Maternal Mental Health

Yá’át'ééh! In today’s episode, we invited a special guest Dr. Jennifer Richards with Johns Hopkins Center for American Indian Resilience, to discuss Perinatal Mood and Anxiety Disorder (PMADs) and ways to support birthing people who may be affected by this. We appreciate Dr. Jennifer Richards for joining us and sharing her knowledge. 

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Transcript

Intro Ya’ateeh. Welcome to the Maternal and Child Health Podcast, where we discuss maternal and child health topics and provide strategies for improving the health of Navajo families. Amá dóó áłchíní ats’íís baa áháyá baa yadelti. (Translation, we will be talking about the health of mothers and children).

Amber-Rose I'm your host, Amber Rose Begay. Hashk’ąąhadzohi nishli, Táchii’nii bashichiin, Tábąąhá dashichei, Naakai Dine’é dashinali. Nataani Nez denashaa. I'm originally from Shiprock, New Mexico, where I live and work at Diné college as a project coordinator of the Navajo Maternal and Child Health Project. I am a Navajo woman and mother of two.

Stacey Yá’átééh! I am your co-host, Stacey Litson. Tódích’íí’nii nishłį Tábaahá báshischíín Áshiihíí dashicheii Kinyaa'áanii dashinalí. I'm originally from Tsaile, Arizona, but I currently live and work at Northern Arizona University in Flagstaff, Arizona. I'm so happy to be a part of this podcast to better help our native families and listeners.

Amber-Rose Today, we're going to talk with special guest Dr. Jennifer Richards with the Johns Hopkins Center for American Indian Resilience to discuss perinatal mood and anxiety disorder and ways to support birthing people who may be affected by this. Dr. Jennifer Richard, thank you for joining us. Can you please introduce yourself? 

Dr. Richards Hi, good afternoon. Yá’átééh. Shí éí Jennifer Richards yinishyé. Áshįįnii nishłį. Anaałání báshischíín. Taos dashicheii. Áshįįnii dashinalí. Tó Naneesdizídęę nashaa. Good morning or good afternoon, depending on where you're at. My name is Jenny Richards. I go by Jenny Salt Clan on my mom's side and on my dad's side. I'm Oglala Lakota, and my maternal grandfather is Taos Pueblo from northern New Mexico. I'm a mom. I have a 13-year-old son who's in eighth grade. We currently live in Flagstaff, and I'm an assistant research scientist with the Johns Hopkins Center for American Indian Health, and I've been with our center since 2013. I left briefly to work part-time and got my Ph.D. from the University of Arizona in 2020 and returned as an assistant scientist. So I've been doing this research role since May of 2020. Thank you for having me. 

Amber-Rose Can you tell us about your work and improving maternal mental health? 

Dr. Richards Yeah, so I finished my MPH, my Master's in Public Health, also from the University of Arizona in 2008. And since then, I've been working almost entirely in maternal and child health or MCH. But that's kind of evolved over the last few years more broadly to family and child health, which kind of takes into account the role of other caregivers like grandparents and specifically fathers. We have a strong father study going on in Tuba City and Chinle and the effect of other people on children's health and development and family wellness. I would say my interest in maternal mental health has kind of narrowed focus more in the last few years as well with this Doula study that I proposed and that I've presented to a few people on the Navajo Nation. And that interest really came back in 2008 when I was working for the Great Plains Tribal Chairman's Health Board or the Great Plains Tribal EPI Center on the CDC-funded PRAMS study, which is Pregnancy Risk Assessment Monitoring System. And it's the point-in-time surveillance program that we did with nine tribes in South Dakota. And this was where moms, new moms were called and asked about their behaviors before, during, and after pregnancy. And it became really apparent that maternal mental health was an area that we had a lot of inequities with rural American Indian moms. And that also translates down here to Navajo Nation. Statistically, we have a really high maternal mental health disparities. So it's kind of evolved over the years from MCH and kind of honed in on maternal mental health with this Doula study that I'll be talking about a little bit later. 

Amber-Rose Thank you for that. Can you explain the importance of mental health for birthing people during and after pregnancy? 

