized when you're not a mother and then motherhood is stigmatized. So putting those two things together is really difficult. Yeah.
Dara: I had a quick question with regards to research. I mean, I would think that this would be a very challenging area to focus your research on. And I'm assuming because of that, we're probably somewhat limited with research studies. Is there anything of note, or is there any, perhaps any research that you want to see be done down the road?
Dr. Emily Watts: No. I mean, I think this is being, doing research on pregnant women presents a lot of limitations. You can't do randomized control trials, which is sort of like the gold standard. A lot of studies are retrospective. The data is often really messy and mixed with many confounders. And so actually this is where the field of reproductive psychiatry comes in as a sub-specialty because interpreting some of this data is difficult and it takes a lot of work and group work. And, you know, it's, it's really an art because it's not really black and white. There's a lot of shades of gray. And then you have to take that into consideration with a person's own individual risks. Though I will say we know a lot more now and the preponderance of data shows that medications especially antidepressants during pregnancy and even preconception during fertility treatments and so forth is incredibly safe, does not affect fertility, does not affect outcomes for miscarriage. If anything, lowering stress and depression improves those outcomes. And we know that the risk in the first, second and third trimester are minimal and even, you know, outcomes post that are developmentally are it's shown to be very safe.
Dara: That's reassuring.
Rena: What's the difference between a psychiatrist and a reproductive psychiatrist?
Dr. Emily Watts: Well, I'm a psychiatrist as well. I see general psych patients as well, men and women, but I, I just have sub-specialized in this field working, again, a patient population where women may be more susceptible to hormonal, hormone-sensitive mood states and to be able to have, I've studied to how to go through this literature, essentially. Unfortunately, most general adult psychiatry, residency and fellowship trainings do not cover a lot of this yet, which is a huge problem. I think it's something like 56% of residency training competencies in this area. And so a lot of general adult psychiatrists feel uncomfortable treating pregnant women and often need referrals to a referred reproductive psychiatrist both for medical legal reasons and to go through these, the risk and the literature step-by-step with patients and an informed consent process.
Dara: But that's great to see that, that, you know, you're starting, you know, hopefully you're, you're starting something new by teaching at schools and teaching the fellows and their, the residences, residents. And hopefully there'll be a change.
Dr. Emily Watts: Totally. No, there's a huge push nationwide. There's about 10 or 12 formal programs in the country now. And most residency training programs are trying to start including electives and more work in this area.
Rena: Oh, that's wonderful. So I know, I know a patient will ask because I say, you know, I'm getting prescribed my Zoloft from my GP or my psychiatrist. Do I now need to go see a reproductive psychiatrist instead?
Dr. Emily Watts: Yeah. So I, I, I, I think most of us who specialize in this area do see patients who already have psychiatrists either as, like, a two-part consultation to discuss what it is to take medications during pregnancy, to discuss whether you would come off of it before, during or after. And again, this is the end of this is weighing individual risk versus what we know about the risk of medications. And fortunately we tell people there's no risk-free option. There's risks of untreated illness and there's risks of the treatment in terms of medication. There's always a risk of medications, modern medicine broadly, but the risk of the treatment, especially with SSRIs is much lower and much rareer risk than what we know the risk of untreated illnesses.
Dara: Yeah. That's important for our listeners to hear.
Dr. Emily Watts: Yeah, no, I mean, it's, it's a, it's with almost sheer certainty when somebody has a history of anxiety and depression, a lifetime history, which is often cyclical that this is a vulnerable period and that there are real, tangible, both obstetric and neuro biological, and neuro behavioral outcomes that are real and likely.
Rena:This is an amazing information, I think so informative. Do you have any other like final thoughts or recommendations that you think are, must knows, you know, for our listeners who are either trying to conceive or pregnant or postpartum?
