Jeff: What program do you work for or what umbrella would you say you are under?
Bill: I'm a clinical social worker but right now under case management but I have faculty appointments and The Dept. of Psychiatry and Ob/Gyn.
Jeff: In this capacity what do you do?
Bill: I was the director of the postpartum support program for 20 years. In the past it was a support group but it has disbanded but now I'm a resource. People either call me or come in and we have informal chats which I can both assess what are their needs and try and connect them resources or provide short term counseling.
Jeff: And that is typically around postpartum depression?
Bill: Anything related to pregnancy and postpartum which really covers any number of situations
Jeff: Do you mind going into what some of those situations could be?
Bill: Well, sometimes it can be that somebody thought that they were going to be really excited about their pregnancy and in fact they are very anxious. It could be somebody thought they were going to be really happy but after they've had the baby they are in fact feeling sad. It might be that somebody had a very difficult labor and delivery and are having a reaction to that. It might be that somebody finds themselves without the support they were hoping for. It could be that they are having trouble with their partner, it could be that-you know there used to be a book that we could recommend "This Isn't What I Expected" and sometimes when I say that to mothers they say that's exactly what I'm dealing with right now. But sometimes it can also be termination of a wanted pregnancy because of fetal anomalies. It can be dealing with a child with special needs and reactions to that. So any number of things that are related.
Jeff: That’s fantastic-That's really helpful to hear because a lot of folks thought maybe it was just postpartum depression that you focused on. A lot of these issues come up with the moms that we see.
Bill: That’s right.
Jeff: You said you had the support group for twenty years. How long would you say you've provided these services?
Bill: Probably 25 years. I've been in the high risk obstetrics clinic -it will be going on twenty years.
Jeff: How would you say most clients find out about you or practitioners?
Bill: A lot of pediatricians and obstetricians have come to know about me partly because I work in a site that trains OBGYNs and many of them go on to practice in the community. But then I think word has basically gotten out that I'm somebody that if a patient calls me I get them in to see me very quickly and I get them connected very quickly. And although we no longer have a group here, there are several groups in the region and I try to connect people if that's what's indicated. Also, sometimes people need a medication assessment and because I also have connections within the Dept. of Psychiatry, I can sometimes work it out for somebody to be seen sooner rather than later.
Jeff: That's great! That's fantastic. So you mentioned you've been working in this field for about 25 years. What would you say has changed over the past 25 years in the way you've provided services or what issues have come up.
Bill: I want to think, and I think it's largely true, there is less of a stigma these days associated with saying "I need help". I think there is greater awareness that postpartum depression is so common. I think among providers, more and more people are being screened and more and more people are asking the question. I think partly because they also know that if somebody screens positive for depression they can send that person to me. So I think this helps them think about asking the questions. And Durham Connects has also been a great resource to refer people to me.
Jeff: Have you noticed anything else in the community that's in the past 10-15 years, that's really aligned services or started conversations more so than not.
Bill: Durham happens to be a very resource rich community and as you know programs like Early Head Start, Center for Child and Family Health and Durham Connects, I think that there really is a patchwork of services with people talking to each other. I think we're in a good situation here.
Jeff: What is the most common question you receive about either the services you provide or the realm that you are in?
Bill: I think a lot of times people will call in and say, "I don't know if this is postpartum depression or not." as though it is something like Diabetes or the Measles where you can say this is something you have. And for me I really think it's what I would consider postpartum distress which I think it can cover anxiety it can cover depression and so often, almost always if I hear their story and I hear what it is that is contributing to their distress, it becomes very clear to me what is needed. It can often be a combination of concrete help, somebody to talk to, medication assessment, help in the household, relationship help. Very often I think mothers who are distressed are feeling that way because they simply don't have the support in their lives and this whole notion it takes a village-it does take a village. Some of our mothers have two babies and for them it takes two villages. It's not uncommon that some of these mothers will have zero support and it's very painful to hear that.
Jeff: I would almost think that if someone calls and says "I'm not sure if this is postpartum depression." even if it isn't that's still something that's bothering you that needs to be addressed.
Bill: As far as I’m concerned, if it's within the first year after having a baby let's call it postpartum depression, which can include anxiety, depression and distress. It's one thing if you are a researcher and you want to say OK we've got to have this criteria, but if you are a practitioner anything that fits under the realm of distress, I think can go into that category.
Jeff: What are some of the barriers or obstacles you see that if they were taken away would help you do your job better?