Dr. Richards Yeah, sure. Before I do that, I just wanted to put out there that I will be talking about some concepts of maternal illness and even maternal mortality or death. And I just wanted to mention that before going forward, because I know culturally, that's really important, for some birthing people. As far as the importance of mental health, I would say, first and foremost, it's a part of overall health. And I think one of the really beautiful things about Native people is that we have always had that woven into our belief systems, whether that's through our traditional philosophies or wellness concepts like Hozhó or Lakota or even medicine wheels and all the frameworks that we have with all of our different tribes, we acknowledge that mental health is linked to physical health, emotional health, and spiritual health. So first and foremost, it's a huge part of that mosaic that makes up our overall health. In terms of maternal mental health, I would say that it's a really important indicator of maternal illness and even risk of maternal mortality or death. Unfortunately, we do have really high rates of maternal mortality among American Indian women. So it's really important to look at from a public health standpoint and upstream approach of what can we change, where can we intervene? And so that's why a lot of maternal mortality prevention initiatives really focus on mental health. And there's other areas that people focus on, but that's the one that we're really going to focus on with this proposed Doula study. And mental health is really important during pregnancy because it's associated with a whole host of adverse outcomes and really positive outcomes if your mental health is in a good place. But it does matter, you know, how much anxiety and if their symptoms of depression during that perinatal period. So I would say it's  incredibly important. It also is very telling on the child's health, whether that's during pregnancy, labor delivery, or even newborns and in that first year of life. So in terms of like maternal depression and anxiety, if it's associated with poor nutrition, increased risk of smoking, and even substance misuse. For the baby, it's associated with low birth weight, and premature birth delivery complications. The list is pretty lengthy. So all that is to say, it's extremely important for both mom and baby and then also to the larger family as well. 

Stacey Thank you for saying the association between maternal mental health plays impact on the overall health of the mom and the baby. I feel like we don't really hear that often. And just you reiterating that and just making known can really probably show light into like what can be done for solutions that are going on to help decrease these rates among our native women. So what is postpartum depression and perinatal mood in anxiety? 

Dr. Richards Yeah. So I also the PMADs and I want to explain that. So Perinatal Mood and Anxiety Disorders, our PMADs, is kind of like an umbrella term that is used to describe a group of symptoms that may or may not impact women's mental health during and within one year of pregnancy. I do want to say I'm not a clinician by any means, so if anyone has really specific questions about PMADs, I really encourage them to talk to their health provider because it is really important to talk about this overall umbrella term. It can include a lot of conditions, but for the sake of time today, I think the ones that will mainly talk about are anxiety or depression in terms of the perinatal period. Again, that's pregnancy, labor delivery when you're postpartum or one year after the baby is born. It can be mild, it could be moderate, it can be severe, it can range. We have what is not really considered one of the PMADs, but is actually really, really common is baby blues. And that's something that happens shortly after, obviously at labor when they deliver the baby, it's about 1 to 3 weeks. And it's just general feelings of, you know, being weepier or being having some fluctuations with mood, irritability, all things that are super actually common with sleep deprivation. But I think where it becomes a little bit more of a concern is if it doesn't resolve on its own within a few days or at least 2 to 3 weeks, and then that's when it kind of goes into another territory, which is postpartum depression. And I wanted to say baby blues are so common that in some populations, it's estimated that 85% of birthing people have symptoms of baby blues right after. Postpartum depression is more of like feelings of being sad, crying a lot, intense anxiety, intense ruminations, or even obsessions which can kind of go into postpartum or perinatal OCD or obsessive-compulsive disorder, loss of interest in usual activities, feelings of worthlessness, extreme fatigue and irritability, change in appetite, sleep disturbances, having a really hard time concentrating, worrying excessively about the baby's health, and then at the extreme of the spectrum, even suicidal thoughts. So it's really a spectrum of things. And I just want to emphasize that. I think if there's any concern that this is happening where there's depressive symptoms, I think that we should encourage and support brithing people to seek help and to make sure they get screened or get checked by a health provider. There's also perinatal anxiety, which we sometimes don't talk about because, you know, there's a lot of focus on postpartum depression, as there should be. But anxiety is, you know, feelings of excessive worry again, restless sleep, and maybe even repeated thoughts of something scary happening to the baby or even panic attacks or hyperventilation. So there's two different conditions there that kind of go hand in hand. I know perinatal and postpartum anxiety are really strong indicators for postpartum depression, but I wanted to make sure I separated the two because there are two separate conditions, and sometimes we overlook anxiety. 

