Ep. 14 Struggle to Impact: Dr. Ashley Gresh on Postpartum Care

Dr. Ashley Gresh, PhD, CNM, RN, and Assistant Professor at Johns Hopkins School of Nursing, transformed her own difficult postpartum experience into the foundation of her life’s work. A certified nurse-midwife and public health nurse, she is dedicated to eliminating maternal health disparities in the U.S. and globally. Through the Addressing Women’s Health Inequities initiative, she fosters collaborations that develop evidence-based, nurse-led solutions with a central focus on reimagining postpartum care, because the “postpartum cliff” doesn’t need to be so steep. Her research on perinatal group-based care and her global fellowship experience highlight her commitment to co-creating human-centered solutions that honor families, shift power, and transform systems of maternal and child health.

Check out the links below to connect with Ashley or to learn more about her amazing work!

Addressing Women's Health Inequities / Faculty Research / Linked In

Transcript

SPEAKER_00 0:00

Welcome to the Perfectly Disordered Podcast. I'm your host, Briality Pasquale. This is a place where heroes' journeys are told, where stories of hope are shared in a time when it's needed most. We shine light on the messiness of life so we can ultimately become the hero of our own stories and not just a background character and someone else's. Enjoy the show. Ashley, let me hide these. I always forget to take off like my rings and all that stuff because it can be loud. Um, but yeah, thank you for being on the perfectly disordered podcast. Yeah. I'm excited to have you on. Um, I'll start with like how I know you. Okay. Um, so you're a client of my brother's, um, and you know, he's been trying to help me like find interesting people and just supporting me on this vision, you know. And he goes, Man, you gotta talk to my girl Ashley. Like, she is like a badass lady. Um, and he like gave me, he just gave me some highlights of like some of your story, and I was like, oh my God, I gotta talk to this woman. But today I wanted to have you on to talk about your journey um getting into this field and um how motherhood impacted your um like your vision, like your your calling in life. Um so we'll start at the beginning. Yeah. So, how did becoming a mom change your life?

SPEAKER_01 1:38

So, in many ways, I always say it's like the most beautiful and most challenging job. I think most moms say that um that they've ever had. I would agree. Yeah, I would agree. Yeah. Um, so really what was pivotal for me is that I had just started my PhD program and was taking classes and then started full-time when my son was eight weeks old.

SPEAKER_00 2:00

Which is crazy.

SPEAKER_01 2:02

Like my brain was barely turned on.

SPEAKER_00 2:05

Yep. Yeah. And you're just like, I'm gonna do a PhD. Like, are you serious? Yeah, yeah.

SPEAKER_01 2:09

It's a little nuts when I think back on it, but he came to every single class with me except for exams when they did not let him in. Um You brought him with you? That's so nice that they let you do that. Yeah, it was very nice. Horrible. Yeah. So, but I had originally gone in thinking I was gonna do research on pregnancy and prenatal care, and then I had him, and I was like, oh my gosh, my whole like body, mind, everything's changing. And I had this like most beautiful birth. I was so lucky. I was surrounded by like multiple midwives and friends, and just this like birth center birth that was like really I wish everybody could experience. It's just it was so beautiful, and then postpartum hit. It was like I had breastfeeding challenges, I had infections, I had all sorts of stuff. I at the time was partnered, but my he wasn't able to be in the country, and so I was on my own, and it was just my son had challenges that he wasn't gaining weight, and all of a sudden I was like, Oh my gosh, I can't like focus on pregnancy when postpartum is like, and then I went to my six-week visit, and you know, we're trained to be like, and good luck. Um but we send you off, yeah, and then there are no clinical guidelines, nothing to really guide people past six weeks after birth. Um, and so really I pivoted then to be like, I'm gonna focus my research, my time, my energy into how we can improve postpartum care.

SPEAKER_00 3:40

Yeah. No, so I mean, what was what was your postpartum experience like? If you can kind of speak a little bit more detail into that, because I feel like that was based off of what we talked about before, like that was what really pushed you. Yeah. So what was that experience like more like in detail, if you could share?

