“I love my baby but I feel trapped.”
“Maybe having a baby was a mistake.”
“Every part of my life has changed. I miss my old life.”

I often hear these statements hesitantly shared by women experiencing ambivalence and regret after a new baby—along with, “I can’t talk about this in the new moms group.” But it is possible to find ways to hold these experiences without judgment, so that you can share the thoughts that have been swirling around in fear, guilt, and hopelessness. These feelings occur to many women – and their partners – after having a baby. You are not alone. In my work with new mothers we’re making space for feelings of ambivalence, regret, grief and loss that might come along with a new baby.

“How has motherhood been, compared to what you thought it would be like?”

Reflecting on what your expectations were and from where they came can help. Messages from partners, grandparents, Instagram, even strangers at the grocery store can morph into one loud proclamation: “You’re supposed to love this baby and this experience of parenting unconditionally.” In reality, we know that’s not always the case and we can work on tolerating a range of feelings and experiences of motherhood. You can love your baby and not love the baby stage at the same time.

“Not everyone feels an overwhelming burst of love for their baby at the birth. Some do, but for others, it comes a few weeks or even months later. Not feeling it now doesn’t mean you won’t ever feel it. How has it been for you?”

When you’re not feeling connected to baby, it can feel like it won’t ever get better and there must be something wrong with you. Yet not everyone has a made-for-TV moment with baby right after the birth. A scary birth experience, past trauma, or NICU stay can be a factor; sometimes, the love just takes longer to build. I’ve seen it happen.
Connecting with a newborns can also be challenging. They’re not great conversationalists. They won’t tell you you’re doing a good job. And the job never really seems to be complete. We start seeing more social smiles and sustained eye contact at about 6-8 weeks. Around 3 months they’re starting to try to grab for things. Understanding the rough guidelines for infant development can help you know what’s coming and put some of the challenges in context.

“What are you doing with your baby?”

Take a moment to acknowledge all that you are doing with and for your children. Sometimes parents feel pressure to be doing or teaching more. Those emails you might receive saying, “at this age, your baby should be…” can reinforce this. But what babies need most is for you to simply “be with” them, comfort them, feed them. All these moments can feel insignificant, especially if you feel like you are going through the motions, but these actions are the foundation of a secure attachment. So recognize that even if you’re not feeling like you’re doing enough, you can be still be meeting baby’s needs and building a connection.

Ambivalence can emerge no matter how challenging or how easy the tasks of parenting feel. But there are also larger stressors that can make things more difficult, such as

• Expensive or hard to find childcare
• Work pressure around maternity leave, schedule, or role
• Limited social support
• Challenges for military families
• Discrimination and the effects of racism, homophobia or other oppressions

Finding others who might also be experiencing these challenges—and connecting with them in real life if possible—can help you keep perspective and reduce feelings of failure and self-blame.

Coping with and managing feelings of ambivalence and regret is challenging, but my hope is that by making space for a range of experiences of motherhood, including ambivalence and regret, we can lessen the feelings of shame, fear, and despair.

What can you do?

• First, know that these feelings are not uncommon. Regret about being a parent or a sense of grief after becoming a parent are feelings many new parents feel.
• Feeling ashamed that you have these negative thoughts is also not uncommon. Having negative thoughts about parenting doesn’t mean you’re not a good parent.
• Replace “but” with “and.” “I love my baby and I miss my old life.” Both of these can be true.
• Stay connected with friends and family to support yourself during this time.
• Take care of yourself – make sure you’re sleeping when you have the chance, eating well, getting outside, and engaging in other self-care.
• Talk about it in your PEPS Group or in another support group.
• If any of these suggestions are feeling particularly difficult or you want more support and a place to process your experience of having a new baby, seek out a therapist—preferably one with expertise in perinatal mental health. Perinatal Support Washington is a great place to find one.

