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This podcast provides the platform to bring awareness to various critical topics in the fields of reproductive science and women’s health – topics that are often not discussed enough. We will cover a range of topics and will focus on creating content that is understandable to individuals from all levels of education and backgrounds, with no science experience required.
IfWH Comms (00:05.966)
Hello?
Chiara (00:07.193)
Hi, can you hear me?
IfWH Comms (00:12.408)
IfWH Comms (00:23.49)
I might just, if you can hear me, I'm gonna rejoin with headphones so that I can hear you. I'm speaking into a microphone, but can't. Just give me one second.
Chiara (00:26.623)
Yes, yes, yes, sure.
Chiara (00:34.525)
Thank
IfWH Comms (01:57.504)
there we go. Okay, yeah, I can hear you.
Chiara (01:58.827)
Hey, can you hear me? good. You're quite quiet though. I don't know if I can hear you that well.
IfWH Comms (02:07.308)
Am I? Maybe it's the wrong mic.
Chiara (02:10.329)
I mean, I can hear you fine, it's just not the best.
IfWH Comms (02:15.574)
I wonder, I just want to make sure it's the right microphone.
IfWH Comms (02:24.856)
Yeah, it should be.
Chiara (02:26.623)
Yeah, that's okay. Don't worry. can hear you fine. Sorry, it took me a few minutes to join. I was just finding the links and stuff.
IfWH Comms (02:29.09)
Okay.
No, that's okay. Of course, yeah, no, it's I've never used it on this, on Riverside before, so it's new to me. I've, I thought I had been messing up, but I'm glad that you sorted it on your end.
Chiara (02:48.107)
Yeah, it seems okay. Are we using video as well, Gina?
IfWH Comms (02:54.708)
Yeah, if that's okay. I think that it will be good for YouTube. I'm just trying to figure out. So we're recording now. And you said, so I saw your email. So you've got that printed out. You've got the whole annotation on your end. In terms of what I'm thinking just for the intro, maybe I could run through. I don't know if you saw, if you open that document again from what I sent you.
Chiara (02:56.501)
Yeah, you're the best, bye.
Chiara (03:11.008)
Yeah.
Chiara (03:14.987)
Mm-hmm.
IfWH Comms (03:21.438)
But basically it's just a sentence at the end of my intro and I wanted to just make sure I have it right. I can always re-record it but at the moment I've got Chiara is a clinical academic obstetrician and gynecologist doctor here at UCL and UCLH.
Chiara (03:28.523)
you
Chiara (03:39.691)
Carry on, yeah. We'll do it.
IfWH Comms (03:42.314)
where she focuses her studies on, and then I just left that blank for now. Maybe we tackle that sentence first.
Chiara (03:52.811)
And yeah, no, basically, I do still kind of work at UCLA, but technically, I'm now working in a different hospital. And I've come towards the end of my research at UCLA. So maybe I can just say, maybe you can just say she is a clinical, academic politician, a gynecologist working, doing her research at UCL, because I mean, this podcast is about UCL rather than UCLA anyway.
IfWH Comms (04:02.679)
Okay.
IfWH Comms (04:09.739)
Yeah.
IfWH Comms (04:17.442)
doing her research. Yep.
Chiara (04:20.915)
And then you said focusing her research on what was the next bit, sorry.
IfWH Comms (04:24.748)
I just left that blank. I wanted to get your thoughts on that.
Chiara (04:28.683)
You could just put maternal mental health.
IfWH Comms (04:32.344)
focusing her studies. Is it a PhD that you're pursuing? Where she focuses her P.
Chiara (04:36.937)
Yeah. Yeah.
IfWH Comms (04:46.988)
where she's completing, where she's working towards.
Chiara (04:49.355)
Mm-hmm.
Chiara (04:52.819)
I mean, I'm nearly there. I guess you can say she's completing.
IfWH Comms (04:54.424)
Yeah, where she's completing, where she is completing a PhD focused on maternal mental health.
IfWH Comms (05:10.87)
Okay, as you will come to learn, she is passionate about maternal mental health and focuses, that's kind of a repeat. I might just delete that sentence.
Chiara (05:21.195)
Or you can say perinatal mental health because I'm going to go. Yeah.
IfWH Comms (05:26.05)
Okay.
IfWH Comms (05:32.758)
I took a line from the UCL website, it says, focuses her work on improving access to reproductive services for vulnerable women.
Chiara (05:40.491)
You can definitely say that. It's not necessarily what we'll talk about, but you're very welcome to say that, which is it's true.
IfWH Comms (05:52.376)
Okay, great. And then I just wanted to say as well, I don't I think we talked about when we first chatted, but I feel like at the beginning, you may have heard my other episodes, but I tend to ask sort of like where it all started for you and how did you get into this field sort of like anecdotal relatable content just for the listeners to be like, okay, she's a human too. And she's not just this incredible doctor. Okay, so I'm just gonna say like, before we get into it, let's hear about that. And you can just say,
Chiara (06:06.187)
Mm-hmm. Mm-hmm.
Chiara (06:13.437)
Yeah, yeah, yeah. Yeah, that's fine.
IfWH Comms (06:22.786)
Kind of that, if that's okay. Okay.
Chiara (06:24.757)
Yeah, of course. then structure wise, because we were going to say, so one of the important things was to add a trigger warning. When did you want to do that?
IfWH Comms (06:29.248)
Yeah.
IfWH Comms (06:40.26)
we can do that at the beginning. and I can just say, just so everyone listening is aware, this episode we'll be talking about.
Chiara (06:56.011)
Well, because I mean, I was going to mention suicide as well. we can just say this episode will be discussing some sensitive topics, including mental health and suicide. So please take care when listening to something like that.
IfWH Comms (07:02.807)
Yeah.
IfWH Comms (07:13.048)
Okay great, this episode will be discussing sensitive...
IfWH Comms (07:21.418)
and suicide. Did you say mental health and suicide? Yeah. So just, so take care.
Chiara (07:24.683)
Mm-hmm. Yeah.
Chiara (07:30.741)
Yeah.
IfWH Comms (07:38.828)
Yeah, perfect.
Chiara (07:40.075)
Cool. And then in terms of just outline kind of what I had, but obviously just I'm very happy for this to be organic, but just so you know what I had on paper. If you want, I can just briefly introduce what's meant by perinatal mental health, just as a concept. And then I think if you wanted to, what's quite helpful for this, what I do when I do lectures anyway, is to kind of say, to set the scene, I think it's important.
IfWH Comms (07:45.334)
Yes.
IfWH Comms (07:56.598)
Yep, I think so, yep.
Chiara (08:09.675)
to give some statistics and then I can just talk about the impact, kind of, you know, basically stats heavy, but just all of that sort of thing.
IfWH Comms (08:12.759)
Yep.