Amber-Rose Thank you for that. I feel like since having had children, you know, the feelings that you get afterwards is so great now that they're putting terms with, unless it's always been a term. But to me, I didn't learn this until years later after. I was told like, this is normal, but if it continues, you'll please come back to see us. If I would have heard that statement, you know, I think I would have felt a whole lot better and more supported from my provider or even just family members. But I'm sure they didn't know what was going on. I know it kind of seems like for me, I would just kind of like, you know, you have to tough it out and get it, you know, cry it out if you have to, but, you know, need to keep going for your babies. So but I'm really glad that we're having these conversations, as hard or uncomfortable as it might be for some. But you also did talk a lot about some signs and symptoms of postpartum depression and perinatal mood and anxiety disorder. But are there any other specific kinds of symptoms of depression and/or perinatal mood anxiety that birthing people might need to be aware of? 

Dr. Richards I think I went through all of the major ones. I think the biggest thing I would say is don't discount symptoms, like you said. A lot of times, we're told that it's normal, it's common, and that could be true. You know, a lot of it is baby blues, you know, when you're sleep deprived and the baby's just small, you know, everyone's hardly getting any sleep. So I would say that all of those are all signs and symptoms, that it could be something like baby blues. But if it continues after three weeks, then you really should talk to your health provider. And that's why they have postpartum checkups also, is to kind of tell the health provider how everything's going. And those are also opportunities to get screened. That's why those postpartum appointments are so important. And even during pregnancy, they do ask those questions, and that's why they're so important. But I would just say everything that I listed, and I know it was a laundry list, and it was a little overwhelming. I would say that those are all things to kind of look out for. You know, even if you're just uneasy, you might discount it and just say, Oh, it's just nervousness. It could just be nervousness, but I think it is important to kind of communicate that. And I think that's actually a really good segue way into ways that pregnant and birthing people can have support. And I'm a huge advocate for home visiting. We have different home visiting programs in different tribal nations. And I know on the Navajo Nation we have, I think, we have parents as teachers in addition to family spirit. And I'm a trainer for Family Spirit, which is an early childhood home visiting program that we do through our center. And we enroll people as early as possible in pregnancy, and then we're with them until the child is three years old and it kind of tapers. But it's also a big reason why we need more doulas and we actually have some really exciting Doula work going on in tribal communities in general, but especially on Navajo. We have the Diné Doula Collective which is really active and I think you had Amanda Singer on before talking about that. We have family spirit in different tribal communities. We have some public health nursing, they have training in specific early childhood home visiting programs, WIC is a really good hub for these type of resources. But I do think it's important to really just acknowledge that we have resources right now and culturally knowledgeable people that can provide these types of support. So I just wanted to mention that little plug for our home visiting and doulas. 

Stacey Thank you for that. Dr. Jenny Richards So my next question is how can we reduce the stigma around receiving mental health support for birthing people and their families? 

Dr. Richards Yeah, I actually think conversations like the ones we're having, I mean, you're having a podcast episode highlighting mental health is really important and I think it's important that we normalize talking about it. And like you said, I don't know if that was Amber-Rose or Stacey, but just talking about how there's a name for something that I might have been feeling and making sure that everyone knows that, that there's people who go through it and that it's not something that they're going through alone or in isolation. I think that's a huge part of reducing stigma. I think having programs that encourage help seeking in general is really important. Even with our Strong Fathers, our Azhee’é Bidziil program, we talk about the importance of needing to get emotions out and how we can do that in healthy ways and how we can cope in healthy ways. So I think those are all ways that we can reduce stigma, maybe also providing reassurance to birthing people that, you know, what they're feeling is something that we hear them. Even if we can't really relate. It's okay to say, I hear what you're saying, supporting them without judgment, supporting them if they say, I think I need help, definitely saying, well, how can I support you? Providing resources and connecting to existing resources that we have in our communities. We have mental health at our clinics, we have counselors. We're really lucky to have traditional healers as part of our health care system, too. In addition to having traditional healers available in the community, we have doulas, we have breastfeeding coalitions, we have home visiting programs. So I think reducing stigma is just to keep this conversation going and always bringing in how mental health is a part of this larger conversation. Because a lot of times we talk about physical health because we can see that right. It presents to us and we can tell when someone is unhealthy, but with mental health it's harder. So I just think it's really important for those of us who work with these vulnerable populations to always remember mental health is a part of overall health and making sure we keep these conversations going. And as family members of birthing people to check in with them and ask them how they're doing and recognize that self-care looks different for everyone and people are birthing and what does that look like for them? Is that exercising, is that walking, offering to do that with them or offering to watch baby while they do some type of self-care. I think that's really important in reducing the stigma and just making birthing people feel seen and feel heard. 