“How did they let me leave the hospital with this brand-new baby? How will I keep him alive?” This is a common refrain voiced by new parents in the first few days after their baby is born.  After all, there’s a steep learning curve to feeding and diapering a newborn, getting enough sleep and adjusting to a new normal. Unfortunately, a large number of new parents (mothers and fathers) also experience intense anxiety that something bad will happen to their baby. We just don’t talk about it.

Disturbing thoughts don’t mean you’re crazy.
For some, this distressing fear is experienced as unwanted images or thoughts. They’re scary, uncontrollable and feel like they’re playing on a loop in the parent’s mind. The thoughts are disturbing and can include someone — maybe even the parents themselves -- harming the baby.
Parents I see at the Swedish Center for Perinatal Bonding & Support sometimes share these scary thoughts with me. Their first questions are, “I would never do anything to hurt my baby! Why am I thinking these things?” and “Am I going crazy?” 
In fact, these thoughts are symptoms of anxiety, depression or obsessive compulsive disorder, which can occur during and after pregnancy. By themselves, these thoughts don’t mean a parent will do anything to harm a baby. 

Maternity-related anxiety is common and treatable
Talking about intrusive thoughts, anxiety and depression is hard. Women feel ashamed and worried that if they disclose their symptoms, someone’s going to take their baby away or think they aren’t good mothers. While postpartum depression has received media attention, ongoing silence around intrusive thoughts contributes to ongoing stigma and feelings of isolation for new parents. 
Nearly 1 in 5 women and 1 in 10 men experience depression or anxiety after the birth of a baby. For many of the women, their symptoms started in pregnancy. Anyone can experience these symptoms, but factors that increase a woman’s risk include: 

• A personal or family history of a mood or anxiety disorder 
• Complications during the pregnancy or birth
• Financial or relationship stress 
• A history of infertility, miscarriage or loss of a pregnancy or child
• Poverty and experiences of racism or discrimination

​Read the rest of the piece on the Swedish Blog, where it was originally published...

This group will be a chance to gather with and get to know a small group of other pregnant women while learning -- and practicing -- a number of strategies that can help you create more peace in your pregnancy, birth, and motherhood. You can read more about the group here. 

I thought I'd take a moment to answer a few common questions I encounter when speaking with prospective clients. Have a question that isn't answered here? Comment below or you can always feel free to contact me.

Whether it's due to fear about divulging the thoughts that keep you up at night, hesitation about "starting over" with a new provider, or just the quagmire of finding a therapist who takes your insurance and has openings, reaching out to find a new therapist can be challenging and anxiety-provoking. Wondering about these additional questions is unnecessary.  

Q: "I see from your website that you specialize in working with pregnant and postpartum women. Can I still see you for therapy if I'm not pregnant/postpartum/a woman?"

A: Yes! While I do have a specialty in perinatal mental health and women's reproductive health, I also see adults and adolescents who are neither pregnant nor parenting. And I welcome transgender individuals and men to my practice.  I enjoy working with a wide range of people; each brings a multitude of identities and struggles to therapy. The best way to determine if I might be a good fit for you is to schedule a phone consultation. 

Q: "I have Tufts Health Insurance. Do you accept that?"

A: I accept "Tufts Health Plan - Public Plans." These are typically the Tufts Health Plan products that you would have if you have MassHealth or purchased your insurance through the Health Connector. You might have had "Network Health" previously.

I do not accept Tufts Health commercial plans at this time. Typically, if you have Tufts insurance through your or your partner's employer, that is a commercial plan. You can always call the Member Services phone number on your health insurance ID card and ask them if I am an in-network provider for outpatient psychotherapy services for your plan. My NPI number is 1639208234. It's always a good idea to confirm that a provider is covered by your individual health insurance. 

Q: "Can I bring my baby with me to therapy?"