IfWH Comms (08:20.64)
why it's important and bringing that in and how many people it affects. Absolutely.
Chiara (08:25.995)
And then if you want, but we don't have to, I can mention at some point, like there's a basically a really important study that was done in the 80s. the point being that it demonstrated that it's the most vulnerable time with regards to a woman's mental health in terms of her entire life. So we can talk about that. And then your point about what leads to this, why women at risk. And then we can start talking about the biopsychosocial model. And then
IfWH Comms (08:52.205)
Yeah.
Chiara (08:53.991)
with that, if you want to, but we don't have to do it like that, we can talk about kind of which of these things in turn so kind of as an example of kind of biological, I can talk about sleep and why that's important. And because that's kind of the focus of my research. And then psychological, we can talk about birth trauma a little bit. And then
IfWH Comms (09:10.038)
Yep.
Chiara (09:23.455)
social we can talk about and Yes things like you know the example I had on like housing and domestic violence that sort of thing and then if you wanted to we could go on to talk about and Yeah, some of the key conditions including
IfWH Comms (09:42.328)
I think that makes a lot of sense. was going through it yesterday and I really liked how we broke it down into those different sections. And I think, you know, we can see how it's going with time. I think we should try and keep it to 30 minutes, 35 minutes if possible. But obviously like it's not a big deal if it goes a little bit over, like if it's a 40 minute episode, that's amazing because the content will be great. But I think that this is a really good outline so we can just see how it goes and yeah.
Chiara (09:48.523)
Mm-hmm.
Chiara (09:55.722)
Okay.
IfWH Comms (10:10.87)
Sounds like you're very prepared, I don't need to tell you, but...
Chiara (10:13.323)
No, that's fine. I'm just thinking about because if it's going to be a video, I just don't want people to see me flipping through pages and I'm just trying to think.
IfWH Comms (10:21.568)
don't worry. Don't worry. I wouldn't. It's okay. It's a casual. It's not too, like, serious.
Chiara (10:24.073)
Yeah. Okay.
Chiara (10:29.92)
Yeah.
IfWH Comms (10:32.128)
If that's okay. Okay. Okay, great. I just, keep trying to make sure that we're definitely recording. But yeah, I think we're good. I think it's definitely okay. I'm just paranoid. But let's get into it. And also obviously, like if we need to just take a pause or restart a section, it's totally flexible. It's not like going to be a continuous shot.
Chiara (10:32.747)
Yeah, yeah, absolutely.
Chiara (10:40.907)
I mean, it says Wreck at the top.
Chiara (10:47.474)
Yeah
Chiara (11:01.109)
Cool, because it will be of edited, right? Yeah, cool.
IfWH Comms (11:03.456)
It will. Yeah, exactly. So if there's anything also like after the fact that we're deciding like, maybe we don't actually want to put that out. Totally fine. So this is just the big, big recording and we can edit down afterwards. Okay, great. Let's get started. So I'll just do the intro and then we'll we'll get into it.
Chiara (11:12.393)
Okay, that's
Chiara (11:17.835)
Sounds good.
Chiara (11:27.915)
Mm-hmm.
IfWH Comms (11:29.813)
Thank
Hello everyone and welcome back to It All Starts Here, a podcast focusing on the communication and education of topics in reproductive science and women's health.
I'm your host, Olivia Moyer, and we are back here today at the Institute for Women's Health here at UCL. And today we're going to be talking about maternal mental health right around and sort of following childbirth. You may have heard of this under the tagline of baby blues, but we're going to be diving a little deeper into it with none other than the lovely Dr. Chiara Petroselini. Chiara is an academic obstetrician and gynecologist doctor doing her research here at UCL.
where she's completing a PhD focused on maternal mental health, which we will dive in deeper shortly. I'm so excited to get into this with you today, Kiara, and really just learn more about this time in mother's lives. But first, let's hear from you about how you got into this and where it all started for you. And just so everyone listening is aware, this episode will be discussing sensitive topics like mental health and suicide. So just a message to take care while listening.
Now let's get started. Kiara, let's hear from you. How did you get into this?
Chiara (12:43.403)
So thank you for having me. First of all, I'm very grateful to be here. And so I'm Italian, I grew up in Italy. And I first went to UCL when I was 18. So I moved to the UK to study human genetics. And in that time, I did a bit of research in psychiatric genetics. So the genetic aspects of mental health, and I became super fascinated with
mental health, mental illness, and I really wanted to dive deeper and I basically went to medical school just to be a psychiatrist. I only had that one objective. I didn't just want to be a doctor. I wanted to be a psychiatrist. And then basically I accidentally fell in love with an obstetrics is what happened. I realized that there were so many aspects of looking after women that fitted my personality and that that definitely was the right career choice for me. But also somewhat to my surprise,
Mental health and mental illness was an enormous part of obstetrics and gynaecology, a very neglected part, as I'm sure we'll go on to talk about, but I realized that this was the perfect way for me to combine lots of interests and that doing obstetrics, looking after women, definitely didn't mean that I wouldn't be able to explore my interest in mental health because there's an enormous need for it. So that's kind of how it all came together.
IfWH Comms (14:00.002)
So cool. I feel like that is such a common theme of how you start school down one path and then, I mean, what's not to love about obstetrics, I think. It really pulls you in.
Chiara (14:09.599)
I agree. Yeah.
IfWH Comms (14:13.112)
That's awesome. So I guess getting into our topic today, which the very technical term being perinatal mental health. I wonder if you could just sort of introduce that for us and describe what does that mean and just a broad overview, I guess, of that period of motherhood.
Chiara (14:31.443)
Yeah, of course. So basically, peri means around and natal means birth. So basically perinatal mental health refers to the mental health of a woman or birthing person over the course of pregnancy and throughout the first year of after childbirth. And as a field, it's kind of developed for people to have expertise in mental illness that existed before pregnancy. So you might have heard of,
like depression or even schizophrenia. So women who have pre-existing illnesses who then get pregnant and who will have special needs within that time. But also illnesses that are unique and that emerge for the first time in the perinatal period. So things like postpartum depression or postpartum psychosis that we'll go on to talk about. And the reason it is its own thing is because perinatal mental illness has really distinctive features and risks. So you can't just extrapolate from what you know about mental health in general because there's something extremely unique.
about this time.
IfWH Comms (15:32.844)
That's really interesting. think it's...
it's always important to sort of think about, as you said, the kind of environment that someone is existing in with that mental health condition or struggle that they're going through. And I think it's a really interesting term, know, perinatal honor around pregnancy. And I guess it would be good to hear more about specifically like why this drew you and why is this so important and why it's so relevant this kind of period specifically around birth.