Amber-Rose I 100% agree. I like that we have so many home visiting programs, like different programs I know for my oldest, we had to utilize a bit round trip because she needed early intervention services, and at the time I was like I was 15 years old. But it was so helpful, and it helped me so much. Just understand what was happening, what I could do for my child. We actually obtained one resource led to another. We're able to get help from the New Mexico School of the Blind and Visually Impaired. So we had somebody else come out and help us too, I believe it was like up until she was three or five years old. So it's really important you reach out. We have these resources, and that can lead to additional services that you might need, your child might need. And I'm really glad for the Home Spirit program because if I was a teen mom, I guess when I was a teen mom, I would have loved that additional support. I was actually in parents with teachers that actually taught me so much about taking on the role of the parent, what my child needs, and even just relationship advice because it's really rocky when you're young. 

Dr. Richards Yeah, it is. It really is.

Amber-Rose Mm-hmm. Yeah. So thank you for that. And you've kind of already answered this question, too, but how can birthing people start the conversation to seek help? 

Dr. Richards Yeah, I think it's not only on birthing people, too, to start the conversation. I think we should acknowledge the courage it takes to say I need help. And I think part of that is we need more training and communities in general to recognize symptoms of when a loved one is struggling, especially someone that we know that is is going through that birthing process and that whole experience. We need to understand what that looks like. And also we really need to strengthen linkages. And like you said, I think it's so powerful to get connected with even one linkage, like, say, a home visiting program, because they know of a Doula, so home visitors usually don't go to labor delivery, but they know that doulas might be able to do that and be with the mom during that whole process. And like you said, teen moms, if they're partners there in their families there, that's great. But having someone who's really non-judgmental and very neutral is also an added plus, and just having that extra resource and then doulas know lactation counselors and lactation consultants. And we know that everyone has different sources of stress, right? For some people, it might be, you know, they're worried about weight gain, and weight loss. There's some people that might be breastfeeding. Breastfeeding can be a huge source of stress. So having a home visitor, who knows a Doula, who knows the lactation counselor, and really connecting all of those pieces to somebody who's struggling or high risk or vulnerable and really addressing that source of stress is really important. So we really need to strengthen these referral linkages and have these opportunities to kind of network as supporters. I think that's really important. But I just wanted to mention that we should really commend people who do acknowledge when they need help or do acknowledge when they're having trouble. I think we should always commend them and validate that. In addition to seeking help, we should also discuss self-care. What does that look like for the birthing person? Like I said, it could be exercise. I know what works for me doesn't work for others. I like to walk and listen to podcasts, but other people might like drinking water or tea or music or meditation or yoga or journaling. It's different for everyone. But I do think that we should stop and kind of ask the mom, like, what makes you when you're super stressed out. Like what helps you and what makes you feel better, and then supporting them to kind of have that time to really alleviate their stress. And maybe that's not where it stops. Maybe they do need to seek counseling, maybe they do need to seek clinical help or have, you know, especially for postpartum depression, look at medication. You know, there's different options that birthing people have. And so I think starting that conversation is listening and also just validating and knowing the resources. Like recently, we had the 988 maternal mental health crisis hotline come out, which is such a huge victory. And having these hotlines come out in addition to providing local resources, are really important because what works for one person won't work for another. And maybe they need to talk to someone that they don't know to really understand. Like, Wow, I really need additional resources and then they can have someone to help connect them. And we also have national maternal mental health hotline. I think it's 18339-help-for-moms. Maybe you could put that in your show notes, but I think that a huge part of starting the conversation is listening and recognizing all the resources that we have. The crisis hotline, the National, and this was on I think the vice president, Kamala Harris, is really supportive of improving maternal health in general. And one of the initiatives that she supported was the crisis hotline, and that's just 988. You know, we have 911 for normal emergencies. Maternal mental health crisis is 988. 

Stacey Okay. So thank you so much for answering all our questions regarding this topic. I want to ask a question about what work you are doing in maternal mental health, and you mention a study. So can you explain that to our listeners, please? Thank you. 