A: Probably, yes. I am well aware of how hard it is to find time without the baby to go to appointments. I attempt to make therapy as easy as possible for you to access and if bringing your baby is necessary, they are welcome. I have an activity mat and some toys (though they often also like playing with an empty paper cup!), and the office is big enough for your stroller or carseat. I also have a chair that's comfortable for feeding your baby if necessary. The easiest babies to accommodate in therapy are non-mobile ones. A word of caution that some parents find it challenging to speak openly with their babies in the room - even very young infants. And if it works for you and you'd prefer to leave the baby at home, that's obviously ok, too. 

Q: Can you help me find a prescriber or complementary practitioner?

A: There are many modalities that can alleviate depression, anxiety, and other emotional complications. In my previous clinical work, I helped families create teams of providers all working together to support a child and their family. I've kept that perspective in this work. If medication might be helpful, I can help you talk with your existing medical providers or refer you to a psychopharmacologist. I also regularly refer to acupuncturists, chiropractors, physical therapists, massage therapists, doulas, and lactation professionals. 

Latest update of the flyer of FREE postpartum support groups that focus on postpartum emotional complications like postpartum depression, mood, and anxiety disorders.

This is a great resource for birth, postpartum, and lactation professionals to share with clients while providing education about prevalence, risk factors and signs to look out for. 

Other postpartum groups can be found at the Postpartum Support International of Massachusetts website. 

The next session of my postpartum group will start in January 2016. Adjusting to Motherhood is a small, 6-week group for women experiencing adjustment challenges or emotional complications in the postpartum year or after adopting an infant. Learn more about Adjusting to Motherhood...

Diapers are expensive. And yet, there are few resources to help families in poverty afford them -- WIC doesn't provide diapers, and "food stamps" or SNAP benefits won't cover diapers (or wipes!) either. One study found that 1 in 3 low-income families cannot afford enough diapers for their children. When you can't change your baby's diaper, you can't soothe your baby. Unsurprisingly, this leads to increased stress levels, depression and anxiety for parents. 

Three years ago, Kerstin Sinkevicius and Aimee Mills - two moms who met through the Somerville Moms yahoo group - started a diaper drive to collect diapers to donate to the WIC office that serves Somerville, Cambridge, Arlington, Watertown, Lexington, and Belmont. Last year, they collected 22,674 diapers which were distributed to over 200 families. This year, they hope to collect 30,000 during the drive, which is running from September 19 to October 4. 

There are drop off boxes around Somerville, Cambridge, Arlington, Watertown and Lexington, including one in my building upstairs at Acupuncture Together, and the one pictured above at the Somerville Library East Branch. There are also registry links set up through Amazon, Diapers.com, and Target to buy diapers and have them sent directly to WIC. Check out the Somerville Diaper Drive website for more information. 

This is an easy, tangible way to support families in this community. If you're able, please consider donating some diapers! 

You've heard of PPD or postpartum depression. But what about perinatal emotional complications? Check out the infographic to learn 5 surprising facts about perinatal emotional complications. Sources are listed below. 
Update: I've had some requests for hardcopies of this infographic, so I created a free PDF you can download. 

[click infographic to enlarge]

Bornstein, D. (2014, October 16). Treating Depression Before It Becomes Postpartum. The New York Times. Retrieved from http://opinionator.blogs.nytimes.com/2014/10/16/treating-depression-before-it-becomes-postpartum/?_r=1

Dennis, C. L., & Chung‐Lee, L. (2006). Postpartum depression help‐seeking barriers and maternal treatment preferences: A qualitative systematic review. Birth, 33(4), 323-331. DOI: 10.1111/j.1523-536X.2006.00130.x.

Foli, K. J. (2009). Postadoption depression: What nurses should know. AJN The American Journal of Nursing, 109(7), 11. DOI: 10.1097/01.NAJ.0000357144.17002.d3.

Goodman, Janice H., and Lynda Tyer-Viola. Detection, treatment, and referral of perinatal depression and anxiety by obstetrical providers. Journal of Women's Health 19.3 (2010): 477-490. DOI:10.1089/jwh.2008.1352.