Chiara (16:04.009)
Yeah. I mean, I think it's important to set the scene with some stats. I feel like that's always gives you a good idea of the context. So we know that over one in five, probably closer to one in four, women will experience a perinatal mental health problem during pregnancy or in the first postnatal year. But we also know that in about 70 % of cases, women will hide or underplay their illness. So not only those problems,
IfWH Comms (16:11.436)
Mm.
Chiara (16:33.291)
common, but they're also associated with quite a significant level of stigma, which means that women don't feel able to talk about them openly. So they're common and people are suffering in silence, in part because of the stigma, in part because I think women don't feel that clinicians are equipped to really understand. And to put that into perspective, you know, I'm saying
one in four women will experience perinatal mental health problem. Other things that we talk about commonly in pregnancy, say gestational diabetes, that's one woman in 20. So these problems are common and they're much more common than some of the things that we kind of like to talk about a lot in obstetrics. And unfortunately in this country, suicide is the leading cause of death within a year of having a baby, which may come as a surprise to some people listening.
IfWH Comms (17:04.12)
Mm.
Chiara (17:23.371)
But it's true, and it's been the case for a really long time. I think we've become really good at dealing with some things like infection or hemorrhage and things like that in this country around childbirth. But we're really not very good at mental health, in my opinion. Unfortunately, women in this period are really, vulnerable. And they are at higher risk of death from suicide, but also from things like substance misuse or from misattribution of physical symptoms, just like psychiatric illness.
IfWH Comms (17:37.496)
you
Chiara (17:52.881)
What I mean by that is, you know, someone who has a pre-existing mental illness, essentially any complaint that they come with, they get kind of, you know, just semi-ignored and it's just assumed that it's all part of their mental illness. And that's how serious things get missed. And, you know, striking statistic as well is that if you look at all of the women who die in this country, about 50 % of them are known to have a pre-existing mental health problem, irrespective of why they die.
So this cohort of people is very, very, very vulnerable. And that's what sometimes gets ignored. And that's also why I'm passionate about it. But it's not just about mortality. Mental health can have an enormous impact on the mother-in-law bond and on the development of the child, particularly when there is delay in recognition of the problem. And that's more on a kind of societal level.
IfWH Comms (18:46.04)
Mm.
Chiara (18:50.535)
You know, the last time this was costed, the perinatal mental health problems cost the NHS and social care services over £8 billion for each one year cohort of births, and that was costed like over 10 years ago. So the impact truly is enormous.
IfWH Comms (19:07.576)
Mm.
So how does this, like, as you said, a lot of it, not a lot of it, but a good amount of women will, you know, ignore or kind of maybe have self doubt about the symptoms that they're experiencing. I mean, not to mention that, you know, just after delivering a baby, I'm...
I'm sure you're just insanely busy all the time. Like I've seen that with mothers and it's just like you barely have time I think to think about yourself in that period. And if you are going through something that seems like a mental struggle, I agree there's a lot of stigma around that where if you're not basically physically, you know, unable to complete your tasks as a mother, I think it's hard to bring yourself to take that time out of the day to go in to see a doctor.
But I think if someone is going in to see a doctor, how is that evaluated? Like, do we have a sort of standardized test for specifically this period of time for women?
Chiara (20:08.565)
So that's a really good question. So there are some what we call screening tools. So let's say kind of brief questionnaires that help us identify who is more likely to have a problem. They're not really used universally. So they're used some very, very basic ones we've used in pregnancy. And essentially, they are very good at picking up someone with a problem, but they're not very specific. So they will pick up a lot of women who just have normal kind of adjustment problems. And this is part of the difficulty because really the skill is in
IfWH Comms (20:24.727)
Mm-hmm.
Chiara (20:38.417)
unpicking what's normal from what's not normal. I, know, arguably becoming a mother is the biggest biological, psychological, social change that a woman will ever go through. So it would be weird if there was no change in the way that they feel about themselves, about the world. So a level of challenge and difficulty is completely normal.
IfWH Comms (20:41.986)
Mmm.
IfWH Comms (20:58.999)
Mm-hmm.
Chiara (21:07.947)
But then on the other end of the spectrum, there is life threatening illness, sometimes that can present as an acute emergency and can present imminent danger for the woman herself and for others. And so the skill as a clinician is to really try and pick what's normal and what's not normal. And I guess in answer to your question, it's not easy. And there's challenges in part because appointment times and things in the NHS are limited.
IfWH Comms (21:26.379)
Hmm.
Chiara (21:35.679)
But I hope, I like to think that there is growing expertise in this and that people are developing those skills where they can really listen and not kind of brush everything under the carpet and say, just get on with it. It's just part of motherhood.
IfWH Comms (21:51.19)
Yeah, absolutely. And I think it's just, mean, I'm watching a show at the moment on the BBC called Call of Midwife, I'm sure you're so familiar with. I've never watched before, but it's just, it's interesting to see kind of like how it all started, I think, in this field and the role that midwives played in advocating for mothers and sort of like, you know, from the beginning, obviously it's a TV show, but.
how it sort of starts and where it is now. And definitely it's grown so much and it's such an important role that I think doctors and midwives and nurses play in this period for mothers. Going back to...
the whole the concept of this and where you know it all starts really what leads to this being such a vulnerable period for women as you said i mean you kind of alluded to the bio psychosocial model but can we kind of unpick that and sort of understand more about what that really is
Chiara (22:49.895)
Yeah, of course. So the biopsychosocial model is a model that's been used a lot in psychiatry in general to explain why mental illnesses might happen, but also why they are perpetuated to what keeps them going, but also more importantly, how to treat them. So in most people, a mental health problem will arise as a combination of biological things. So for example, whether you have a genetic
IfWH Comms (23:09.304)
Hmm.
Chiara (23:18.987)
predisposition to something or if you are particularly susceptible to hormone change or sleep, as I'm sure we're to talk about a little bit more, psychological aspects will be more to do with your perception of change and your ability to cope, your own kind of coping strategies and attitudes, I suppose. And then social things, you know, anything to do with
IfWH Comms (23:44.449)
Mm-hmm.
Chiara (23:47.755)
social support, so who you have around you, if there is, you know, sudden bereavement or change in housing, you know, and that's just to name a few examples. So I suppose for each individual woman, those three kind of fields will play different roles, and it will be a unique combination for each person. Often there's a combination of all three.
IfWH Comms (24:01.976)
Mm.
Chiara (24:17.085)
And it's so important that care for these problems is individualized. So the best way to understand a human being is to try and understand what bits of each of those spheres is coming into play. And you said, I just wanted to pick up on what you said about vulnerability. I think it's important to recognize that this is an extremely vulnerable time, even if
IfWH Comms (24:31.606)
Yeah.
IfWH Comms (24:44.62)
Mm-hmm.
