By Abbie E. Goldberg
As the lead investigator of a Massachusetts study on postpartum mental health among diverse women, I and my research team have the chance to speak to women during their pregnancy and a couple of times after they give birth, including as early as three months postpartum. Although all these women reside in Massachusetts, their experiences with trying to get support and mental-health services vary widely. Some women describe supportive, knowledgeable, and sympathetic providers, while others have come face to face with major barriers as they try to get support for themselves and their families. Some women, for example, are aware that they need emotional support but have felt that their providers (including OB/GYNs, primary care docs, and pediatricians) lacked knowledge and understanding of the challenges that they were experiencing during their initial period of adjusting to the parent role. In addition, providers were not always aware of the need for or location of support resources (including support groups, therapists, and psychiatrists).
In one particularly memorable interview, a woman described how she dragged herself to her provider's office to talk to him about her increasing sadness and poor mood and whether to go back on antidepressants. She acknowledged that she was struggling with this decision in part because she strongly valued breastfeeding and didn't want to stop breastfeeding. Looking for support around this decision as well as specific information about medication and breastfeeding, she was surprised to find out that her doctor was unfamiliar with the risks of breastfeeding while on antidepressants.
Another woman who was also experiencing depression and suicidality described how she had been very disappointed with the support and information -- or lack thereof -- that she received from her doctors. She did not feel that her providers provided much support or validation regarding the emotional ups and downs that she was experiencing due to a relatively traumatic birth experience and a difficult adjustment to new parenthood. Frustrated yet resourceful, this woman tried to join a postpartum group at a local hospital -- but when she arrived for the first session, she found she was the only person there. This woman spoke powerfully about the inaccessibility of postpartum health resources, even noting that she was grateful that she had experienced depression before she became a parent or she would never have known how to get the resources she needed.
Even when new moms in our study do find knowledgeable and supportive providers, they sometimes face structural barriers, including transportation issues (e.g., they cannot get to support group meetings), health insurance issues, and scheduling problems.
How do we address these types of challenges? One solution seems obvious: Providers of all types should be trained to support new parents, recognize signs of clinical levels of distress, and assist patients in accessing supports. Fortunately, MCPAP for Moms is a new initiative, sponsored by the Massachusetts Child Psychiatry Access Project (MCPAP), that can help address this particular barrier to appropriate care. MCPAP for Moms is a new statewide expansion of MCPAP that recognizes the reality that one in eight women experiences depression during pregnancy or in the postpartum period, and it therefore "aims to promote maternal and child health by building the capacity of providers serving pregnant and postpartum women and their children up to one year after delivery to effectively prevent, identify, and manage depression. Providers working with fathers and other caregivers experiencing postpartum depression can also access MCPAP for Moms." Providers can simply call MCPAP for Moms (855-Mom-MCPAP) and talk to a care coordinator who will work with the provider to determine their needs (e.g., consultation regarding psychiatric care, support group identification, pregnancy/lactation consultation, etc.) MCPAP for Moms employs a psychiatrist who is available to see patients for face-to-face consultation as well. And MCPAP for Moms is partnering with MotherWoman to ensure that mothers receive the care and treatment they need. MotherWoman's Community-based Perinatal Support Model© (CPSM) will provide communities with the infrastructure, training and support necessary to develop unified community-wide goals for systemic change and implement protocols across systems to enhance delivery of treatment to women in need. Through funding provided by the Massachusetts Department of Mental Health and MCPAP for Moms, MotherWoman is bringing the CPSM to communities across the state and providing support, training, tools and technical assistance to ensure access to care for all mothers.
Moms with postpartum depression cannot wait for care and treatment when faced with depression and other perinatal emotional complications. The stakes are too high. The impact on both Mom and her infant can be serious. But there is hope. In Massachusetts there is a new model that is providing hope for these mothers and changing the landscape so that providers can provide the essential care that is needed.
For more information on MCPAP for Moms: www.mcpapformoms.org
For more information on MotherWoman: www.motherwoman.org
For more information on Abbie Goldberg's research study: http://wordpress.clarku.edu/agoldberg/research/postpartum-mental-health-among-visible-and-invisible-sexual-minority-women/
Abbie E. Goldberg is an associate professor in the Department of Psychology at Clark University in Worcester, Massachusetts, and a visiting scholar at the Williams Institute at the UCLA School of Law. She received her Ph.D. in clinical psychology from the University of Massachusetts Amherst. Her research examines diverse families, including lesbian-parent families and adoptive-parent families. She is the author of over 60 peer-reviewed articles and three books: Gay Dads (NYU Press), Lesbian and Gay Parents and their Children (the American Psychological Association) and LGBT-Parent Families (Springer). She has received research funding from the American Psychological Association, the Alfred P. Sloan Foundation, the Williams Institute, the Society for the Psychological Study of Social Issues, the National Institutes of Health, and the Spencer Foundation.
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