Hamm, N. (2014, November 25). High Rates of Depression Among African-American Women, Low Rates of Treatment. Retrieved from http://www.huffingtonpost.com/nia-hamm/depression-african-american-women_b_5836320.html

Hobfoll, S. E., Ritter, C., Lavin, J., Hulsizer, M. R., & Cameron, R. P. (1995). Depression prevalence and incidence among inner-city pregnant and postpartum women. Journal of Consulting and Clinical Psychology, 63(3), 445. http://dx.doi.org/10.1037/0022-006X.63.3.445

Howell, E. A., Mora, P. A., Horowitz, C. R., & Leventhal, H. (2005). Racial and Ethnic Differences in Factors Associated With Early Postpartum Depressive Symptoms. Obstetrics and Gynecology, 105(6), 1442–1450. DOI:10.1097/01.AOG.0000164050.34126.37.

Huang, H. L., Peng, L., Zheng, S., & Wang, L. S. (2014). Observation on therapeutic effects of acupuncture plus psychological intervention for postpartum depression. Journal of Acupuncture and Tuina Science, 12(6), 358-361. DOI:10.1007/s11726-014-0805-7.

Kim, P., & Swain, J. E. (2007). Sad Dads: Paternal Postpartum Depression.Psychiatry (Edgmont), 4(2), 35–47. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922346/

Kozhimannil, K. B., Trinacty, C. M., Busch, A. B., Huskamp, H. A., & Adams, A. S. (2011). Racial and Ethnic Disparities in Postpartum Depression Care Among Low-Income Women. Psychiatric Services (Washington, D.C.), 62(6), 619–625. doi:10.1176/appi.ps.62.6.619.

Nonacs, R. (2015, February 26). Treating Depression During Pregnancy Prevents Postpartum Depression. Retrieved from http://womensmentalhealth.org/posts/treating-depression-pregnancy-prevents-postpartum-depression/

Ross, L. E., Steele, L., Goldfinger, C., Strike, C. (2007). Perinatal depressive symptomatology among lesbian and bisexual women. Archives of Women's Mental Health. 10,(2), 53-59. DOI: 10.1007/s00737-007-0168-x.

Smith, M. V., Kruse, A., Weir, A., & Goldblum, J. (2013). Diaper need and its impact on child health. Pediatrics, 132(2), 253-259. DOI: 10.1542/peds.2013-0597.

Wisner, K. L., Sit, D. K., McShea, M. C., Rizzo, D. M., Zoretich, R. A., Hughes, C. L., ... & Hanusa, B. H. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, 70(5), 490-498. DOI: 10.1001/jamapsychiatry.2013.87.

Two interesting news items related to postpartum depression popped up this past week. The first is news that researchers have identified a link between an oxytocin receptor blood marker in some women which increased their likelihood of experiencing postpartum depression. What does this mean? Well, if there were a blood test to give pregnant women to identify which ones were more likely to experience postpartum depression, we could proactively identify those women, doctors and families could put supports into place for the postpartum period ahead of time. 

The second story is about a change in recommendations from the US Preventive Services Task Force about screening adults for depression. Now, if you're like me, you might be asking yourself what the US Preventive Services Task Force (USPSTF) is and what they do. Turns out, The Task Force is convened by Congress and reviews current clinical research to "improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications." This Task Force is now recommending that all adults be screened for depression because of its prevalence (1 in 10 all adults in the US will experience depression), and they specifically identified that all pregnant and postpartum women be screened. 

It's great when postpartum depression gets media attention. It increases awareness of the huge number of families affected by emotional complications in pregnancy and postpartum . Screening and identifying those who are suffering is a critical first step. 

However, there's an immense gap between screening and treatment. Postpartum women--particularly low-income mothers and mothers of color--obtain treatment for postpartum mood and anxiety disorders at abysmally low rates, even after they've been positively screened. 

Why?