Chiara (24:46.417)
it's not that even if someone has never had a mental health problem before. And there was a pivotal study done in the 80s where they basically followed up nearly 500,000 women over a period of at least 12 years. And basically they recognized for the first time that your relative risk of being admitted to a psychiatric hospital, mental health hospital, is extremely high in that first month after childbirth, even if you've never had a history of mental health before.
IfWH Comms (24:51.702)
Right.
IfWH Comms (25:00.525)
Mm-hmm.
Chiara (25:16.105)
And particularly looking at first time mothers, you are 35 times more likely to be admitted to a mental health hospital in the first 30 days after having a baby, more so than at any other time in your entire life. And that study has been replicated in different cohorts all over the world since then. And essentially the same principle applies to both women with and without pre-existing mental health problems.
Can you hear that?
IfWH Comms (25:46.016)
Okay, I can, but it's... I was hoping that this wouldn't happen here because I'm right by a window as well.
Chiara (25:49.481)
going. This will be a bit to cut out.
Chiara (25:59.339)
I live opposite a fire station back home in Italy as well. Sometimes this happens. I'll wait. you're open, need to retay that bit or carry on.
IfWH Comms (26:02.322)
IfWH Comms (26:13.866)
Maybe say that bit again, yeah.
Chiara (26:16.139)
Okay, And I just wanted to pick up on you mentioned the world, the word vulnerability. I think it's really important to recognize that this is an extremely vulnerable period of time for any woman irrespective of whether or not they've had a mental health problem before. And there was a pivotal study that was done in the 80s, where they basically followed up nearly 500,000 women for a period of at least 12 years.
IfWH Comms (26:24.504)
Mm.
IfWH Comms (26:34.413)
Yeah.
Chiara (26:45.131)
And basically they recognise for the first time that the risk of being admitted to a psychiatric hospital, the relative risk is extremely high in that first month after childbirth. And particularly looking at first time mothers, they are 35 times more likely to be admitted to a psychiatric hospital in the first 30 days after childbirth than at any other point in their entire life. And this
concept, let's say, has been replicated in lots of different cohorts all over the world since then. And essentially, the basic principle applies both to women with and without pre-existing mental health problems. And so I think it really is important to recognise both for women themselves and for clinicians who might be listening to this, that irrespective of what may have happened to someone before they ever got pregnant, irrespective of whether or not they have a history of mental health problems,
IfWH Comms (27:35.785)
Mm.
Chiara (27:39.179)
we know that this is the most vulnerable time in a woman's life with regards to her mental health. And what I'd say to some of my colleagues that aren't particularly interested in mental health is, regardless of whether or not you like it, if you are going to do the Sceptrics, you are looking after women at the single most vulnerable time in their entire life with regards to their mental health. So it's about keeping your eyes and ears open to the possibility that this could happen.
IfWH Comms (27:55.521)
Yeah.
IfWH Comms (28:05.098)
Yeah, and I think we'll get into it later when we're talking about some different sort of myths and misconceptions to bust, but I just can't help but say at the moment, like, how you describe this and how common it is and sort of the importance in being a doctor that is able to recognize that and the prevalence.
It's just crazy because I think the public perception is that, I mean, I think we're starting to get better at recognizing it, but I think at the moment it's commonly that this is the most important and happiest time in your life. You know, you're going to deliver a baby and it's just going to be all sunshine and rainbows. And, you know, it's not like it is obviously a really exciting time and bringing new life into the world and this beautiful child, but
it's not about that exclusively, like, as you said, the three sort of the biopsychosocial model. And I think as well, what's really interesting, is I think, again, the public perception is a lot around biological factors that go into this, you know,
but not even your susceptibility to hormone changes, but just like, this person is having trouble, they're a new mom and they're just not coping. And that's sort of, I think, the sort of tagline that gets associated to it. But there are so many factors, as you said, even just within those three kind of headers under the biopsychosocial model. And it's just so interesting to unpick it and understand it more.
Chiara (29:42.165)
Yeah, yeah, absolutely. And I think, you know, so, so much would be better if there was a better ability to speak about the fact that these problems are common, and that if someone isn't coping, isn't because they're not good enough, it's because they're human. And that doesn't mean to say that we should undermine or kind of belittle
IfWH Comms (30:01.281)
Yep.
Chiara (30:08.821)
very serious mental health problems that can happen in this time. But I think it would help so many people to realise that the norm is to struggle at least a bit, not to do everything perfectly and to have everything nailed.
IfWH Comms (30:17.324)
Yeah.
IfWH Comms (30:21.866)
Yes, as you see on social media.
Chiara (30:24.456)
Exactly.
IfWH Comms (30:25.944)
That's so interesting. So I guess going more into it, what these conditions are, as I said at the beginning of the episode, I think the one you hear the most commonly is baby blows. I mean, definitely I've heard of postpartum depression, but I know that there is more to the story than just those two. So could you kind of run us through the conditions that we need to be aware of?
Chiara (30:51.199)
Yeah, so I mean, as I mentioned before, perinatal mental health and perinatal mental illness, it's a spectrum from normality to severe illness. And it's important to bear that in mind because there's 50 shades of grey, let's say, within that spectrum. it doesn't always fit into neat little boxes. But I suppose in terms of some key highlights that people should be aware of,
you mentioned earlier the term baby blues. So that's considered a non disorder in the sense that we know that 60 to 80 % of women will experience baby blues. So it is considered essentially the norm to an extent. And essentially what that means is that around day three to five postpartum, usually when the milk comes in, sometimes, you know, in relation to a sprinkle of sleep deprivation,
there will be a change in mood that is transient. Women may feel irritable, tearful, overwhelmed. And it's very, very common. And it's not considered a disorder. But the really important thing there is that it will get better very quickly. And it will respond to reassurance. So what that means is if you are able to have support and have a nice
IfWH Comms (32:00.149)
Mm-hmm.
Chiara (32:17.611)
chat with your family, your friends, get a good night's sleep, get some rest, it will get better very quickly. And it doesn't compromise your ability to function and to look after your baby. And that's why it's not an illness. But by contrast, perinatal depression is an illness. And the reason for that is because, so firstly, by definition, symptoms need to have lasted at least two weeks. And most of the time, you know, they're grumbling symptoms that
have gone on for a really long time. But importantly, they do compromise your ability to function as a person. And that's the difference. And it can affect so many different spheres of your life. So it's not just that you will be low in mood. There are often what we call somatic changes. So significant changes in your ability to eat and your ability to sleep and to care for yourself and to care for your baby.
IfWH Comms (33:02.21)
Yeah.
Chiara (33:14.933)
pervasive. So it affects every domain of your life. And it doesn't respond to reassurance, it doesn't respond to a bit of a hug and a good night's sleep. And that's the biggest problem that when women are really struggling, often they get dismissed with like, it's a bit of the baby blues, just have a good night's sleep. And actually, it doesn't make any sense because, you know, that five months postpartum, they've not slept for two months and have been crying every day. That's not baby blues, you know. And that's a really, really important distinction.