SPEAKER_01 3:57

Yeah, so I was on my own. So my I think my sister was there for like, she was there for the first few days. My mom was there for the first few days, and then it was me and my son Kobe and trying to figure it all out. And I so I had like a lot of breastfeeding complications where I had like just excoriated nipples.

SPEAKER_00 4:19

I don't know if this is too much information, but purple disordered podcasts.

SPEAKER_01 4:24

You share the messy news, but it was like I know mastitis, but what is I had that too multiple times, but so that was that he so he had a a lip and a tongue tie that interfered with his feeding, so he was unable to latch properly. And what that did was over time, it just like basically was like a raw, like a wound, essentially, yep, on my nipples. Sounds horrible. It was terrible. And but I was like so committed to breastfeeding and trying to figure out a way that we could do it that I pushed through it, but it was a lot of like I needed a lot of support, and also at the time I was a student and I was not making a lot of money, so I had like WIC and Medicaid and all the things that hopefully we can save. Yeah. Um, but it was hard to find like lactation consultants, even though I'm trained as a midwife, right? When it's happening to you, you need other people to help you to guide. So I was like trying to find things that I could afford, and I people were trying to help, which was really nice, but everything was like patchwork together, and I didn't feel like that I had all of the things that I needed. Um, and then it wasn't just six weeks, like I had mastitis multiple times, which just like knocks you out. It's exhausting.

SPEAKER_00 5:39

I never had the full-blown because I did have some friends who gave me some really good advice about like you know, cool, not heat, um actually pressing up on the breast versus pushing down. Yeah, so I did have some really good advice, but um, it can take you out. I mean, and the antibiotics, the stuff you have to take, um, and then you're trying to keep up breastfeeding and keep up your supply, but you it's it's very hard to navigate.

SPEAKER_01 6:05

Yeah, it's really hard. And so that, and then when you're on your own, it's like when you're knocked out, like who takes care of the baby? So you're like trying to figure that out. And then I always like you are actually sick, yeah.

SPEAKER_00 6:17

Sick you've got like a fever, yeah, the whole thing. As you're talking, be careful of your hands. I'm such a hand talker too, but it does like this like tap dance on the table, it's always like, oh no. So just kind of like you can try. I don't know how to do that with people to be like, if you can just like put your hands in the air, like wave on like, you know, that kind of thing. Yeah, but yeah, but yeah, so it's a lot, you know. You're so you're handling you know, a newborn and the health stuff and the latching and your baby's own health things, and it yeah, I can't even imagine.

SPEAKER_01 6:51

And then my partner came, was able to come into the country uh when my son was six months old, but then our relationship had become very, very strained. So then we added in relationship issues and a lot of toxic dynamics that um was a lot to then navigate that on top of like trying and then transitioning to motherhood in general is like a lot, even without any complications. So true. It's a new identity, it's a new everything, and you're trying to figure out you know how you navigate life with this new beautiful identity, but it's still hard.

SPEAKER_00 7:25

Yeah, yeah.

SPEAKER_01 7:26

How do you how did you make it through?

SPEAKER_00 7:28

Like what supported you in making it through?

SPEAKER_01 7:30

So I had really good friends. I mean, my family stepped up a lot, um, but I was lucky to have like a lot of people who really like loved and cared for me from all different parts of the world were really. That's wonderful. Yeah, that part I was very, very, very fortunate to have that um yeah to carry me through the tribe.

SPEAKER_00 7:49

Yeah, that's awesome. Yeah, I love that. Yeah. So, like looking back, what stands out most from that time frame for you?

SPEAKER_01 7:58

Um I think just the general overwhelm, the feeling like, how can anybody possibly do all of this without like built-in support? Um, and how I think our systems are not designed to care for people and to like center joy. I think that's what I wish that at some point there was something that was focused on like, okay, this is but this is a beautiful thing that's happening, and we're here to uplift you.

