Mindful Maternity: Navigating Mental Health Through Motherhood's Milestones

Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week I am joined by Dr. Nicole Derish discussing the nuances of reproductive psychiatry, the importance of mental health care for women during pregnancy, postpartum, and other reproductive stages, and the benefits of telehealth for providing accessible psychiatric support across Florida.

Dr. Derish is a double board-certified child, adolescent, and adult psychiatrist, renowned for her expertise in women's mental health, parenting, and supporting individuals with invisible disabilities. Specializing in providing tailored care to women navigating pregnancy, the postpartum period, fertility challenges, or trying to conceive, she operates a private practice that extends its reach through telehealth services to patients across Florida, New York, and New Jersey. Additionally, Dr. Derish serves as a voluntary faculty at the University of Miami, where she teaches and mentors residents, fellows and faculty in the psychiatry and OBGYN departments.

00:00 Welcome back! Guest Intro
00:47 Role of a Reproductive Psychiatrist
02:23 Path to Specialization
03:47 Differences in Women's Mental Health
05:24 Seeking Reproductive Psychiatry
06:47 Managing Medications During Pregnancy
10:51 Challenges and Societal Impacts
16:14 Educational Initiatives and Support
19:45 Infertility and Mental Health
27:57 Closing and Contact Information

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Connect with Dr. Reller
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Transcript

Kerry: 0:29

Alright. Hi, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, doctor Kerry Reller. And today, we have another special guest, doctor Nicole Darish, who's actually located in Miami, but she practices telemedicine all over Florida. So why don't you tell us a little bit about who you are and what you do?

Dr. Derish: 0:47

Yeah. Thank you so much for for the introduction and for having me today. So I am a reproductive psychiatrist. And for anybody who doesn't know what that is, it is a psychiatrist that specializes in treating women who are either pregnant, postpartum, or thinking about becoming pregnant. And, also sometimes we work with challenges surrounding menopause or puberty.

Kerry: 1:14

So how does 1 get into that field, like, if you go to a psychiatry residency, and then did you have additional training for that?

Dr. Derish: 1:22

Yeah. That's a great question. So as of right now, there's not a formal fellowship. So the way that you do it is looking through experiences. In my case, when I did my residency, I was already extremely interested, so I was able to carve out rotations during my residency they were very, very supportive there in New York, and there was a lot of opportunity to network with other specialists that were already doing that, which, you know, I think New York is very unique in that sense. So after residency, I was very committed to continuing to learn about this. And University of Miami actually had, at the time, just opened a reproductive psychiatry department and they were also very motivated to grow and develop it. So they offered me a very unique opportunity to come and to train in child and adolescent psychiatry fellowship, which is a 2 year fellowship, and split my time between training as a fellow and Also working in their reproductive psychiatry clinic.

Kerry: 2:23

Wow. Yeah. This is a unique road to it. So there was nothing particular that inspired you, you're just really interested in it, and then this opportunity, which it sounds amazing, kinda fell in your lap

Dr. Derish: 2:32

This opportunity came along, and then afterwards, actually Once I graduated, I went to work for the Motherhood Center of New York, which is a center that does exclusively, reproductive psychiatry, and I was the attending physician for their PHP program. So they have a wonderful day treatment program where basically mommies and babies or pregnant women go there, they can spend the day. There's a nursery. And that is always what really drew me to to this field. When I was in med school, I had a rotation actually in Germany where they had a mother infant unit. So it was a space where mothers who had just delivered rather than being separated from the baby were able to spend the day in this therapeutic environment where people would help them be able to learn how to become mothers and Some of the struggles, particularly people with severe mental illness have, you know, the adjustment of motherhoods and to be able to see How how much is the difference that makes to be able to support mothers in the right way? I just found it fascinating, and I've always been drawn to sort of reproduce that model of care.

Kerry: 3:39

Yeah. It's definitely, more of a niche and a unique experience. What was PHP? You mentioned that. I didn't know what that was.