IfWH Comms (33:40.716)
Yeah.
IfWH Comms (33:45.09)
Yeah.
Chiara (33:47.276)
And
IfWH Comms (33:47.608)
I'm guessing that that is sort of where the lines get blurred a little bit in determining a more serious condition and then being able to treat that more serious condition that a woman is struggling with. Like, I'm guessing that that threshold is probably a lot higher than it should be.
Chiara (34:08.427)
Sorry, in what sense? Let's start this bit again.
IfWH Comms (34:12.13)
Definitely.
So I'm guessing that that sort of distinction is where the lines get blurred, you know, between baby blues and postpartum depression, you know, where something continues on for longer than it really is meant to. But I'm guessing that the threshold to get to that full kind of postpartum depression diagnosis is too high, you know, in practice, when in reality it's probably much lower than is treated for.
Chiara (34:45.237)
Yeah, absolutely. I think it's extremely under diagnosed. In the States, they say that it's the single most under diagnosed condition of pregnancy. And it's exactly for the reasons that you've just said.
IfWH Comms (34:51.5)
Yeah.
IfWH Comms (35:01.154)
Yeah.
That's really interesting. And then going further into some other conditions to be aware of. So I know you mentioned before to me, postpartum psychosis, what does that look like?
Chiara (35:04.331)
Yeah.
Chiara (35:16.085)
So postpartum psychosis is the focus of my research. And I think what I want to say about it is that it's a medical emergency, but also that it is treatable. And people get better very quickly and very effectively. But it is also extremely underdiagnosed. So it's a severe condition.
that happens in up to one in 500 people who give birth. And it can present in lots of different ways, but essentially the key feature is there's a bit of loss of touch with reality, hence the term psychosis. It's serious because almost always the symptoms start very suddenly and women get worse very, very quickly. So it can present with what we
IfWH Comms (35:48.642)
Mm.
Chiara (36:14.037)
typically called psychotic symptoms. So that would mean delusions, hallucinations. So either hearing things or seeing things that aren't there or believing things that cannot be true. But what's often a misconception about this condition is that although these psychotic symptoms are very prevalent, they are not the defining feature. The defining feature is a very big mood component. So you can have
IfWH Comms (36:26.296)
Mm.
Chiara (36:41.415)
mania, a state of persistently elevated or irritable mood, where you're not sleeping or eating, kind of functioning at a million miles an hour, or profound depression as well. So it's not that it sits in a completely separate box to perinatal depression, because you can also have profound depression within this. But importantly, you can also have disturbances in kind of your cognitive functions. So women are often very confused.
IfWH Comms (36:50.861)
Yeah.
Chiara (37:11.717)
And they will come in and out of this state of perplexity where things don't really make sense. And for the medics listening to this, it looks a lot like delirium, actually, like what you might see in the elderly, for example. And so one of the problems with this condition is that it presents in lots of different ways. It changes very quickly, and so it's hard to spot. But essentially, because of this gradual loss of touch with reality and these
IfWH Comms (37:33.762)
Right.
Chiara (37:40.895)
fixed false beliefs that are associated often with the baby. It's a medical emergency because it is associated with a significant risk of suicide and or infanticide. And so it needs to be treated as a medical emergency because things escalate so quickly. I think it's important to say that although there are some recognized risk factors for it, in about half of cases,
IfWH Comms (37:51.736)
Mmm.
IfWH Comms (37:59.414)
Of
Chiara (38:09.407)
there is no history of pre-existing mental illness. And so once again, it's about kind of looking out for it and realizing that it's more common than you might think, because it's often branded as rare. But I really don't like that term because rare, first of all, it's not rare. By definition, it's uncommon. But also the term rare kind of has this implication that it's something that you don't really need to know about.
IfWH Comms (38:18.764)
Yeah.
Chiara (38:35.483)
And a comparison I quite like is that it's just as common as Down syndrome and screening for Down syndrome and pregnancy is something that we all talk about all the time. And extensively counsel women on the various screening approaches. But no one talks about postpartum psychosis. So again, that goes back to stigma. Why is that?
IfWH Comms (38:54.327)
Mmm.
IfWH Comms (38:58.4)
Right. Yeah, you definitely hear about Down syndrome quite a bit. Absolutely. So it's a really good comparison to make. I think that's really interesting as well about how it's sort of branded in terms of it being rare versus uncommon and important, obviously, to make that distinction and communicate that differently. I think that that was one of our kind of key
misconceptions that we wanted to bust. But I know the other one was around the lack of sleep, which I think mothers listening will just love to hear because, you know, it is definitely branded like, it's just part of it. That's just what you see, you know, lack of sleep is normal. And so can we go into that, I guess?
Chiara (39:47.977)
Yeah, of course. mean, so I'm particularly interested in sleep as that's the focus of my PhD. And it's a very fascinating thing to study, actually, it's something that we all do, but not very many of us know anything about it. And it's, it's a whirlwind, I'll tell you. But I think the first thing to say is that sleep is not just the absence of wakefulness, it's a very apt
tightly regulated metabolic process that is absolutely fundamental for your health. And it's got lots of different biological functions. And you know, just to name a few, it's when, when you sleep is when your cardiovascular system shifts from a kind of sympathetic nervous system state, so your fight or flight to your parasympathetic nervous system, so kind of rest and digest, calm down. And so it's fundamental for your cardiovascular health.
And it's also when your glymphatic system works. So that's a network of capillaries in the brain that clears waste. So that's literally when the brain is getting rid of its waste products. It's when your immune system gets regulated. So when there isn't sufficient sleep, there is an association with kind of immune dysfunction, but also DNA damage and several cancer risk. But it's also when your neural connections get strengthened.
kind how memory consolidation and learning happens. And so these are all fundamental processes. And in the perinatal period, basically, for a combination of reasons, sleep gets worse. So even within pregnancy, we know that things like being breathless or needing to go to the toilet or being in pain mean that your sleep will be really kind of disrupted.
IfWH Comms (41:11.884)
Mmm.
Chiara (41:34.495)
But we also know that the hormones of pregnancy, so oestrogen and progesterone, will affect sleep architecture. So that's kind of the structure of your sleep. the hormones will interfere with your ability to maintain both non-REM and REM sleep. And also disorders of sleep are more common in pregnancy. So whether that's insomnia or restless leg syndrome, sleep apnea. And so as a combination of all of these reasons, as pregnancy progresses, sleep quality worsens.