Bill: If I had five more days in the week.
Jeff: Or five more of you!
Bill: Five more of me and so on! Right now we don't have a support group in Durham; although we do in Chapel Hill and Raleigh. Another question that comes up is if we have a group for Spanish speaking mothers which we do not. When someone is in need of a medication evaluation, typically these are not women that can wait a month, in a perfect world we would have access to psychiatrist or mental health provider they could see right away.
Jeff: If there was one thing you could tell an up and coming practitioner or even you 20 years ago, what would you say to them?
Bill: Well when I first started in this and I knew how prevalent postpartum depression was (at least 10%). Every mother has a story and if you listen you learn why she's distressed. One of the things I think is so important to say to mothers is to get across the concept of the "good enough mother". Help them understand that perfection has no meaning and that if their needs are taken care of, like the old airplane analogy-put the oxygen mask on yourself first, this will help them be the best possible mother. This idea that it takes a village. If they are out there trying to do this by themselves they will feel overwhelmed, this doesn't say anything suggesting that they are inadequate, that basically the world in which they are living is inadequate. In most cultures there are the grandmothers, the aunts, and the mothers that nurture the mother, take the baby from the mother bring her food, etc while she rests and recovers. We have less and less of that in our mobile society. So when mothers don't have that and are trying to raise their baby by themselves it's no wonder that they feel distressed. Sometimes simply reminding mothers of this can be very useful and helps to depathologize what they are experiencing.
Jeff: This might be a hard question to answer but you've brought it up you've been successful because you've had great outcomes with parents and we at Durham Connects absolutely love you and think you do fantastic work
Bill: Well I love you too!
Jeff: Anytime someone mentions your name a smile comes on their face. What would you say has made you as successful as you are?
Bill: I think I've learned really about listening to people. I saw a mother yesterday, she's almost a mother, she's somebody again that's new to this area by herself because the father of the baby is living in a different state. At the end I told her I thought she was going to be OK and I thought she was going to be a good mother and of course I only said that because I believe it but I think she really needed to hear it. I was able to get her in quickly and I think everybody has a fundamental need to feel listened to. I think that's probably been my strongest asset, that I know how to listen and I think I convey a sense of being non-judgmental and supportive.
Jeff: I could go on and on about what you are good but we would like your head to fit when you go out the door. So what is your favorite thing about working in the Durham community?
Bill: I love the Durham Community because of its heterogeneity. There's really a mix of people from different backgrounds, races, socioeconomic points of view or socioeconomic status. There's really an opportunity to mingle and get to know people from all different walks of life and of course what you find is there is so much overlap yet there's also distinct differences.
Jeff: If you had a magic wand, what would you do with it? In order to help with your patients or your clients in the realm that you work in?
Bill: I think for some people, I would ask them to really think through before they have a baby anytime soon. I think if I had a magic wand maybe I would have a support group that had childcare there and transportation. I would have fathers be much more involved in the care and welfare of their children. I would make all the buildings safe that our mothers were living in. And world peace!
Jeff: If you had a camera and you could take one picture that represented what you do, what do you think you would take a picture of?
Bill: It would be conveying to patients that we care about them and this is what I try and instill in my interns as well. So often when they first start here they think their role is to connect people with resources and while that's a part of the role, what I want them to come round to is this idea that what is essential to convey to the patients is that we care about them, that we get to know them that we get to enter their world and through that see how we can be of help.
Jeff: If you could start a band right now, what genre of music would your band play and what instrument would you play?
Bill: Well I actually played in a band and the name of the band was Sixties Souvenirs and I played keyboard, guitar and saxophone. We played all kinds of sixties music- Beatles and all of that, so it would be along those lines.
Jeff: Were you the lead singer?
Jeff: If I jumped in your car right now, what would I find in your CD player?
Bill: You would find a range of things. Everything from the songs nominated for Grammys in the past year, some folk music, rock music, classical music.
Jeff: You're flipping through the TV and a show comes on and you stop and you have to watch, what is that show?
Bill: It's going to be 60 minutes, Point of View on PBS-the documentaries, an occasional football game. Last night I taped the Cubs winning and I watched that this morning.
Jeff: Are you a Cubs fan?
Bill: I am!
Jeff: I’m sorry! Well, that’s it…that’s all the questions I have. Thank you so much Bill for doing this, I really appreciate it.
Bill: Sure, sure my pleasure!