Dr. Derish: 3:47

PHP, that's 1 of those acronyms that I think if you're not a psychiartrist, kinda just you would never know. It's partial hospitalization program. So I think that most people have the idea that they're either inpatient, meaning you were admitted to the hospital, or you're outpatient, meaning that you are in your house and you just go to office visits. But there's actually a middle ground between the 2 where you spend about 5 hours a day, 5 days a week in a treatment program, but you still go home to sleep at the end of the day. And that's a really nice balance for new mothers who, don't want to be separated from their children. They can go and receive treatment and not have to be sleeping outside of their home, particularly if, say, for example, they have other younger children Or we wanna keep moms in their families. Right? It doesn't always make a whole lot of sense to pull them out of their natural environment and treat them in a inpatient unit. So it's very interesting to try to replicate as much as possible those those conditions. So that was a a very unique training actually,

Kerry: 4:55

Yeah. And in a different country. Right?

Dr. Derish: 4:57

Exactly. Oh, the Mother Earth Center was in New York. Yeah.

Kerry: 5:00

Oh, okay. The 1 in New York. Got it. So in general, I know you focus on women's health. I think we'll dive more into the reproductive stuff too. But how does women's health psychiatry or mental health differ from men in general?

Dr. Derish: 5:15

Well, I think the 1 very obvious way is women or people who have uteruses can get pregnant.

Kerry: 5:23

Mhmm.

Dr. Derish: 5:24

So I think oftentimes, we are taught by default how to treat men and pregnancy, for example, is seen as kind of the exception when in fact 50 percent of all women will be pregnant at some point in their life. So if you look at that, that's 25 percent of the population will have a pregnancy, and yet it's treated as an unlikely event that Doesn't necessarily get covered in normal physiology as far as how to understand how symptoms present, How to adjust medications accordingly, safety of medications, screening.

Kerry: 6:03

So sometimes it's like you're treating maybe they have Some other mental health condition and then how to treat it throughout the reproductive period. Is that kind of what you are saying?

Dr. Derish: 6:12

So it can look a little bit like either. Right? Like, either a subset of disorders that are specific to pregnancy such as, for example, postpartum depression or postpartum psychosis or women that have psychiatric disorders at a baseline and then would like to get pregnant or find out that they are pregnant or breastfeeding.

Kerry: 6:33

Okay. That makes I mean, that makes a lot of sense. So what particularly within That whole reproductive journey, do you kind of focus on and discuss with patients, or how do they come to you, and how do you deal with that, I guess?

Dr. Derish: 6:47

favorite way of patients coming to me is oftentimes when they start thinking about becoming pregnant because that gives us a little bit of an opportunity to plan. Oftentimes, people think that in order to see a reproductive psychiatrist, you have to already be pregnant. And in reality, It is really nice to have a little bit of a window of opportunity if, say, for example, we want to be adjusting medications in order for the patient to be on the most ideal regimen for pregnancy, which could either look like having your symptoms very well controlled or eliminating some of those medications that they're on but really aren't doing much, or sometimes we want to condense regimens to have to avoid polypharmacy. So those are 3 important things that we really try to optimize, and the best time to do that is before Pregnancy. What I always say is when somebody's pregnant, it's almost like an like an orchestra. Like, once the music has started, you don't adjust the music. So I really do- if you're going to be making tweaks, I think that an ideal time is, hey I am starting to think about Having a pregnancy. I wanna discuss my mental health. I wanna discuss the symptoms I'm having. Can it be improved? I wanna discuss the medications I'm on. Should we change them? Should we keep them? Because oftentimes, people are actually on wonderful regimens and simply they need to stay on it, but out of fear that they're not safe or Out of not knowing who will be the person who can continue and prescribe these medications when they're pregnant, they actually discontinue treatment. And then that's when I get another, type of case, which is women who have discontinued their treatment, are now pregnant, And it's more of a help help me get back on track, which is also completely valid, and We do a great job with that too, but it's a it's a little bit and then we're kind of building back the amount of medications that we need to get somebody well maybe is a little bit more than just to keep somebody well. So that's a typical way that I also get patients. Oftentimes, I get referrals from other psychiatrists. There are OB GYNs in the community who are comfortable managing medications in pregnancy, but there's a little bit higher complexity to the case. So that's when I either take over the case for a little bit or provide a consultation. I see what's going on. I also do psychotherapy. So sometimes it's just a matter of Giving some tools, reframing some lifestyle changes. And then another very typical moment, I think, where a lot of people do reach out is postpartum. There is a lot of new onset pathology that comes in postpartum. So a lot of mothers that really never had a reason to see a psychologist or even a therapist or be on medication up until they had a baby And then either because the birth was traumatic, they have a baby in the NICU, they have new challenges. They have 2 children, and they're having a hard time really balancing, this transition. That's when I can come in, and that's a little bit where it's very nice to have both the view as a physician of how the influence of hormonal changes that happen in the delivery, in breastfeeding, But also the social expectations all sort of come into play and sort of teasing that apart and getting moms just Feeling well so they can enjoy the baby.