• stigma, fear of judgment
• lack of or inadequate health insurance, high copays, high deductibles
• few trained perinatal providers in many areas
• time constraints and difficulty securing childcare 
• experiences of discrimination within the medical system

Efforts like the community health center pilot program in Massachusetts that embeds comprehensive postpartum support within community health centers both increase screening rates and address these barriers to treatment. More innovative community-based programs are needed to bridge the gap between screening and treatment for perinatal mood and anxiety disorders. 

There's also a little fact in the original research about the oxytocin receptor that's interesting. The study found that there was no connection between the oxytocin receptor and risk for PPD in women who had depression during pregnancy - the link was only in women who were not depressed prenatally. Not only does depression in pregnancy increase the risk for postpartum depression, but untreated prenatal depression is also a risk factor for unfavorable pregnancy outcomes including low-birth weights and pre-term births. So, we still need to screen all pregnant women AND treat those who are depressed. 

The Massachusetts legislature overturned the Governor's veto of funding for the pilot program I mentioned above.  I've been asking many of you in Massachusetts to contact your legislators about this recently, so thank you for all your advocacy!

Meanwhile, Congresswoman Katherine Clark and Congressman Ryan Costello introduced legislation, the Bringing Postpartum Depression Out of the Shadows Act, to increase and improve screening AND treatment for women with postpartum depression through grants to the states to develop new programs. 

What's caught your eye in the news lately related  to pregnancy or postpartum emotional complications? 

I've moved upstairs in my building to suite 317B! The new office has a waiting room and is tucked away in a quiet corner in the back of the building. Most excitedly, it's large enough to run groups. There are still some final touches to make, but I'm seeing clients in this office as of July 1.

I'll be offering the space for sublet for Monday day & evening and possibly one other evening. If you know any other therapists, nutritionists, coaches, or other folks who do group work, individual or family therapy, or consultations looking to start a practice or expand to a great Cambridge location, please put them in touch with me!

I went to the screening of the maternal mental health documentary, Dark Side of the Full Moon, last night, organized by Leslie McKeough, LICSW - a Lynnfield therapist - and the North Shore Postpartum Depression Task Force. The documentary highlights the experiences of several women who experienced perinatal mood and anxiety disorders, the dismal state of screening for emotional complications in pregnancy and postpartum, and the barriers to treatment for these women. Interspersed are the news stories of the lives lost to maternal mental illness while they were filming the documentary. 

Women feel guilty, self-conscious, isolated, and overwhelmed when they're experiencing emotional complications in the postpartum. Supporting women with perinatal emotional complications is about more than a 10-item questionnaire, though that's a good first step. It's about more than having a therapist's phone number, though that's needed too, and hopefully many people have that therapist's number or know where to look. It's knowing that if they reveal to you how they feel, they're doing so with fear and worry about not being a good mother, about their baby being "taken away," about never feeling like themselves again. 

Supporting women with perinatal emotional complications is about having effective systems of care in the community that would include 

• doctors and midwives who are screening at regular intervals during pregnancy and postpartum, and who are aware of both the risk factors for perinatal emotional complications and their patients' histories regarding those risk factors, 
• behavioral health clinicians & psychiatrists who are trained in maternal mental health, who are accessible geographically and financially (a troubling trend is in psychiatrists' reluctance to accept insurance)
• a network of treatment options and support including groups, peer support, home visits, acupuncture and other complementary treatments, 
• insurance companies that reimburse treatment, and
• psychiatric emergency providers who understand and can assess the difference between intrusive, scary thoughts and true psychotic symptoms
  

We are on our way, in Massachusetts, to creating such systems of care, largely thanks to the advocacy of families with lived experiences of perinatal mood and anxiety disorders, clinicians, and state legislators, but we still have a ways to go. 