And what people often fail to recognize is that sleep is awful, even before the baby's in the picture. And so women already get to that point when they're in a sleep deprived or sleep deficient state. And then there's the bit that we all know about, which is that basically postnatally, there's a significant reduction in how long we get to sleep for, but there's other parameters that change as well. So for example, your sleep efficiency gets worse. So that's basically your ability to...
IfWH Comms (42:07.904)
Mm.
Chiara (42:30.261)
capitalise the sleep that's available to you. So what proportion of time in bed do you actually spend asleep? So there's so much about sleep that changes in this time. But importantly, we know that it correlates really strongly with mental health problems. So insomnia in particular has the most evidence. So insomnia is the inability to initiate or maintain sleep, but despite the opportunity to sleep. So a baby waking up all night, that's not insomnia.
IfWH Comms (42:45.08)
Mm.
Chiara (43:00.127)
But if you're lying in bed wide-eyed, unable to sleep, even when the baby sleeps, that's insomnia and that's different. And so we know that insomnia correlates really robustly with depression, both in pregnancy and postpartum. But really importantly, this is a prospective relationship. So it's not that the two problems are happening at the same time. We know that when there's insomnia, it's predictive of future depression, both within the pregnancy and postpartum.
So that kind of implies a direction of causation. It's not just that the two things go hand in hand. There is something about sleep that generates mental health problems. And we're talking about postpartum psychosis. We know that sleep is likely to play a really important role because we know that not needing to sleep or not being able to sleep is by far one of the earliest and commonest symptoms.
And also in women with bipolar disorder who have an increased risk of postpartum psychosis, when they've done some studies following women up in the pregnancy and postpartum, women who lose at least one full night of sleep in the interpartum period are five times more likely to get postpartum psychosis than women who don't. And sleep is a very powerful thing. And on its own, it's independently associated with an increased suicide risk.
even when you account for the mental health diagnosis and the severity of the mental health problem. So there's something about sleep that is so fundamental to our existence, to our ability to function, to our survival mechanisms, you know. And so coming back to what you were saying, it's just, you know, it's not, it's easy to dismiss it as part of
IfWH Comms (44:33.815)
Yeah.
IfWH Comms (44:37.236)
Yeah. Yeah. Important to not just... know you go.
IfWH Comms (44:51.671)
Yeah.
Chiara (44:52.509)
motherhood, but it's a fundamental biological function.
IfWH Comms (44:57.152)
Yeah, exactly. I was just gonna say exactly that. Like for some reason, it's very easy for us to just brush that off, but important not to because of all of the effects that it can have. And to try and figure out, I guess, how that can be treated and how you can ensure that you're getting a good amount of sleep, which I think leads us into, you know, our tips.
for our audiences that are listening. So mothers, families that are supportive of mothers, healthcare practitioners, what are our suggestions for this period and for handling different conditions that may arise that are related to perinatal mental health.
Chiara (45:42.921)
Yeah, I mean, I think the first tip which applies to both patients and clinicians is just recognize that these problems are common. And I'm not saying that to scare people, but I'm saying it almost to normalize it. So you need to have a high index of suspicion and to be able to recognize that there is likely to be a mental health problem if someone is coming, trying to talk about one.
IfWH Comms (45:54.487)
Yeah.
Chiara (46:11.211)
But also as a patient, as a person, just be empowered to reach out because actually struggling is more common than not struggling. But even in very serious conditions, for example, I spoke about postpartum psychosis, in almost all women, they will return to their functional baseline and they will not have further episodes of severe mental illness. This is very treatable and the outcomes are really, good.
IfWH Comms (46:20.952)
Mm.
Chiara (46:41.033)
you reach out in time and if you're taken seriously. And so I suppose the first thing is speak out, don't be afraid to speak out and look out for it if you're a clinician.
IfWH Comms (46:56.63)
Yeah, absolutely. I think it's so important. You know, and we talked about that at the beginning of the episode is just not brushing it under the carpet, knowing that even, you know, I think that just goes across the board when it comes to mental health. And we've done a lot better with breaking the stigmas, but just because it's not sort of physical presenting.
illness, that doesn't mean that it's not a valid illness. And it's absolutely something to recognize, you know, as the patient, we have a role in recognizing and reporting. And healthcare practitioners and anyone involved in that space has a role in sort of advocating for those people and ensuring that they get the right treatment, absolutely.
Chiara (47:39.263)
Yeah, and I think it's important for women to know that you can and you will get better. So if you ask, you know, it's not all doom and gloom. The outcomes are really good. You can and you will get better.
IfWH Comms (47:46.838)
Yes.
IfWH Comms (47:51.254)
Yeah. So interesting. I think just also, you know, using different resources and going online, listening to podcasts such as this, being aware that there is more to, you know, giving birth and, you know, the physical symptoms that come along with that. But just being educated on these topics so that you're then able to recognize what is happening.
Chiara (48:17.107)
Absolutely. Yeah. I think, you know, it's important, you know, going back to sleep, that there's a complex, bi-directional relationship between sleep and mental illness. And I always say that, you know, just because something is common doesn't mean that it's normal. So not sleeping well for a year, it might be common, mean it's normal. And whilst sleep disruption is extremely common, there can be times when your inability to sleep
IfWH Comms (48:34.306)
Yeah.
Chiara (48:46.283)
underlies a very serious mental health problem. So once again, don't dismiss it, feel able to say that sleep is a problem. And as a clinician, don't dismiss it. Because it could be a marker of very serious problem. And that's when it comes into the nuances, you know, for example, figuring out when sleep, you know, it's the difference between saying I'm not sleeping all the time, because babies crying all the time. And saying,
IfWH Comms (48:53.975)
Yeah.
Yeah.
IfWH Comms (49:00.181)
Mm-hmm.
Chiara (49:13.213)
actually, that when sleep is available to you, when the baby's fast asleep, if I gave you a luxury bed in a five-star hotel, would you be able to sleep? And it's the women that say no, that you need to be careful about.
IfWH Comms (49:23.158)
Yeah. Yeah. It's really interesting. This has been such an incredible episode and learning from you, I know that all of the listeners right now are just, it's such an important topic to cover as are everything, but it's been great and appreciate you coming in and talking about this with us. We'll link some resources in the show notes that everyone can have a look at if they want to learn more, but it's been wonderful. So thank you so much for joining.
Chiara (49:40.991)
Problem? Thank you.
Chiara (49:52.853)
Thank you for having me.
IfWH Comms (49:56.65)
Hey.
Chiara (49:58.025)
I've got some other bits if you want that we can just record quickly and then you can add them in as and when, whatever you think. Unless you think, just because the natural flow meant that I didn't cover them, then you can pick and choose or whatever you want.
IfWH Comms (50:04.084)
Yep, definitely, for sure.
IfWH Comms (50:13.172)
Absolutely. Is that tips or is that in another section?