Kerry: 10:36

Mhmm. Are there any particular medications that someone needs to avoid? Like, you know, there's specific ones we use for other things that you really shouldn't be on while you're pregnant, but anything for like, for anxiety, depression, or anything that you see that they need to stop.

Dr. Derish: 10:51

So most medications can be continued. Some medications we do look to avoid particularly Depakote, which is a mood stabilizer that's used for bipolar disorder. That said, as You may know the most critical time period when these medications can cause birth defects is really in the first weeks, And sometimes women don't even know that they are pregnant at that time. So that's why I hate giving blanket statements Because I've had women, being told, oh, this medication is not ideal in pregnancy. Try this 1 instead. And then when you Look at their chart. They've already taken this medication, through the entire first trimester, and now we have exposed the baby to multiple different medications not knowing even if the new version is so, you know, I do recommend that For anybody who's treating women of reproductive age, maybe start with a different mood stabilizer like lamotrigine or lithium and reserve something like valproic acid, Depakote for a last resort. And then other things, things to be avoided are things that are not doing much. Sometimes people take an antidepressant and then take a second 1, and It's really because the first 1 wasn't doing much, but they're still kind of anxious, so they don't wanna let go of something. So if it's not working, it's not worth it. And then, with everything benzodiazepines, like Bellium or clonazepam or nazanax, those medications, we really look to keep the dose as low as possible, particularly surrounding birth because we want that baby to be born. We don't wanna relax baby. When a Baby that's gonna be born and take a really deep first breath and have the drive to really eat. So we just wanna make sure that we're avoiding anything that's too sedating right around delivery.

Kerry: 12:59

Yeah. That makes sense. You answered 1 of my questions, which was, do you avoid them in a woman of childbearing age? What about if you had to use that? Do you make them have to have some sort of contraception?

Dr. Derish: 13:11

I think I don't make anybody have contraception. Right? I

Kerry: 13:17

Yeah.

Dr. Derish: 13:18

I recommend that everybody plans their pregnancy. I have this conversation with All women because we know 50 percent of all pregnancies are not planned. Even with contraception, sometimes it fails. So I like having this conversation early and often. Some medications, like, for example, needing a benzodiazepine occasionally for a flight, I don't think is a reason to not have a baby. And I think that it's important that we're also not scaring women because I have had patients who've had an unplanned pregnancy and have come to me most apologetic saying I'm really sorry. I would have Never done this. I knew that I just couldn't have children. And, you know, when we get done, but they wanted to, but they really felt like they needed those medications to function. So What we need to understand is that even in these high risk medications, we're still talking about the vast majority of Babies will be fine. This is you know, even with the absolute don't go there, defecate, if you we're We're talking about a 10 percent of children are born with birth defects. That still means that most babies will be absolutely fine. So I am not a fan of absolute no nos. I do think that as long as we can, we should plan and use the safer options. And With benzodiazepines, we know that just generally less is more. Medications that cause tolerance and dependence, I think should be used more as a as needed rather than a regular continual treatment.