SPEAKER_00 8:29

And um yeah, there isn't ironically a lot of emphasis on joy in general. I think that it's a lot about um survival. Yep. And then a lot of the content that you take in from social media, um even like books and stuff like that, it's very much like survive um and very much geared towards a lot of postpartum depression, yeah, which is uh important and it the information needs to be out there. Yeah, but I think there is ironically this lack of um like the pursuit of joy and like thriving, yeah, which is a huge. I also saw that. Yeah. A lot of negative energy, yeah. Um whether it's given to you or the fear-mongering, definitely.

SPEAKER_01 9:18

And this narrative that we should be doing it all, like from six weeks on, that you it it's like it makes sense to go to school to do your PhD, to have a baby, to work, to do all of these things. Like that narrative, I think, is hard to be like that, but it's yeah, you should just keep going. It's like, no, there's this huge life transition that just happened, um, and systems should be in place that we can be present in that, definitely.

SPEAKER_00 9:43

So, why do you think moms don't get the support they really need after birth?

SPEAKER_01 9:48

I think from a healthcare system perspective, our systems are just not created for that. They are mainly focused on the baby and don't really recognize that there's a person that gave birth to that baby and is navigating things. And so we see in the US healthcare system most of the time, I think there's slowly a shift, and that's what I'm trying to do. Yes, absolutely. That's why you're here. Yeah, is really right, the first visit usually after you give birth is focused on assessing the baby. Um, and then you have like what's recommended is you know, maybe a three-week visit, maybe a six-week visit, and then that's it. Um, and and then it's very pediatric focused. And so I don't think that our system is built to be able to like guide people through postpartum. Um why why do you think that is? Like, why? I mean, I think we just don't value birthing people, um, sadly. I don't think it is, and just like cherish them, right? If we think about like history and how much, right, there was like back in the day, there was a red tent where women would go and men straight and reading right now. Are you yeah? Oh, nice. Um, but you think so many different cultures, and that's just one example, have really held space. And like some cultures have 40 days after um someone gives birth, where like that is just the time where they're protected. Yeah, and there are now some like new models of hotels that people can go to, but it's very inaccessible. Yes, people. I'm sure it is. It's very nice, but it's like in the it's very expensive. Um, but so there are places that uphold it, but I feel like in the US over time it's not as frequent that we would find people valuing that this is like an important part of our life course.

SPEAKER_00 11:38

Yeah, that's it's a shame. I you know, I I see like videos about, you know, I think it was in Japan or yeah, like that's where they have that kind of system where they stay home for 40 days and they're fed and they're bathed and they don't like lift a finger. I'm like, man, like how do we miss that here? You know, why does that happen? So yeah, just there's a system that's really set up to fail. Yeah. So if you could just change like one thing about how postpartum is handled, like right now, yeah, what would it be?

SPEAKER_01 12:08

So right now, most of my work focuses on group care. So instead of the individual one-on-one visits to provide care for people with similar aged babies for up to one year after birth. So to time it with pediatric visits, but not just provide pediatric care and to do assessments for both the postpartum person and the infant. Um, but in a group, so that it's not like 15 minutes, it can be 90 minutes to two hours long, which is it in a circle. And you do interactive learning and can like do games and learn how to take care of your baby and how to take care of yourself. And what we're finding is that people build community in those groups, and it's a part of our healthcare system, it can be a part of our healthcare system, and clinicians really like it. It can be fun, right? When you're saying the same thing, because oftentimes we'll say the same health education, right? Because we have like there are a lot of similarities across things. Of course, there are different things that happen for people, but it's more fun to do it in a group and also honor that we are all our own experts of our own lived experience. And I remember you said that on the phone.

SPEAKER_00 13:16

And I I thought about that more. Um because you feel like you're so I'll speak from my own experience, like feeling, you know, and I was a nanny for like over 12 years, right? So I have a lot of experience with um with children, yeah, and I felt very confident in certain areas, but when it came to like the breastfeeding, when it came to just navigating things overnight, you know, those are things that I didn't have a lot of experience in. And um, I definitely did not feel like an expert. Yeah, but when you said, you know, we're all experts of in our own experiences, and I was like, Yeah, it's true. Like you do become um the one that knows it all from what you're living, I guess. Yeah.