Chiara (50:17.469)
It's in another section. But I'm happy to go with whatever you think. So I can tell you what the kind of things I had that we didn't cover are. I didn't have, so we had stuff on birth trauma to go under the psychological stuff. So we could expand on that briefly if you want. And then the other thing is obsessive OCD, which I actually think is really important.
IfWH Comms (50:19.371)
Okay.
IfWH Comms (50:26.868)
Yep, for sure.
IfWH Comms (50:34.73)
Right? Right?
IfWH Comms (50:40.684)
Definitely.
Chiara (50:47.571)
because there's a distinction to make with postpartum psychosis, and it's very common. That's actually...
IfWH Comms (50:47.925)
Okay.
IfWH Comms (50:51.946)
Okay, I think that that's okay. We can go because with, think let's do the OCD definitely. And we can do the birth trauma as well.
Chiara (51:03.051)
It's just those two actually. I think we did everything else.
IfWH Comms (51:06.944)
Okay, so I might just start off and I'll just say under that umbrella category of postpartum depression, something that you mentioned to me before this episode is postpartum OCD. Is that, do they fit in the same or how would you want that introduced?
Chiara (51:21.265)
Yeah, so I guess there's a few ways we could do it. In some ways, it flows well if we do it after postpartum psychosis, because it's about intrusive thoughts. So I could do it like that.
IfWH Comms (51:25.163)
Okay.
IfWH Comms (51:36.512)
Okay, so why don't you just start off? Because I can just clip that in. So maybe you say, another condition and then go from there.
Chiara (51:43.871)
Mm-hmm.
Chiara (51:49.065)
Yeah, sure, Okay. And so another important condition to be aware of is postpartum OCD, so obsessive compulsive disorder. And because it's really frequent and underdiagnosed, and this is possibly one of the most stigmatized ones that women don't want to talk about, because they feel incredibly guilty about the thought processes that they're having. And basically,
OCD is a condition where you have obsessions, intrusive thoughts that you can't get rid of, compulsion, so the need to perform certain acts, usually to relieve the anxiety caused by those thoughts, or you have both of those things in a cycle. And it's not just, you know, the stereotypical thing of people washing their hands 10 times a day or whatever it is. It's much more complex and common than
And in the perinatal period, very often, will be intrusive thoughts related to the baby. For example, things like, what if I drop my baby? What if I let the stroller go and then it ends in the lake, for example? Or what if I hurt my baby? Or even darker thoughts than that. The problem is that because women are having these thoughts, they assume they're a horrible mother. It fuels their depression and it fuels their inability to speak about it. And also clinicians think that if
someone is saying to you that they have thoughts of harming their baby, then their instinct is to say, my God, she's psychotic, she's dangerous, lock her up. But in reality, it's completely different. And the key here is to figure out if those thoughts are what we call ego-syntonic or ego-gestonic. So you need to ask the person how they feel about that thought. Because a person with OCD that has a thought of harming their baby will feel awful.
about that thought, they will feel like a horrible human being and will have no intention of acting on it because it is completely out of line with their sense of self and what they will do. But by contrast, psychosis is different and a thought of harming themselves, their baby or whatever it is, will come from a place that making sense to them with regards to what their reality is. And so they don't feel guilty or scared by that thought. That thought is in line with their mental state.
IfWH Comms (54:10.433)
Right.
Chiara (54:10.487)
And it's a really important distinction to make. So I think what I think is important to let women know is that having intrusive thoughts like that in the perinatal period is very, common. And also OCD will target anything that scares and matters to you. So often, the more you care about something, the less likely you are to want to hurt something, the more likely you are to have those intrusive thoughts. And it doesn't mean that you're a horrible or dangerous parent.
IfWH Comms (54:35.117)
Right.
Chiara (54:37.611)
And once again, it is a very treatable condition. So feel free to speak out because it doesn't make you a horrible human being. Thoughts are just thoughts and they can be dealt with.
IfWH Comms (54:49.686)
Yeah, absolutely. It's such an important concept to understand. Okay, great. Agree that that it's very important, obviously. And then in terms of birth trauma, I think again, why don't you just start off? Like I don't even think I need to lead you in. You can just say, so under the head, yeah.
Chiara (55:12.905)
Or you could do, yeah, or you could ask me like, I don't know, like, leading with kind of what about the psychological? Yeah. What do you think is important to know about or something like that?
IfWH Comms (55:24.106)
under that header of, yeah, yeah, okay.
IfWH Comms (55:30.902)
I agree. Okay.
Chiara (55:32.619)
Cool.
IfWH Comms (55:35.128)
So diving more into the psychological aspect of the biopsychosocial model, one thing that we've talked about, and I think you've already mentioned briefly, was birth trauma. What and how does that kind of impact perinatal mental health and how is that related?
Chiara (55:56.799)
Yeah, so I think in terms of psychological factors that feed into perinatal mental health and mental illness, a big part of the problem is thinking a little bit about how we process change, because obviously, as we mentioned, motherhood is a time of enormous change. And so your internal coping mechanisms for processing change will somewhat dictate what ends up happening. And birth trauma is kind of part of this.
And it's unfortunately very, common and it's increasingly recognised. But it's important to think about trauma more broadly and what that would mean. So in general, when we say trauma, we're referring to actual or perceived threat of death or serious injury. So someone will feel traumatised if at some point there was a real or perceived feeling of dying or serious injury. And in this context, it will apply to
a woman or she felt that about her baby. So she seriously thought that herself or her baby could die or could be seriously injured. whilst, if you look at the stats, you know, it'll be under 10 % or five to 9 % of women meet criteria for childbirth associated PTSD. And actually, you know, this isn't something that we routinely screen for. So the numbers could be higher.
But if you go out and just ask women in a binary fashion, you know, was your birth experience traumatic? Yes, no, the numbers are much, higher. So the literature says about 44 % and my data from my research is not dissimilar. So almost kind of one in two will say yes. But so importantly, it's not about what, let's say, objectively goes wrong in that birth. It's not about what we as obstetricians might say is an emergency or a complication.
IfWH Comms (57:27.704)
Mmm.
Chiara (57:49.067)
because I've certainly had lots of women who have had lots and lots of very complex emergencies and complications over the course of their childbirth experience that then process this fine, whereas there are some people who will have what we would deem to be a completely straightforward birth experience who feel traumatized. And ultimately, although there is so much data and research in this field, I think it can be drilled down to some very basic concepts.
IfWH Comms (58:08.535)
Right.
Chiara (58:18.043)
this is basically a subjective view of the delivery as an experience and it's irrespective of the peripartum complications. And to me, it all comes down to two things. It's about control, first of all. So if there is a perceived lack or loss of control, that leads to trauma, that makes people feel traumatized. And also suboptimal communication and support. So it's those two things. So if people feel
unsafe and if people feel like they've lost control, that's when trauma happens. And there are so many studies showing that actually what makes a difference isn't the actual complication that happens, it's about how we communicate around it and whether or not we do things to empower women to feel safe around that experience. And so I think what I'd want to say
IfWH Comms (58:51.186)
Mm-hmm.