Kerry: 14:57

Yeah. No. That makes sense. And I think it that's an important point of not wanting to scare them. Right? You're you're telling us the percentages are low and most babies are just fine. But, there's some slight risk, so we would recommend, you know, maybe not being on it, once you find out you're pregnant or something like that. But those are really good points.

Dr. Derish: 15:14

As physicians, oftentimes, we are scared that what we are doing will cause harm. We're afraid of liability, and we're afraid that we're adding a medication to the mix and what if something bad happens. And out of, you know, wanting to cover, our basis and be responsible. We really can encourage women to just don't get pregnant, and everything will be okay. But That doesn't always work necessarily with with desire, their hopes, or wants, or wishes. And I think that for women who really want to have a baby, having a reasonable understanding of the risk and then putting the responsibility back on the family to decide What is an acceptable risk for for you? I like to consider the decision making process a shared 1.

Kerry: 16:03

Mhmm. Absolutely. Yeah. So are there any major challenges that you see, like, in treating women's mental health, particularly in reproductive stages.

Dr. Derish: 16:14

I think that there still is not a a whole lot of physicians doing what I do. So I am very fortunate to have a private practice where I have a lot of time to discuss and to really tailor care, but I would really like to see maybe more insurance based clinics being able to offer the service. I think a big Challenge is that it is time consuming. Having an appointment where you discuss the intricacies related, you really have 2 patients. You have the mother and the baby. So having a standard appointment in that amount of time in the current constraints of health care, I think can can be difficult.

Kerry: 17:02

Yeah. I don't wanna get in the current constraints of health care because there's many. But I saw in your bio that you're teaching at University of Miami to not just psychiatry residents and people, but also the OB GYN group, which is a great thing. So you're kind of educating all of them on these things that you're doing. And I don't know how many practices Or divisions, have reproductive psychiatry, but, I mean, hopefully, that's growing as well for training purposes.

Dr. Derish: 17:29

I think that, yeah, that's that's 1 of the things that I'm most proud of. And, also, I think that The good thing about training in a fellowship and resident level is that then people graduate and go on to form their own divisions in other hospitals, and you really do grow the awareness that way. And Also, interestingly, we're together with University of Miami. They are launching a wonderful site where they're doing psychopharmacology for primary care, and we're developing a course that I believe it's coming out April in Boston, but also online for primary care physicians, and an aspect of it will be reproductive psychiatry in pregnancy particularly, to continue educating because I think that building that awareness across specialties because Pregnant women don't just see their reproductive psychiatrist, and they still have to have these conversations with their OBGYN, with the pediatrician, with their primary care before they're even pregnant. So having everybody on the same team is really important.

Kerry: 18:36

Education, I'm sure will help That too, so that's good. Any, like, specific issues? I know you kinda already touched on it arising during the pregnancy and post Partum, and how do you kind of address that?

Dr. Derish: 18:49

A particular issue. So in postpartum, we really do see a spike in depression and anxiety and also OCD, which I think goes a little bit missed sometimes. Everybody talks about postpartum depression, but Intrusive thoughts are very common. Like, what if I drop the baby? What if the baby falls down the stairs? And it can become very impairing. These images can become very graphic, very upsetting, And don't think that a lot of people feel comfortable really sharing them because they feel awful and icky, and people think that if They'd let their pediatrician know somebody's going to be very uncomfortable with them going home with the baby after that visit. So there's a lot of secrecy around something that's actually extremely common and very treatable. So that's 1 of the areas that I really like Raising awareness around.