SPEAKER_01 13:56

And you know what to ask too, because like, right, you're feeling what you're feeling. No one else can know that, right? We can run lab tests and do things, but the end of the day, it's what you're feeling. And so having clinicians have people in a group, we're also finding that like people disclose more and people feel like the the trust is built and they get to know people so that they can like help to bring that out to be like, hey, you you're presenting differently than you presented last week. What's going on? Do you want to share, you know, and talk about things and like talk about what postpartum depression is, but also talk about like ways to cope and to build community and support and um and then again uplift like joy. Like, you know, sometimes in these groups, like one baby is fussy, and so everybody gets up and sings because they all want to, you know, it's like sharing that experience. That would make me cry. It's so beautiful, but it's like we can all teach each other something, and so we're seeing power dynamics are shifting and that people are getting the care that they deserve. That's wonderful.

SPEAKER_00 15:00

Yeah, I feel like it, you know, when you're in after you have a baby and even during that whole process, it can feel pretty cold and pretty medical. I'll say my experience was not like that, like my birthday experience was also really beautiful, and I feel very blessed to be able to say that. Um, and like midwives and all of that, and my doula. Um so it was very loving, very supportive, but and also, you know, it can feel very medical and very cold, and I can see where you know if you don't have that community built in, um, it's gonna be hard to share like vulnerably how you're doing. And so I love the idea of the group thing because everyone can sit down, share their experiences, be human, yeah, um, and and not under like fluorescent lights. Right. And I think that is um motherhood is such an intimate thing, and it's not meant to be under fluorescent lights, you know, it's not meant to be all microscopes and um medical terminology, it's more about like the soft skills, the empathy. Yeah, um, so I really love that that's what you're working on because I think it's so needed. Yeah. Um so at what point did you realize that postpartum care was going to be your life's work?

SPEAKER_01 16:19

I think my son was, it was after my like first full semester. So my son must have been like, I don't know, 12 weeks old or something like that. You're doing so much. You're you're doing the most. I don't know how you're doing. Yeah. I mean, it is yeah. How are you pondering these things?

SPEAKER_00 16:39

It's pretty amazing.

SPEAKER_01 16:40

Yeah, yeah. I mean, this someone joked that I was like a true academic, that it was good that I was going back to my PhD because I wrote a case report about myself and published it. Um, yeah. Because I was just like thinking about, you know, even things like breast engorgement, like, we don't have great evidence for what the best practice is. So I like dove deep and thinking, like trying to figure out what is the evidence-based practice for this and how do we um pull that evidence together for people to be able to use. Um, but yeah, that I think he was like 12 weeks old when I was like, this is what I'm gonna focus on. And so I kind of changed the um trajectory of my dissertation and um yeah, wow and have been focused on it since.

SPEAKER_00 17:24

Breast engorgement will definitely make you want to fight someone. It's terrible. So, like that will get you pretty fired up.

SPEAKER_02 17:31

Yep, it did.

SPEAKER_00 17:32

Yeah, it's pretty cool. Um so uh how did your struggles push you towards research and teaching? I mean, I know you said like breast engorgement, yeah, but I guess how did you get into, and obviously that's a small piece of this entire puzzle, yeah, but um you know how'd you get into like the teaching aspect of all of this?

SPEAKER_01 17:50

Yeah, so my PhD took me five years. So my son is like my now timeline of my life, this part of my life. Pretty cool. So he was five when I finished, and I kind of was at a fork in the road where I had started my dissertation, and most of my doctoral work has been in Malawi. Um, so it's not been US focused, it's been um mainly there. And so I kind of came to a point where people were like, you should really continue this work, it's really important. Um, and so I started looking at opportunities for what I could do after my PhD. Um, and faculty position like working in research and teaching came to like the top as ways that I could move my work forward. Um, and then Hopkins, um, you know, it was I was fortunate that there was a position open and I was able to get it, and they really were I talked to our dean who was really supportive that I could focus on my postpartum um vision and continue in that work, and they would support me to do that. Oh, that's great. So I'm really lucky to be able to have been given the space to you know apply for grants and um to continue the research, and yeah. That's great.

