How to Create Up To Date DB From Scratch Programatically

[ivanthewebber]

I want to use pytest_postgresql for unit tests which be used to manage test databases for running unit tests concurrently (each database will have different dbname). According to Alembic's cookbook I should be able to make an up-to-date database with Base.metadata.create_all which matches the examples in pytest_postgresql; however I have an issue with duplicate index names and no triggers are being created. How do I correctly create new up-to-date databases from scratch including all triggers?

I also asked this question on sqlalchemy/sqlalchemy, so perhaps we should keep all discussion there; but I wanted to make sure it was discoverable here as well as it may result in an update to the documentation linked above:
sqlalchemy/sqlalchemy#13037

[zzzeek]

dupe of sqlalchemy/sqlalchemy#13037