Dr. Richards Yeah. So the study that I think some of you have heard about. Because I've been doing a lot of presentations, it’s currently, it's a grant that was written called Amà Bizhiil or Strong Mothers. It's a community doula intervention to reduce perinatal mood and anxiety symptoms among rural native women. It's actually a pretty small grant. I decided to go small so I could kind of pilot it and see how it works on Navajo Nation. But it's using doulas or employing doulas or lay support workers who provide cultural and perinatal support to moms through pregnancy, labor, delivery in the postpartum period. And I think important distinction with doulas and midwives is that they do not provide any kind of clinical care. They're just really there to support the mom throughout. Some doulas are just pregnancy, labor, delivery. So they're just there for, you know, very short periods. Some doulas are perinatal birth doulas, some are just postpartum doulas. So it really depends on the type of doula. But the one that I'm really hoping to kind of loop in is like a full spectrum, totally perinatal community doula that's with moms throughout their whole pregnancy, labor, and delivery. Ideally, if it gets funded, it'll be a small little pilot study that we use to develop a doula intervention that takes into account cultural teachings because I think every tribe is different. But I know with Navajo, when I was expecting my son, there was a lot of some people say taboos are natural laws that we kind of had to really pay attention to. And it wasn't just the mom, it was the partner. And even the family try to stay positive. You know, I can tie knots and things like that. But if you think about it, those are all super protective and all contribute to positive maternal mental health. So if it's funded, then it would be a doula intervention that kind of incorporates standard doula best practices. So how can we support moms while also bringing in cultural teachings. I will bring in some lessons from the Family Spirit curriculum that will help moms with sources of stress. For example, like you were mentioning, younger moms might not know how to diaper, how to bathe, how to feed, how to clothe. I know that sounds really basic, but it's actually really important lessons that our teen moms really find valuable. And by how to feed, I mean also how to breastfeed and learning basic latches and how they can get support with breastfeeding. And then the study will also just be a small pilot on the Navajo Nation in a clinic in my hometown. And hopefully, we'll get some good preliminary evaluation done and be able to apply for a larger grant that will be able to do in multiple Navajo communities and kind of see how a dual intervention works with rural Native women. So that's kind of what we're proposing and the main outcome is to reduce perinatal mood and anxiety symptoms in high-risk native moms using a lot of different therapeutic mechanisms, including CBT, and cognitive behavioral therapy activities. So we'll be bringing in a lot of different best practices and evidence-based intervention and really trying to make it our own and see how it helps birthing people. 

Amber-Rose That sounds so awesome. I know you keep saying small, but you say it's going to make a really big impact, I'm sure. I'm really looking forward to this happening and also just seeing the results because I know a lot of our birthing people are going to benefit from this. And, you know, I know some of us like me, should I say, I always try to generalize, but I know when I was pregnant, I heard like, don't do this, don't do that. And I'm like why. And, you know, I don't think my parents could fully tell me why I shouldn't.  Until later on, you know, once I attended college and I took Navajo cultural classes and philosophy classes, I learned why. And it's like, Oh, okay, you know, like a lightbulb moment, that's why. But having that kind of cultural support, when you want to acknowledge where you come from, your Navajo cultural traditions, I think it would be very helpful to have that someone there to say, you know, this is why. Or guide you to things like maybe even traditional remedies that could help just relieve some of that discomfort or help you with breastfeeding. I think that's very important, even down to washing. I remember my mom teaching me how to wash my oldest when we got home from the hospital because I was so scared. Like this little thing is so fragile and, you know, I didn't want to I remember watching the nurses watch her in the hospital, but when we got home, you know, I was worried that I would drop her. She would slip. My mom actually helped the washer once we got home. And I think that's very important, just having that extra support to say, hey, I can help you until you're comfortable or encouraging you that you can do this. And I'm just really so thankful for doulas, and I'm really glad that this project is incorporating those cultural teachings and beliefs, because I know we all want to acknowledge it;  it's just we need some support to get there. You know, we don't know everything so well. Thank you so much, Dr. Richards. I really do appreciate you sharing all of this helpful information. It's just very important hat we let people know it's okay to talk about mental health. It's okay that we feel down sometimes. But if it does last, like you said, I think you said over like three weeks or a little bit longer, you know, maybe we should reach out for help. So I feel like that's like the key message here. 

