An Interview With Lucinda Koza
Don’t speak medical jargon: While medical terms are foreign to many in the first place, the ones used in obstetrics are next level. When speaking to patients, providers should use plain language and check for understanding. If you leave an appointment so unclear about what’s going on and what terms mean that you have to turn to Dr. Google, that’s an issue.
The birthing process is one of the most significant moments in a person’s life, yet the experience can vary greatly depending on numerous factors. From the quality of care to the emotional and physical support given to the mother, there are many ways to enhance and improve this life-changing experience. As a part of this series, I had the pleasure of interviewing Dr. Rachel Dillinger, MD PMH-C.
Dr. Rachel Dillinger, MD PMH-C is a mom, author, and integrative & reproductive psychiatrist based in Philadelphia, Pennsylvania. She is the founder and owner of Extraordinary Minds Psychiatry, a private practice specializing in parental mental health, women’s mental health from PMDD to perimenopause, ADHD and treatment resistant mental illness. She seeks to make traditional and complementary psychiatric treatments understandable and accessible to everyone.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” better. Can you tell us a bit about you and your backstory?
Thank you for having me! I’m grateful for the opportunity to help women prepare for a more optimal birth experience.
I was born and raised in the suburbs of Philadelphia in a small town called Phoenixville, Pennsylvania. I overcame many challenges from yet-to-be-diagnosed ADHD throughout high school and college. I’d always been drawn to science, mental health, and deeply wanted to help alleviate others suffering. I had wonderful mentors and entered medical school with the intention to go into psychiatry, and throughout my time there also developed a love and appreciation for obstetrics and gynecology.
My first child was born a week before medical school graduation, and I started psychiatry residency in Maryland the following month. I coped with postpartum depression, postpartum anxiety, and postpartum OCD. During my years there, I worked with parents with children in the NICU, women hospitalized for postpartum psychosis, pregnant and postpartum women navigating mental health challenges and more. By the time I graduated residency, I had two kids and moved back to Pennsylvania to practice. I’ve since opened my own practice specializing in reproductive psychiatry and ADHD, and love educating others, woodworking, and listening to audiobooks.
In the specific birthing experiences that you have been a part of or witness to, what were the key elements that seemed to have the most influence on the quality of the process, outcome, and aftermath of the birth? Can you please explain what you mean?
Three key elements are information, flexibility and support. The disparity between a person’s expectations and the reality of the birthing experience is where a lot of distress can be generated. I’ve had some women who didn’t know what Braxton Hicks contractions were and worried they were going into premature labor for months, others with gestational diabetes who didn’t know how it might impact pregnancy or delivery, and many who didn’t know they would likely be bleeding for weeks after delivery.
Knowing what to expect is empowering and leaves less room for surprises. It also allows for more flexibility when things go differently than they hoped or planned — it’s easier to come to terms with an emergency C-section when you’re informed ahead of time that there are situations like preeclampsia, failure to progress and fetal heartbeat changes that will trigger one.
Finally, identifying and coordinating support needs is crucial. If a loved one will be present for the birth but may not have the skillset/temperament to comfort the mom or advocate for their and baby’s needs, a doula can be an invaluable asset. Grandparents coming early to watch older children at home, freezer meals or a postpartum meal train, postpartum doulas and a visiting lactation consultant for women who want to breastfeed are other examples of supports that can make a big impact.
Can you tell us about a birthing experience you were a part of as a professional that you actually wish had gone differently? Do you know exactly where it took a wrong turn? Do you think or know there is something someone, even you, could have done to improve this situation? Can you please explain what you mean?
A couple I saw had a full-term baby in the NICU and were struggling to process the traumatic experience that led up to it. While they had been made aware of many pregnancy complications, they had never asked or been told about things that could go wrong during or after delivery. Their assumptions were that vaginal full-term births didn’t carry much risk for complications, and that as long as it wasn’t converted to a C-section, they would get to hold their baby immediately and take her home 2–3 days later. In reality, 60% of babies in the NICU are full-term, and there are many things that can go awry and require more intensive care and monitoring than babies can access in the mother’s room.
Their baby needed just 24 hours of breathing support after inhaling meconium (feces in the amniotic fluid) during the delivery, and went home with them a few days later. I saw the father for several months afterwards as we continued to process his trauma and flashbacks of being in the hospital room, monitors suddenly blaring, a rush of doctors and nurses coming in, being pushed to the side (literally) and not told anything as his baby was whisked away.
The baby needing NICU care would not likely have changed if things had been different, but the event being traumatic or not depends upon how the event is experienced by the individual person. The parents might have been counseled that if the team determines the baby needs intensive care, more people may enter the room and quickly get the baby to the NICU. As the quick initial screen showed signs of concern, the nurse or doctor may have mentioned there was meconium present and it is routine practice to go to the NICU when both those things are true. After the baby was transferred, a nurse or social worker may have counseled the parents on what happened and assessed if they had any needs. Prior to discharge, screening and referral for therapy would have allowed for swifter intervention. I’m thankful the NICU team identified the need and sent them my way, but multiple things could have gone differently.