Kerry: 19:45

Absolutely. Yeah. I didn't really realize that OCD could be prevalent, In the postpartum period and I know, for depression, we're always screening patients. At the pediatrician, they're screening the mom all the time. And then, Obviously, at their OBGYN postpartum visits and even in primary care with the methods that we screen. So, I mean, that one's Well aware, but I also think anxiety postpartum is kind of under diagnosed as well.

Dr. Derish: 20:12

Women don't always look tearful, and they don't always look down. Sometimes it looks like Showing up to the pediatrician all the time, asking the same questions again and again, going to multiple visits, all of that is increased anxiety. Also, a typical way with where it presents is not sleeping at night. And that could often be missed because What mom is sleeping well right after having a baby? Everybody's tired. Everybody's worried. Oh, it's okay. You're a first time mom. It's normal. Normal, normal, normal, and not always is it normal, and it can really go for a long time. And what my patients sometimes they'll say is that I got better and then I got angry. And it's like, I can't believe that everybody was watching me clean the same bottle 3 or 4 times, and nobody realized that I was not okay. Somebody should have realized that this is a medical condition, that this could have been treated, that my life didn't have to feel this terrible.

Kerry: 21:17

Yeah. So when do patients need to know when to Seek out someone like you.

Dr. Derish: 21:24

Yeah. Well, I think,

Kerry: 21:25

whats the turning point?

Dr. Derish: 21:26

Yeah. I think anybody who is thinking about becoming pregnant and would like to discuss at least what their options were. Or as far as if they're already having symptoms, think that a good way a good rule of thumb is if you start to feel for more than a couple days that something's just not right. And, Of course, if you're having suicidal thoughts a typical 1 is not feeling bonded with the baby. I have a lot of moms that will say, I have this beautiful baby that it feels like somebody just dropped off at my doorstep. I care for it. I want it to do really well, it just doesn't feel mine. And I'm just a terrible mother. So feelings of I'm just a Terrible mother. Nothing I do is right. My family would be better off without me. All of those feelings, they feel so real, And it feels so true in the moment that it is hard to realize that that is Depression or anxiety speaking.

Kerry: 22:34

Yeah. Are there any societal or cultural factors affecting women's health, and do you how do you approach that?

Dr. Derish: 22:42

That's a really good and important question. We know that postpartum depression is linked to having contact with other women, other mothers in particular. And I think that in the way that we raise right now, there really isn't the opportunity. It's very isolating to have a baby. There's not even sometimes spaces to gather. Right? If you have your social life surrounding going to work and going to an exercise class or going to the supermarket, There's not really those spaces to just go and be a mother. You can't just sit on the sofa and target and Speak to other moms that are going through that. And the truth is that once women you know, what I liked about these programs that when you get a bunch of moms in a room sharing their experiences, it really ticks down the walls, and you realize that you're not alone, that everybody is going through challenges. And, honestly, just I I think that being Alone for 8 hours with a newborn is already a high risk situation.

Kerry: 23:52

Mhmm.

Dr. Derish: 23:52

And We often see that in the newborn period, there's, you know, maybe a partner, but the partner has a week, maybe 2 if they're lucky, and then they go back to work. And then it's oftentimes the mom alone with a newborn baby for hours and hours on end. And then the night comes, and she's up all night. And then the day comes, and she's up all day with the baby. And there's no other human contact. And any issues that come up, they get magnified when you're all by yourself. So I do think that The culture that we live in where there is very little opportunity for these spontaneous, natural, easy relationships to occur is making things more difficult for new moms. And don't even get me started on when they actually have to go back to work.

Kerry: 24:42

Yeah. Oh, yeah. What do you suggest then? What do you have them, like, get out and meet people, go to mommy groups, or What do you typically suggest?