Dr. Emily Watts: That's a great question. Not at the moment. I guess the, the main thing to say is it's incredibly common to have worries and anxiety during this period, whether it's, again, before, during or after, and that not everything reaches threshold to call it an illness, but it's totally normal to have some increased worries. That it is totally normal to have even obsessive compulsive behaviors. Almost 50% of mothers have these checking behaviors that do subside after the first three or four months and that this huge transition in a mother and the parent's life is not always pathological. That it is important to talk about the fact that it can be difficult and uncomfortable without it becoming pathological. And it's also important to know that if you're at risk, treating early and before pregnancy is the ideal. So coming in well before you're thinking about getting pregnant or while you're undergoing fertility treatments, or before you have, before you start fertility treatments is the ideal process so that you can weigh these risks. If you're going to have a trial off of medications, you'd like to have that trial before you get pregnant, rather than during pregnancy. And so it's, it's incredibly important just to sort of be diligent just like you would with your carrier screens for pregnancy to do it before you get pregnant, if you can.
Dara: I think that would be great in terms of having that as like an initial screening. You go for your initial OBGYN appointment, your initial reproductive endocrinology appointment to have that discussion to be informed and, you know, to have the resources in case they need it, the support now, or, or down the road.
Rena: I think it's always easier to get the support when you, or get the resources when you don't think you need them, right? Like just put them in your back pocket, file them away because it's a lot harder to make a proactive choice and do something for yourself if you're already feeling the symptoms, because then you're already in it. So, agree. I wish we could, you know, make a push to change healthcare to totally be, you know, a required part of the system. I think
Dr. Emily Watts: Well I think in your own practices, you know, bringing it to people's attention, normalizing it for people and helping them find, you know, reach out to, to help is, is great business arts.
Dara: True. So what's the best way to get in touch with you and learn more about your services?
Dr. Emily Watts: Probably through my website, emilywattsmd.com. There's a form on the website that people.
Rena: Wonderful, well we'll link everything on our Instagram. People can DM us if they didn't catch that, but we highly encourage people are looking reach out to you. You're a wonderful resource and we're so happy to have you on to share this super important information.
Dr. Emily Watts: Thank you for having me. It was great to be here with you all.
Dara: So how we end, wrap up our session, our discussions are to discuss gratitude. I'm sure this is something in your practice that you probably mention quite often, but what are you grateful for today?
Dr. Emily Watts: Oh gosh. Besides my family and loved ones, maybe the weather?
Dara: That's a good one. I was thinking about that. I'm like, Ooh, there's still sunshine. Rays of sun in the air
Dr. Emily Watts: It really affects our mood.
Rena: Totally. Vitamin D is so important.
Dr. Emily Watts: What about you all?
Rena: I will say, you know, this conversation got me thinking I'm super grateful for my mental health team years ago when I was pregnant, I'll never forget. I was dealing with, you know, center anxiety and, and history of depression. And my psychiatrist at the time had told me about sleep. And it was like one sentence she said to me, that just really stuck in my mind. And I'm so glad that, that she said that. It helped take a lot of pressure off and then helped me really kind of set myself up for success as a new mom.
Dr. Emily Watts: And what was the sentence she said?
Rena: She just said, listen, sleep is the number one trigger for postpartum. It's really important you have sleep. And if you can, you know, get supports to help you. And so going in, I knew that, and I was, you know, lucky to have some support and, I think it helped take some of the pressure off of breastfeeding and everything that went with that. Since I realized that if I didn't take care of myself, I couldn't take care of anybody else. What about you, Dara?
Dara: Somewhat pigging backing what you said Rena is just overall all the mental health practitioners that are out there, including both of you. You are helping so many people who are great resources and, you know, and, and just like the collective team working, working with a collective group of people to really help support you all walks of life, all parts of your, of your life, just knowing that there's people out there that can be there to support you is is wonderful.
Dr. Emily Watts: Yeah I’ll reframe mine. I'm really grateful for being here today. Hopefully helping people to realize that some of this stuff is really, it's normal and that there's nothing to be ashamed of and getting the help really helps to start the process of motherhood on the right foot, which is, it can be hugely traumatic for people to undergo, you know, depression and anxiety, especially when they're new mothers. So I think it's great to be on with you all and pick up this opportunity to discuss this with you.
Dara: How beautiful.
Rena: Thank you so much.
Dr. Emily Watts: Thank you guys! So nice to meet you all.
Dara: Thank you so much for listening today and always remember: practice gratitude, give a little love to someone else and yourself and remember you are not alone. Find us on Instagram @fertility_forward and if you're looking for more support, visit us at www.rmany.com and tune in next week for more Fertility Forward.

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