These issues, this stigma, these barriers to care are why I and three colleagues founded the Every Mother Project with the belief that every mother deserves comprehensive perinatal support. We developed a Perinatal Toolkit for women's health professionals to better understand, recognize, know how to talk about, and support women through perinatal emotional complications. We've had lactation counselors, doulas, pelvic floor physical therapists, midwives, acupuncturists and many other birth and postpartum professionals download the toolkit. Our hope is that with more training and awareness for all the myriad of people who come into contact - and often develop quite close and important relationships - with pregnant and postpartum women and new parents, more women will feel heard and understood and will be able to be connected to the right supports.

The movie didn't get into the racial and socioeconomic disparities that exist in maternal mental health, but I'd be remiss in not mentioning them here. There's been yet another study that examined stress in pregnancy and risk of postpartum depression, finding that more stress events (financial, partner, trauma, or emotional) in a woman's life was directly correlated with a higher risk for emotion complications. Other studies have identified that experiences of racial discrimination during pregnancy (which can be prevalent within medical systems) not only affect the pregnant woman's own emotional and physical health, but also impact the infant's stress physiology response. So yes, institutional racism and systemic oppression have real effects on pregnant and postpartum women of color and women in poverty, increasing their risk for perinatal emotional complications, all while making it harder for them to be identified and access treatment. 

I'm so thankful for the chance to view Dark Side of the Full Moon, and that so many others did, too. We have much to do still to better support women through perinatal emotional complications - even in Massachusetts. Please, at least take a look at the trailer if you missed it. And maybe we can organize another viewing...

Depression and anxiety are incredibly common both during pregnancy and after childbirth, but sometimes it's hard to get past the jargon and austere clinical descriptions of symptoms. Postpartum Progress features clear, accessible writing from real women who've experienced perinatal emotional complications - Warrior Moms - as well as professionals from all over the country. They also have a private forum and are hosting their first conference in Boston this summer!

One of my favorite posts featured photos of women to demonstrate what it looks like when someone is suffering from a perinatal emotional complication (hint: not what you think!).

"Plain Mama English" posts describing symptoms of postpartum depression, anxiety and psychosis are probably my other most referenced posts. You can even download nice PDFs to print out. Their newest tool is a New Mom Checklist for Maternal Mental Health Help, a checklist that a postpartum woman can bring to her care provider to start a conversation about getting help. 

This year is their third putting on the Climb Out of the Darkness, an awareness and fundraising event for Postpartum Progress and perinatal emotional complications. On June 20, there will be a Climb at Walden Pond in Concord, MA and others around the country where women who've experienced perinatal emotional complications and the people who support them will get together outside, create community, and symbolize the journey out of postpartum depression and anxiety and into the light of hope and recovery on the longest day of the year. You can find a climb near you or donate to my "couch" climb effort here. 

Postpartum Progress started exploring the needs of women of color who suffer perinatal emotional complications and surveyed women of color about their experiences at the beginning of 2015. I hope Postpartum Progress continues engaging and amplifying the voices of women of color, as well as exploring and increasing awareness of unmet needs of mothers of color.

I've professed my love for Momma Zen: Walking the Crooked Path of Motherhood by Karen Maezen Miller before. I worry about parenting books that say "this -- my way -- is the way!" and their effect on vulnerable new moms looking for answers in the utterly chaotic early parenting days, but Momma Zen is different. Karen Maezen Miller says "I don't know either!" and compares the exhaustion of motherhood to a humidifier. Plus, the chapters are short: 3-4 pages and perfect for a quiet couple of minutes before bed, in the car while baby is sleeping, or while you're bouncing baby on a yoga ball. 

This is the book I recommend and give to my friends who become mothers. And, just because, I'm giving away 2 autographed copies. Subscribe to my email newsletter to enter!

I've been getting lots of great responses in my survey of groups and classes for pregnant women, parents-to-be, and new parents. Please, keep them coming! If you're expecting a child, have a young child, or work with expectant and new families, please share your thoughts in the survey below. Responses are anonymous, but if you have any feedback or groups you want to share with me directly, please feel free to contact me! And if you want to be sure to get the compiled results and hear about next steps to meet the needs in the community, sign up for my newsletter. 