SPEAKER_00 19:01

I mean, the need's definitely there. Yeah, so it's nice that you, you know, had this calling and then you didn't have to fight to find a place, yeah, which is huge. Yeah, yeah, yeah. Yeah, I was very, very lucky. Yeah, that's wonderful. Yeah. So what drives you to keep going even when the work is hard? Because it is.

SPEAKER_01 19:18

I feel like you're up against a lot of different things. It is, yeah. I feel like now I've developed a network of colleagues that I love working with. And so that's wonderful. I love to hear that. Yeah. I was just at a conference this past weekend, actually, um, that was our annual midwifery conference. And so being around like over a thousand midwives or midwifery supporters was like very energizing. And I think we infuse the same values that we want for postpartum care into our work. Um, so a lot of the teams that are on really try and give space for each other, knowing that we all have different caregiving roles and things, and to be able to come in, come out, um, and find joy in our work too, and like have fun. Um, I think that part is because things are hard. Um, it's a lot of work. Um, academia is its own beast of a place to work in. I don't know a lot about it, but yeah, it's got its own thing. It sounds hard. Yeah. And teaching is time consuming and great and also challenging. Um, but I think the key now for me in it is like working with people that I um are inspiring and um are just as committed as I am. Um we joke that sometimes we create more work for ourselves than we need to. Because we're like, oh, this is really an area where we should try and do group care here, do apply for this grant or do this thing, and we're just adding to our workload.

SPEAKER_00 20:43

I mean, that's leadership though, right? It's doing more than what's expected because you feel called to. Yeah, you know. I think it's kind of interesting though, because you talked about like the need for community postpartum. But I feel like what stood out to me as you were talking was the need for community within your like academic um, you know, academic fields, yeah. Um needing that support and feeling um just feeling you know uplifted by spending time with those other people, I'm sure is really important.

SPEAKER_01 21:16

Absolutely. Yeah, I always think so. One of the um where I did a lot of international development was in South Africa. And have you heard that saying, Ubuntu gabuntu gabuntu, which is God bless you?

SPEAKER_02 21:28

God bless you.

SPEAKER_01 21:29

No, I have not we are people because of other people, essentially, like so we need each other, right? And so I think that that shows up in all parts of life as you know, we need community to keep going, and so that's beautiful.

SPEAKER_00 21:43

I've never heard that before. Yeah, maybe think of a kuna matata to be honest, an inner Disney nerd, kind of like I know that one. Yeah, so what does postpartum care look like um in your work now? You said group stuff, which is really uh sounds very powerful. Anything else that's shifted for postpartum?

SPEAKER_01 22:02

Um so now what I'm also I'm looking at group care and trying to do research to just study the actual outcomes and then also looking at how we can do not just group care but also how we integrate both postpartum and pediatric care. Um, and looking at different ways that we can do that, whether that's home visiting or trying to figure out how we can create a model for that that could potentially be standardized and offer people different options because not everybody wants a group. Um although I would I would kind of say like if you don't, why?

SPEAKER_00 22:34

I'm gonna say like, hmm, let's let's let's let's dive into that together.

SPEAKER_01 22:39

Yeah. But also thinking about you know, different telehealth options. We were talking about that this weekend and like how we can just have different care modalities for people in this um life course phase so that we can just set people up for success and having like honoring their preferences. Yeah. Um accessibility is really important.

SPEAKER_00 22:59

Yeah, yeah. I know but that's something I think we talked about a little bit on the phone. Yeah, because you work with so many you work here, obviously, and then of course there are things you're doing overseas. Yeah, um so there's like virtual, in-person groups, and so making sure that people can be reached where they are. Yep, exactly. Yeah, and especially because like being a new mom, there's uh such a a pool to isolate at times. So I feel like if anything, your job would take some some reaching, if that makes sense.