Dr. Richards Yeah. Yeah. I do want to say that another key message is that mental health is considered the leading cause of preventable maternal mortality. And that's huge. Approximately 85% of maternal deaths are preventable, and we're at extremely high risk as rural Native women or Native women in general, but rural and urban. For example, in Arizona, I had a report and you probably seen it, that I think native women have seven times the rate of maternal mortality. And so this is a huge, huge problem. And I think we don't talk about it enough. And so there's a lot of other initiatives that are going on. I know there's some maternal mortality review committees that are going on. Diné college, which you're all a part of, is piloting this Doula certification program. Zagiidawin is a doula training, I think, it's happening next week in Kayenta. So there's all these different movements and really decolonizing indigenous Doula momentum going right now. So it's really neat to be a part of this movement in decolonizing reproductive health and,  also providing support at a time when reproductive health is, is really kind of being attacked. I think that's also really important to have someone like a doula. But I do want to mention that in being a researcher it is important that we have this data because data drives policy and policy makes the biggest, broadest most systematic impacts to our people. And so we can't really influence policy if we don't have this data. So it is really important that we evaluate these programs and are able to say, you know, numbers don't lie, it's in black and white. This helps, especially high risk native moms. And I think as a researcher, it's really important for me to incorporate culture because, I mean, we've always been researchers as native people, but to be able to revitalize cultural teachings among young moms, it's a really important gift. You know, a lot of us don't know why, but it's an opportunity to teach like this is why this is how we handle the afterbirth. This is why we carry our umbilical cord or subtribes-this is why we're very specific about who catches our baby. I know in some tribes, it's very important who catches your baby. And I think it's really important for providers to understand, like, wow, if you're going to be an OB-GYN or a midwife, like this is really important to Native women. And this is why and hopefully further down the line that be part of the training for all providers in tribal communities is to really understand our sources of stress. There's a reason why we're all afraid to get health care, sometimes, not everyone, but you know, there's a long history of medical use and research abuse and forced sterilization of native women and really getting all your prenatal care in rural community and then having to give birth off the rez where you don't know anyone. And there's, you know, a complete disregard for your cultural beliefs. So these are all really important sources of stress that I think health providers will need to be aware of and need to be aware of. And we do have a lot of health providers who know that now. But I just want to acknowledge that this is part of like a huge movement, and it's really neat to be a part of it. And I'm really glad that, in some small way, we can do this evaluation and hopefully have some good data to support, do this as a way to improve our mom's mental health. So thank you, guys for bringing some attention to this issue. I think it's really important. Ahe’hee. 

Stacey Thank you for joining us today, and thank you for all you're doing for your work. Kind of advocate for this topic, educating and providing a study that hopefully will get passed. And if it does, you can come back on this podcast and share all your findings with us and what you learn to help better our native women in our community in general. So we really appreciate your time and all the valuable information you provided. So thank you,  Dr. Jenny Richards.  

Dr. Richards  Thank you for having me. 

Chassity Hey, listeners, please enter the code word. Support spelled support on our Facebook and Instagram pages. Comment the code word under the flier for this podcast episode to be entered into a raffle for a crocheted plush animal, crocheted pincushion or crochet pair of earrings from Rolanda’s Yarn. We will be choosing three winners for each of these items. We appreciate your continued support. Ahe’hee. 

Amber-Rose Now, we'd like to move on to our segment, where we discuss some key points from the interview with our special guest. Stacey, what are some key points that you want to talk about from our interview with Dr. Richards? 

Stacey So one thing that I found interesting from her interview was about PMADs which stand for perinatal mood anxiety disorders, which can impact a birthing person one year after they give birth. And I thought that was very astounding to hear. And that if a birthing person is experiencing these symptoms that she encourages, that the birthing people get seen and get screened so they can seek help and whatever resources that are available to them. And then another thing was acknowledge when you may need help and that we as people are not birthing person can validate their feelings to make them feel seen and heard and then just understand self-care. So what does self-care look like for birthing person, and what might work for them may not work for other people, just knowing what kinds of help they might need is very important. 