Which of these do you feel most in contention with, if at all: lack of time, lack of resources, lack of information regarding a patient’s specific case, healthcare worker burnout, compassion fatigue, or something else entirely? Can you please explain what you mean?
Lack of awareness, screening, and resources for father’s perinatal mood and anxiety disorder’s (PMAD’s). We have come so far in helping meet the needs of mothers coping with these conditions, and recognizing the impact they have on mothers, children, and the economy. However, the impact of father’s PMAD’s on relationships, parenting, mental and physical health of father’s, child’s mental and physical health, and finances are also significant. PMAD’s can start during pregnancy and impact the birth experience, and when mother’s experience it, the chances their partner’s do, too, skyrockets.
In your dream world, what would a perfect shift at work be like for you? If you had a shift with back-to-back births, what else would be in place structurally that would make you feel as if you are fulfilling your dream for birthing parents? Now, how can we take this out of your dream world and root it in reality?
As I support parents as a psychiatrist, I don’t have to personally navigate the logistics of back-to-back births. I do home visits for my postpartum birthing parents, and thankfully there’s more flexibility in timing if I have a few who give birth around the same time.
Are there any innovative practices, technologies, or policies that you believe can significantly enhance the safety and comfort of the birthing process?
Doulas being standard and universally covered by insurance.
Let’s move on to the heart of the discussion. Can you please share “5 Things That We Can Do to Improve the Birthing Experience for Mothers”?
1 . Don’t speak medical jargon: While medical terms are foreign to many in the first place, the ones used in obstetrics are next level. When speaking to patients, providers should use plain language and check for understanding. If you leave an appointment so unclear about what’s going on and what terms mean that you have to turn to Dr. Google, that’s an issue.
2 . Give them a lay of the land: So many things about medicine and pregnancy are second nature to those of us in reproductive healthcare. It might be the fourth glucose tolerance test we’ve ordered that day, but it might be the only glucose tolerance test our patient will ever take — and knowing why it’s important and what the repercussions are can make stomaching that sickeningly sweet glucagon drink a little easier. Let them know what the most common progression through pregnancy, labor and delivery are.
3 . Support legislation to get doula care covered by insurance: There are many efforts happening at a state and federal level to support this, particularly for birthing people of color and birthing people living in poverty. You can find more information on this and how to get involved at https://healthlaw.org/doulamedicaidproject/
4 . If…, then…: Counseling on common pregnancy, labor, delivery, and postpartum complications and what is done for them actually reduces anxiety. Ignorance is not bliss — birthing people don’t need to believe everything will be perfect, they need to know that their team can handle whichever way it goes.
5 . Playing the tape forward: As a psychiatrist, playing the tape forward by imaging what it would be like to experience a potential future outcome and processing the feelings has been very helpful for my patients. Expectant mothers can speak with their therapist, psychiatrist, and/or journal about it. For a woman whose blood sugar is just on the cusp of diabetes pre-pregnancy, I might ask her to imagine what it would be like to be diagnosed with gestational diabetes, require insulin, be induced (medically trigger labor) before it naturally occurs, or get a C-section. This can help desensitize and better position her to be ready to mentally navigate things in the months to come, and become better informed on different options so she can make an empowered, educated decision.
How do you ensure that there is effective communication between healthcare teams and expectant mothers to reduce anxiety and build trust during labor and delivery?
Encouraging frequent collaboration of care between team members is critical. As a psychiatrist, I will often speak with the person’s OB/GYN and their child’s pediatrician, and ascertain and coach moms with what and how to ask at their appointments to assuage their fears.
If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
Restarting the random acts of kindness movement would be an excellent choice. Revamping our healthcare system in the U.S. is another that would benefit millions.
How can our readers follow your work online?
They can find other articles and posts on my blog (https://extraordinarymindspsychiatry.com/blog), Instagram (https://www.instagram.com/extraordinarymindspsychiatry), and Facebook (https://www.facebook.com/ExtraordinaryMindsPsychiatry/).
Thank you so much for joining us. This was very inspirational.
Thank you again for having me!
About the Interviewer: After becoming her father’s sole caregiver at a young age, Lucinda Koza founded I-Ally, a community-based app that provides access to services and support for millennial family caregivers. Mrs. Koza has had essays published in Thought Catalog, Medium Women, Caregiving.com and Hackernoon.com. She was featured in ‘Founded by Women: Inspiration and Advice from over 100 Female Founders’ by Sydney Horton. A filmmaker, Mrs. Koza premiered short film ‘Laura Point’ at the 2015 Cannes Film Festival and recently co-directed ‘Caregivers: A Story About Them’ with Egyptian filmmaker Roshdy Ahmed. Her most notable achievement, however, has been becoming a mother to fraternal twins in 2023. Reach out to Lucinda via social media or directly by email: lucinda@i-ally.com.
Dr Rachel Dillinger Of Extraordinary Minds Psychiatry On How to Improve the Birthing Experience was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.