SPEAKER_01 23:30

Yeah, absolutely. And I think what we find too with groups, and I think there's a place for home visiting too, right? Especially in those early weeks when you know, you just want people to come to you. Yeah. And also it helps as a clinician to see where people are. Like what do they have in their home? What is it, you know, what access, what what types of resources do they have and who's there to support them? And I think you can be better informed to help care for them the best you can. Definitely. So, what would you love to see postpartum defined 10 or 20 years from now? So, I'm another mission of mine is to change the definition, which really stood out to me. We were on the phone. Yeah, and so actually, I was like last year, I um just was someone gave me a pot of money, which was very nice to have a convening to start that conversation. And so I just like reached out to the World Health Organization and the UN and all these different people to come together, and they did, they came. That's amazing, but they're very careful. So, this it takes a long time to take guide to change guidelines and to like build the evidence, and it's very bureaucratic as it should be, because we should think very carefully about that. Um, so they were very people from World Health Organization were like, this is the start of a conversation, this is not a change. But my vision is to be able to change it to like at least 12 months, at the very least. Some people will say postpartum is forever, and I might not argue with that, but I would argue that stupid.

SPEAKER_00 24:56

I mean that's stupid, but I hear I get what they're saying. Like once you're a mom, you're a mom, and that doesn't change.

SPEAKER_01 25:02

But there's some specific needs that are like medical aid needs, chemical needs to birth. Like there are specific things that happen, and we know of those at least to 12 months, yeah, if not maybe two years. Um and so if we could, I want to push to change that and then have clinical guidelines that correspond so that we people we can give people recommendations to say, don't just come back at six weeks, we're gonna see you at 12 weeks, we're gonna see you at six months, we're gonna see you at nine months, and we're gonna see you at 12 months. And these are the things that we're gonna go over. And you're we're gonna have touch points with you so that you have the ability to be cared for. Um, so that's what I hope. That sounds amazing.

SPEAKER_00 25:41

Yeah, it's like changing the SOP. Yeah, you're like, all right, this is baseline. Like you're gonna, we're gonna be seeing you now and now and now and now. Yeah.

SPEAKER_01 25:49

Yeah. And hopefully that'll even just that hopefully could make a difference in people's mindsets to be like I this is normal for me not to be, you know, to have a little bit of an like maybe I need some pelvic health work, you know? Like we don't talk about that enough. Like incontinence is a real thing that happens. Yeah, it is.

SPEAKER_02 26:07

Yeah, it is.

SPEAKER_00 26:08

And there's like, you know, there's physical therapy that you can do, and you can do that for, you know, working through like birth injuries, uh like how to do gosh, there's so many different birth trauma, birth injuries, um, yeah, tearing, like all of that stuff needs attention. Yeah. I got literally zero attention. I had a third degree tear. And I love my doctor, don't get me wrong, I had a great experience, but literally, like my doctor looked at me and was like, you're good. And I'm like, okay, you're right. And then I'm like, do I need like pelvic floor or anything?

SPEAKER_01 26:44

They were like, I mean, yeah, their answer should have been yes.

SPEAKER_00 26:47

You could if you wanted. And I was like, well, maybe I don't need it, you know. And so I didn't then I started working out and kind of getting it stronger on my own. But I totally could have used a prescription.

SPEAKER_01 26:58

I mean, yeah, like a consult. Like everybody could use a consult to just like, you know, it doesn't hurt to like pay attention to your pelvic health. Yeah, definitely not.

SPEAKER_00 27:07

I think you should do that even if you're exactly not having a kid. Prepare yourself. Mm-hmm. Yeah. All right, let's see. Uh, what's one piece of encouragement you give a mom who's in the middle of postpartum right now?

SPEAKER_01 27:21

I think to find their people, um, to bring in support, to not be afraid to ask for support, to really be able to take space and to find ways to find joy in it, um, and to be proud of themselves, right? It's a big thing that people go through. Um, yeah, and to be as present as possible because it's everything passes. The hard things pass, the beautiful things pass, right? We all know time goes. Um, so yeah, to just try and cherish it.