Dr. Derish: 24:53

Oftentimes, I really suggest that people take advantage of the opportunities for socialization that exist. Sometimes moms have a sister. They have a cousin. They have neighbors who want to come, and they want to be helpful, but they are saying, well, my house is a mess. I can't have anybody over. I haven't done the dishes. I don't feel like, getting dressed. I haven't slept. So people can't come over because because I can't be entertaining. So first of all, you're not going to be entertaining. The best moms I know have a Post it on the fridge that says the stuff that needs to be done. When people come to be with a new mom, let them do a load of laundry. Let them fold the laundry. Let them Just sit with you and drink tea while you walk around a crying baby. Take away the expectation that you have to You can put on clothes. How you are is fine. Let people in and keep in touch. And a big thing that I really try to promote is allowing other people to help so that you can sleep. Because At the end of the day, I can do therapy. I can do medications. But if you're not eating and sleeping, nothing is going to work. And It's mysterious how men sometimes figure out, you know, when they sleep when they're tired, they eat when they're hungry, and women just don't have that down yet. And so many women in the postpartum period go hours and hours and hours without eating because they can't figure out a moment to make themselves some food. So I really tried to restore some opportunities for whatever support is in place to help Oh, bring me some food, get me some groceries even if it's just nuts and some cheese, and then get some sleep. Because oftentimes, simply by restoring sleep and A normal meal or some resemblance of normal meals, mood can really improve, and then we can get you maybe going for a walk.

Kerry: 26:52

Mhmm. Accepting that help is so important. And then, obviously, I would say, going for a walk with the baby, if It's possible. It's very good for, you know,

Dr. Derish: 27:01

out. And as you said, mother groups and opportunities to just Be around other kids. Have some adult conversations. There's so much that changes in the immediate postpartum that it feels like you could have lost your entire life. But if we start reintroducing Slowly, those little things that made you feel whole, like, getting your nails done once every 3 months, just having those little moments of joy and creating, again, a little bit of a feeling of having some structure to your day. Because what can happen is if you take away all the things that you did that brought you joy and that brought you structure and we're just left with nothing, It you can feel very icky and not even know where to start fixing yet.

Kerry: 27:48

Yeah. Well, let me let me change gears. Did you wanna touch upon anything that And any comments about infertility? Because I know you deal a lot with that as well.

Dr. Derish: 27:57

With infertility? Yeah. I mean, infertility is a very difficult, journey that a lot of moms, by the time they get pregnant, it's been a very, very long process of grief and of loss, And it really just prolongs the preinatal period intensely, and I think that'll you know, I also focus a lot on on invisible disabilities. And I think that this entire process it it's up to debate if infertility and you know pregnancy is a disability or or isn't, but I think that it it does sort of create this entire set of challenges that a woman can be silently facing without anybody really knowing what is going on. Right? All those IVF cycles, all the bad news, all the losses, all the pregnancies that they haven't even told somebody that they've had. All those challenges can be it can be little hiccups, but sometimes they do become mountains.

Kerry: 29:01

Mhmm.

Dr. Derish: 29:01

And I really like to help people create structures that allow for that. Maybe discussing in your job the accommodations that you need so that if you do have to do another round of IVF, it is not so stressful because oftentimes, there's a lot of shame and secrecy around it And, again, very isolating. So giving a little bit of space for that experience. And when it comes to loss, oftentimes, all you can do what is actually most helpful is just holding space for that, giving giving, space in sessions for people to discuss their hopes, their dreams, the feelings they had attached So that and how it is affecting your family.

Kerry: 29:47

And definitely those kind of things people carry Alone and often don't share, and that's probably 1 of the hardest parts I think with that. Not just the infertility or IVF cycles, but also, like, pregnancy loss and things like that. And I think that more people are being more vocal, you know, if there's a loss with pregnancy, but I still Don't think people often discuss the infertility at all with others, and I think that's very lonely. Right? And Like you said kinda stressful as well with the whole procedure and things like that.

Dr. Derish: 30:19

agree. I agree. I think that slowly we do see celebrities are talking about it. It's more public and it does make me very hopeful.

Kerry: 30:27

So by invisible disabilities, You're referring to just they don't consider pregnancy a disability, or what what did you exactly mean by that?