My dear friend and colleague, Divya Kumar, does amazing work. She's certified as a postpartum doula and lactation counselor, runs groups for new moms, and uses her public health background to develop and advocate for effective programs that actually improve access to comprehensive support for pregnant and postpartum women. All in the name of not just treating postpartum depression, but fostering emotional wellness. Here's my interview with her about the pilot program that was funded* by the state of Massachusetts to integrate postpartum support into existing medical systems.  

Tell me how the pilot program came about. 

DK: I was transitioning back to working outside the home after my second child was born and I started working as a postpartum doula.  I have a public health background, and I tend to think in terms of systems and programs.  I think about who has access to what services--and how and why. Every new mom can benefit from a postpartum doula, but not every mom knows what one is or can afford one, so I started thinking about how to increase access to postpartum doula services for all moms, and I thought it would be fantastic to have a postpartum doula in every pediatrician's office so that new moms could get emotional support, ask questions about things like sleep and soothing, and get help with breastfeeding.  

When my first child was a newborn, I had met Jessie Colbert at a local new moms' group. She is the administrative aide for Rep. Ellen Story, who chairs the Postpartum Depression Commission. So later, when I came up with the idea of integrating postpartum support into pediatric health settings, Jessie suggested that we develop this program as a postpartum depression prevention initiative. Rep. Story pushed for funding and the pilot program received $200,000 in 2013 to be split across four community health centers that serve a diverse patient population, including folks who are disenfranchised and under-served. 

What exactly does the pilot program look like?

DK: The pilot looks a little different at the different community health centers, meaning that the centers have incorporated and built upon different aspects of perinatal care based on the capabilities of their own sites and the needs of their patients. In Lynn, mental health providers do home visits for new moms experiencing perinatal emotional complications. In Worcester, a team of OB advocates work with moms from pregnancy through the first two years of their child's life. In Jamaica Plain, we provide lactation support in our pediatric service, regardless of whether a baby's mom is a patient at the health center.

What makes this different than other efforts to address postpartum depression? 

DK: One of the big differences is that the pilot program integrates perinatal support into existing medical systems, and this integration reduces barriers and increases timely access to care for folks who need it. Being a new parent can be exhausting and overwhelming, and for folks who are disenfranchised by poverty or other extenuating circumstances, timely access to comprehensive services is key. At Southern JP Health Center (where I work), we see all new babies at their first pediatric visit--as early as 3 days postpartum! I come into the exam room after a physician sees a baby and screen the new mom for postpartum depression with the EPDS [Edinburgh Postnatal Depression Scale]. Also, providing comprehensive services means that we approach the mom and baby as a dyad. So, if a mom is struggling with perinatal emotional complications, I can connect her with a mental health provider in-house or in the community, and I can also help with issues within the dyad (breastfeeding and lack of sleep are the usual culprits here!) that can be exacerbating these complications.

What difference do you see yourself and the program having in people’s lives? 

DK: I have had many moms tell me that they would have given up on breastfeeding if I hadn't walked into that exam room! It is such an honor to be in a position to help someone in that moment of distress. I have also walked patients who were having a mental or emotional health crisis up to our mental health department, where they were seen within the hour. Without screening them at their child's appointment, there's no way to know whether that crisis would have been identified and if they would have received mental health support. Also, I have had numerous moms contact me months after their babies were born to ask questions, get referrals, or just additional support, and many of these moms say to me, "It's so helpful to know that you're here to help me figure all of this out!" Having someone that they know they can contact with questions or concerns (especially those that are not directly related to their baby's health) is very reassuring for moms.

What do you see happening next for the pilot program? 

What’s one thing you would tell all mothers of newborns? 