IfWH Comms (59:02.712)
Mm.
Chiara (59:13.043)
to women is first of all that unfortunately it is common to feel traumatized by your birth experience and you shouldn't accept the one-liner of, but aren't you glad it all went well in the end because that's not what defines trauma by definition. And you are entitled to your trauma, even if everything went well on paper. And similarly, as clinicians, don't assume that you know whether someone in front of you will be traumatized or not because it's not about
IfWH Comms (59:28.193)
Yeah.
IfWH Comms (59:33.303)
Yeah.
Chiara (59:43.165)
what went wrong or what could have gone wrong. It's about the subjective experience and whether or not there was loss of control and whether a woman felt unsafe in that process.
IfWH Comms (59:45.91)
Yeah.
IfWH Comms (59:55.702)
really interesting and I love how you broke that down. think it's probably something a lot of people, including myself, haven't heard in that way before, you know, the concept of how trauma develops. And I think it's important, especially in this period of childbirth, where you just feel like you absolutely have no control. So it's really interesting to learn about that and how that can play into it.
IfWH Comms (01:00:24.96)
Okay, great. This has been so wonderful. Just exceeded any expectations that I had. I feel like I've learned so much.
Chiara (01:00:32.939)
Thank you, sorry that I interrupted you at one point because I was like, sorry, I don't understand questions. shit
IfWH Comms (01:00:39.48)
Oh no, that's okay, don't worry, I worded it weirdly. But yeah, that's what editing is for, so it's all good. This has been so good though. So I'm gonna try and get done with this episode this week.
Chiara (01:00:49.183)
Yeah.
IfWH Comms (01:00:57.398)
and send something to you by Friday for you to have a review of. I'm not sure how I'll be able to send. I think it'll probably be on OneDrive because you have a UCL email. So I'll probably send it to you that way, just like a link to be able to open it that way so you can see the video and listen to the episode. And then we can send it back to Holly and just let her know that we're ready to go live with it.
Chiara (01:01:21.68)
cool. Do you reckon it's too long?
IfWH Comms (01:01:24.888)
I don't think so. don't, mean, it doesn't matter too much. I'm sure that with all of the editing and everything, we can get it down to 40 minutes, which isn't, isn't too long. Absolutely.
Chiara (01:01:37.632)
I mean, obviously I'm biased because it's the area that I'm interested in, but I just feel like all of it's important, you know?
IfWH Comms (01:01:42.136)
I know, I know, it's so true. And it's funny, because I think sometimes I have people on and I've had people on in the past and it's like we're done in 19 minutes and I'm like, this is your passion, like talk to me, tell me, you know? But no, you were such a natural and I feel like it was just so easy to have this conversation. So I'm grateful. Yeah, absolutely. Made my life so easy.
Chiara (01:01:53.193)
Really?
Chiara (01:02:03.994)
that's nice to hear. Thank you.
Chiara (01:02:08.619)
And I'm really grateful to have done it because I've been invited on a few podcasts before, like, one was like, not related specifically to my passion, let's say. So this is, this is nice.
IfWH Comms (01:02:14.55)
Yeah.
IfWH Comms (01:02:20.554)
Yeah, yeah. It's a good to have an intro episode. And do feel like it's less scary than you thought it was going to be?
Chiara (01:02:29.427)
Yeah, yeah, it's really I mean, it's all stuff that I kind of lecture around. So in terms of the content, I feel very comfortable with it. I guess what less easy is because I'm used to like, next slide, you know, it's like very structured, whereas to make it like a conversation, sometimes it's hard because yeah, that's the difficult bit for me. But I hope it's not natural.
IfWH Comms (01:02:34.497)
Right.
Yeah.
IfWH Comms (01:02:42.284)
Yeah. Yeah.
IfWH Comms (01:02:49.048)
True. Yeah, no, it's so true. It did. It did. It definitely did. Like, it came across really well. It's really, I'm really excited to put this out. I think it's just, like we've said, it's just something that's not talked about enough or really at all. Like, I just, I'm not in the motherhood stage yet, but I definitely don't hear about this. And I hear about a lot of other things related to birth and motherhood.
Chiara (01:03:12.202)
Anani.
IfWH Comms (01:03:14.804)
So it's really important to highlight and I'm excited. I think as well this period of the year can be hard, especially for people. So I'm kind of grateful that we're putting it out at that time. Not that this is exclusive to certain periods, but I think it's just maybe. But yeah. OK, so I will keep you posted.
Chiara (01:03:18.891)
You too.
Chiara (01:03:30.579)
Yeah, yeah, no, that's true.
Yeah. Is this like a second season or something? Is this like the start of a new season? How does it work?
IfWH Comms (01:03:40.682)
It's actually the end of the second season. So you're my last episode in like with the Institute for Women's Health. So I'm gonna just start doing the podcast on my own separately. Yeah, I really like it. But it's like, they're running out of budget basically at the Institute for Women's Health. And I just really enjoyed doing the podcast. So.
Chiara (01:03:43.306)
Okay.
Chiara (01:03:52.715)
good for you.
IfWH Comms (01:04:04.568)
This was really good for me to learn how to do it remotely because I'm sure that I'll have to do that a bit more as well. But I'd like Riverside. I feel like it's a pretty straightforward website to use.
Chiara (01:04:18.611)
Yeah, think it probably gives you flexibility in terms of like meeting up with people at the convenient time.
IfWH Comms (01:04:23.943)
I think so. Yeah, it can be so hard with getting rooms at UCL especially, which I'm so excited to not have to deal with anymore.
Chiara (01:04:31.443)
Yeah, yeah, sorry that it's been so hard. I'm sorry it took so long to get this recorded.
IfWH Comms (01:04:34.418)
no, I'm sorry. It's not for you to apologize. It's my it's it's I'm sorry that this has been the case. It's not normally this laborious to get an episode done, but it's been great. So I'm glad that we that we held on.
Chiara (01:04:50.261)
Yeah, no, I'm really grateful. Thank you.
IfWH Comms (01:04:53.016)
Okay, well, I'll be in touch. Like I said, I'll send through the episode for your review. Hopefully by Friday is my aim, but I will keep you posted.
Chiara (01:05:01.547)
Do we need to press anything to make sure that it saves before we just leave? Okay. Okay. Cool. Thank you so much. See you soon. No problem. Bye.
IfWH Comms (01:05:07.646)
I will on my end. I'm yeah, I'll press stop. So don't worry. Yeah. Anyways, have a good rest of your day. Thank you so much. Bye.