Dr. Derish: 30:35

so invisible disabilities is another area, and I know that you mentioned that in 1 of the questions, so I wanted to make sure to explain it because I think it's a term that people don't oftentimes

Kerry: 30:45

Yeah.

Dr. Derish: 30:45

know. So invisible disabilities, I think of it differently than the medical model of disability. So I think in medicine, disability is if you're not able to work, if you're not able to function, then you have a disability that can be corrected through medicine. That's how we as doctors view it. Right? And then there's a social model where if, for example, every step was 3 feet high, most people would have a disability because they wouldn't be able to go up them. So it is the exchange of the goodness of fit between what you can do and the environment that you're in. So for example and this has affected me very personally as somebody that had a lot of back challenges since Very early on. So I went into residency already looking, young and fit and, you know, I look like I have a completely healthy body, and I could carry out all the tasks that were expected of a resident so long as I had appropriate ergonomics. But once I was challenged with, working, standing up for many hours or poorly fitted desk situations, then it became more and more difficult. So that can be an invisible disability in the sense that when the work environment is not appropriately modified for my body, then I can't carry out the task, Or I can carry out the task at a huge personal expense, meaning that I could work from 9 to 5 if I came home and went to sleep and lie down and didn't do anything else after 5 PM, which is not necessarily a reasonable expectation for somebody to have.

Kerry: 32:39

Yeah. Can't function like that.

Dr. Derish: 32:41

So something similar can happen in pregnancy, where it's invisible In the sense that you don't have a wheelchair, you don't have a cast, and Particularly the postpartum period where Whitman say, well, how could I take 6 weeks off and do an intensive treatment for Postpartum depression. What will people think? They'll just think that I'm having a hard time leaving the baby and and going back to work. Like, well, if You were hit by a car and your arm was in a cast nobody would think twice of the fact that you need to spend 6 more weeks recovering from an injury.

Kerry: 33:22

I think those are definitely important things to focus on as well. Is there anything else you'd like to share that we didn't touch on about what you do or your practice or anything.

Dr. Derish: 33:34

Yeah. No. I mean, I really appreciate you giving me the chance to share what I do. I can give you my contact information. My website has a lot of ways to contact me. It's derishmd.Com. And 1 thing that I forgot to mention about how I work is that I really, really love doing telehealth. I think it's given me a very unique opportunity to be able to work with women that otherwise wouldn't be able to because they are either in areas that just don't have a reproductive psychiatrist or they have, you No complicated pregnancy, childcare issues, work life balance issues, and being able to offer virtual appointments has It's opened up a whole new world of possibilities. So if anybody hears this and wants to reach out, Please feel free. I offer free consultation because even oftentimes, if I can't help, I can at least pair people with the right help. And, You know, as as we've discussed, there's not a lot of people that know exactly how to differentiate or diagnose, but I think at the very least, I know what resources exist, and I know how to get people to the right place. So I really love also having that free consultation to just, say to people, look this is a great, you know, fit with Postpartum Support International, they have online support groups for women that have had recurrent losses. Check this website out. It's for your donation base and things like

Kerry: 35:02

Mhmm. Yeah. That's super helpful. I didn't know that existed either. So you said derishmd.Com, and you're physically located in Miami, and you see patients in Florida, New Jersey and New York. Correct?

Dr. Derish: 35:16

Virtually. Yep.

Kerry: 35:18

Well, thank you so much for coming on the podcast, and thank you so much for what you're doing. Yeah. So important in what you're doing, and you're welcome.

Dr. Derish: 35:26

thank you for what you're doing. I've Just learned so much about women's health. It's wonderful to have and your podcast was a a really interesting a set of interviews with other people that are doing fantastic thing for women. I I love it. Thank you so much.

Kerry: 35:42

Yeah. Thank you. Thank you for listening. And yeah, everybody, Tune in next week, and look up doctor Derish if you need her, and we'll have all the information in our show notes. Okay? Alright. Take care.

Dr. Derish: 35:55

Thank you.