DK: You're not supposed to do this by yourself!  New moms are really isolated these days--many of us don't live with our parents or siblings, or in a home where friends and relative are constantly coming and going. I have heard many moms say, "I feel like I'm supposed to be able to do this by myself, but it's really hard!" Taking care of a newborn, figuring out breastfeeding, and adjusting to life as a parent involves a HUGE learning curve...while being utterly exhausted and recovering from the actual birth. Doing it yourself is often a very, very difficult task, and not one that new moms should have to take on. Ask for help. Accept help. Call a lactation professional. Call a friend. Go to a moms' group. Parenthood is better when we do it together! And, if I could tell expectant parents one thing, it would be to make a postpartum plan and get to know their local resources *before* their baby arrives. Make a list of lactation professionals, postpartum doulas, new parents' groups, meal delivery options, etc. 

I want to thank Divya Kumar for answering these questions and most importantly for all her work supporting new moms and advocating for better systems to care for new families. Have any questions for Divya? Continue the conversation in the comments!

03/06/2015 UPDATE: I'm excited to share that Kathleen Biebel, PhD, Program Director for MCPAP for Moms (M4M) was kind enough to add some comments and clarifications to my post. I'm including her words below in red. And, they are working on creating their own infographic, which will aim to capture some more of the subtleties of the flow of what happens when a woman and her medical provider contact MCPAP for Moms. Once it's available, I'll be sure to link to it.  

Another unique-to-Massachusetts resource, MCPAP for Moms offers medical providers a Monday-Friday 9-5 phone line to speak to a care coordinator who can connect the provider to a MCPAP for Moms perinatal psychiatrist for consultation and/or help with connecting a mother and family to a community perinatal mental health provider. 

What does this look like? If a woman is at her OB's office or is talking to her primary care provider (PCP), and she feels comfortable sharing that she is struggling with anxiety or depression or other emotional complications in the postpartum period, her doctor can call MCPAP for Moms. The medical provider will get a call back from a MCPAP for Moms psychiatrist to discuss diagnostic questions or get guidance about a medication prescription. (They can (and do) discuss a whole range of issues that can also include depression screening, community mental health resources – it can really run the gamut). A MCPAP for Moms care coordinator can also provide referrals for therapists and support groups in the woman's community who specialize in postpartum mood and anxiety disorders. 

Since finding psychiatrists that have openings, who feel comfortable managing medication in pregnancy or while breastfeeding, and who accept insurance can be an enormous challenge, there is the great potential for this to help with more rapid connection to treatment for moms.  (Absolutely! Another huge part of what M4M docs do is to help the calling provider start and/or continue to provide mental health care for perinatal women when appropriate.  This is a huge goal of M4M – to support OB and PCP and psychiatric providers as they attend to the mental health care of their patients, and to increase their capacity and comfort in doing so).

My concern about the program, however, is whether it will be effective in increasing access treatment for women of color, who frequently experience discrimination in the medical system. I wonder whether women of color will be willing to bring their questions about emotional health to medical providers, especially if those providers have not already screened for emotional distress. I look forward to hearing more from MCPAP for Moms about who they're reaching. (We at M4M share your concern that minority and under-resourced women are more likely to experience perinatal mental health concerns, and are less likely to access and engage in treatment. M4M aims to increase access to treatment for all women by increasing the capacity of providers serving perinatal women with mental health concerns.  Our M4M docs, when working with calling providers, encourage depression screening, discuss a wide range of treatment options and considerations, review community based resources, etc.  Our M4M docs work with providers with the information they share with us about their patients, which may or may not address someone's racial or cultural identity.  We at M4M do not provide any direct treatment for women).

Medical providers who are looking for more information about MCPAP for Moms can look here. 

I've talked with many folks who are unsure how the MCPAP for Moms process works, so I created a little infographic to help explain it. The information was gathered at meetings I have been at with MCPAP for Moms and their website and represents my understanding of the program. I'm not affiliated with MCPAP for Moms.