Amber-Rose I agree with all of that. I think there are some very important messages that she talked about. Some of my key points were that mental health is woven into our belief system as Diné. And I learned a lot about this, and I feel like it is a part of our overall well-being. And I don't know why sometimes we kind of think that our elder generations sometimes have that mentality to sweep things under the rug. And, you know, you just got to keep going. I feel like that's their way of handling problems that they might have had. But we don't have to continue that. We can talk about it. We can talk to somebody about it. And I think that's just part of our own self-advocacy is unlearning that way of slipping things under the rug and really advocating for ourselves and knowing ourselves and understanding when something doesn't feel right- we need to talk about it, whether that's with our family or our partner, or our doctors. We want to be the healthiest that we can be, especially during pregnancy. I remember learning that, you know, you have to really be in a good, positive state when you're pregnant because your baby feels everything that you're feeling, what you're going through. That can seem a little daunting, but as long as you have good intentions, I feel like that's what counts, what's important. And the other thing that I found interesting was when Dr. Richards mentioned we need more training for the community. You know, we kind of put it all on ourselves to know how we're feeling to reach out, but we also need to kind of be able to have that support from our family, our K’é. I know not everybody has that in their lives, and that's something we just have to know and understand. But there are people out there who are wanting to be there to support us, whether it's our doctor, whether it's our counselor or therapist or our doula, our friends. So if you can, you know, try to find that one support person for yourself, whether you're pregnant or not. But I really like that we need more training for the community. I just that kind of filled my head with all kinds of ideas, like, oh, my gosh, you know, we could have like mental health support system trainings, we can make it culturally inclusive. It definitely can include our cultural teachings because they do mention how to be well, mentally, physically, emotionally, and spiritually. There are teachings behind each of those in order for us to be healthy. It really does go deep. So that just gave me so many ideas on how we could do that, and I might not be the one to do it, but we can definitely work with somebody to be able to do that. And I just want to shout out the Department of Behavioral and Mental Health Services. I feel like they do so much, especially during the pandemic they really stepped up to provide information and resources not only for adults but teens and children. And so maybe we can work with them. The other thing, as I mentioned, about accessing early intervention services for my child and, you know, that really did provide me and my child at the time very needed access to services that I probably wouldn't have gotten if I had just not have talked about it or not have reached out. You know, you have to reach out. You have to find and identify what is needed for yourself and your child. At the time, you know, I was just focused on my child, but now I feel like I could have reached out for myself if I was feeling down, or I could have reached out to my provider maybe. But like having access, that one resource led to accessing another resource. And I think that was very beneficial because I've never heard of the New Mexico School of the Blind and Visually Impaired. So having that kind of support and resource coming to my home doing home visits and really made me feel good as a mother, but made me feel even more good for my daughter. And so, you know, just reach out, you know, try to find the services that you need or your child needs, because that could lead to other things, other great things, other good support systems. But, yeah, those are my three things. I was really excited to talk to Jenni Richards today because she has a wealth of information and such good things going with this Doula project. I think it's great. 

Stacey I would like to go back to what you said earlier about how many of our birthing people on Navajo or distant Native reservations, we are in stressful situations and like some things they might be in kind of stressful interactions daily, and it never really occurred to them like, oh, like I am stressed. So like, maybe this will affect me later down the road. But I don't think a lot of us don't think that way. Going back to how we need more culturally appropriate programs. And I feel like that could help maybe Navajo and Native reservations in general to overcome all of our disparities and health disparities, to just be more centered to ourself. Our tradition, and our just our culture. But that's going to take a lot of work and effort. But I feel like we are starting that journey, and I'm happy to see how our younger generations and what it looks like in the future. I feel like we are moving toward that in a very positive way. Slowly but surely I feel like, and also to focus on what you're saying about how you felt like you didn't have those resources or you only thought about your child during pregnancy and after birth and that you didn't really think about yourself. I feel like that just goes to show that birthing people in general, we don't think about ourselves and their selves. We just really think about the baby. But I feel like sometimes we just need to step back and think, Am I okay? Like really doing a self-care, like honing into yourself. There should be more emphasis on that and how to do that. And these organizations are like in the physician's office, like in a checkup with the child. How can we think about the mom too? At the same time, the child's health. 

Amber-Rose Yes, we should be having those conversations and we should be thinking about ourselves. Also, don't think it's, I guess, selfish. You know, sometimes we do have to be selfish. Sometimes we do have to be like, hey, I need a break. Take the baby. Take the baby for like maybe 30 minutes to an hour and meditate or work out or like, how do you, like, drink water and, I'm like, okay, cutting up cucumbers, cutting up lemon, putting it in my water. And that to me, I feel like is self-care because I'm taking the time to, like, nourish my body and infuse the water. And not everybody sees it that way. Like, maybe, I think another way is like just taking a drive and listening to music is self-care also.

Stacey Hey listeners, thank you for listening to our discussion from our interview with Dr. Jenny Richards. We appreciate your time and listening to this podcast. 

Outro Ahe’hee. Thanks for listening to the Healthy Navajo K’é Podcast. For more information or to provide feedback, visit us on Facebook at Navajo MCH Project at Diné College

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