SPEAKER_00 27:52

Yeah, yeah. Soak it. It's really hard when you're trying to survive and also soak it all. When you're right in the midst of it, you're like, screw you. Screw you time. Yeah. Um, but yeah, it's kind of like this funny thing of people would always say, you know, um, don't blink. It'll be over before you know it, or oh, soak up every moment. And so it is this weird kind of feeling of I can't wait for the next season. Right. It's like you get through the, for instance, like the newborn phase where you're up all night long. Oh, I can't wait till that's over. Um, but then also like, oh man, it won't be like this forever. And it is like this dance that you kind of do.

SPEAKER_01 28:29

But I think the more people you can find that are going through it with you, and that's another thing why I like groups, because then you can also find those people who get it. Like not just get it from like seven years ago, but like get it right now, um, and be able to text them in the middle of the night or have them with you in the middle of the night to be like, this is hard. Yeah, yeah. You know, and find something to laugh at or to, you know, to be able to get through those really hard moments. So I think really the biggest thing is like finding your people that will hold you in that time.

SPEAKER_00 28:59

Yeah, I would love I I would have loved to have taken part in something like that. I would have like really benefited from that. Yeah, because it's hard to make new mom friends. It is like you're trying to like go to the library or go to you know, whatever, and you see another mom and you put yourself out there. It's like dating. It is like dating. It is like dating. Um, but if somebody would have said, hey, there's this group that meets and they're all babies the same age as yours, and other moms looking for friends and looking for community, I would have been in there like swimwear. Right. And then it's also your healthcare.

SPEAKER_01 29:31

So you can like check that out. Which would be so much.

SPEAKER_00 29:33

It's already hard enough to do all these things anyway.

SPEAKER_01 29:35

I know, because it's hard to find time to like go to this support group and go to that support group because they're all, don't get me wrong, I think they're all so beautiful, but to be able to just be like that's a part of your care.

SPEAKER_00 29:44

Yeah, yeah. Baseline insurance could cover it, yeah. Huge. Yeah, exactly. So, what's been the biggest win that you've had so far in this uh pursuit?

SPEAKER_01 29:57

So I think my so just in recent memory, now I went to this midwifery conference and the American College of Nurse Midwives did just publish a position statement that I had written to extend postpartum care up to 12 months. So now it's like from a professional organization that supports this. So I feel like that's one step closer to getting to a definition change. Oh, congratulations. Thanks, that's wonderful. Yeah. Gosh. Oh must be so nice being so smart. It must be so nice. All right, well, where can listeners find your work or follow along with you? Um, so LinkedIn, I'm trying to be better. I feel like an old millennial. I'm trying to get better at having a social media presence. So I'm trying to do LinkedIn. Um, and then I've got my like faculty profile page that is an easy way to be able to like find my email and connect with me that way too.

SPEAKER_00 30:47

I'll have all of that in the um in the blurb below. Um so if someone's listening and they want to start changing their postpartum experience today, what's one simple step they can take?

SPEAKER_01 30:59

Um, so they can go, depending on where they're living, they can um reach out to their providers to figure out like there are some, there are websites like centering pregnancy or centering parenting is the main model of group care in the US. Um, so they could look at that to see if there's a practice near them if they want to try and enter into a group care setting and look at their other local practices to see what they provide. And I think asking lots of questions of their healthcare providers to know what they can expect or not expect, and so that they're able to make informed decisions on who they want to have involved in their care. Nice.

SPEAKER_00 31:38

And then if you could take me back in time, yeah, and there's a postpartum you with a new baby and you're in it, if you could like speak to that version of you in this moment, like what would you tell that version of you? Oh, that's a hard one.

SPEAKER_01 31:53

Um I think to be comfortable with uncertainty, um, that we don't know what the outcomes are gonna be, and things might be hard, but that's okay. That's a part of the journey, and it can be exciting and terrifying, and to just be comfortable with that.

SPEAKER_00 32:12

Well, thank you so much for being on the perfectly disordered podcast, Ashley. This has been lovely. Thank you so much.