July 29, 2013

 “My father was a general practitioner for fifty years and he regularly made house calls. It seemed like a natural step for me to do the same,” said Bobbie Posmontier, PhD, who has delivered more than 2,000 babies in homes, hospitals and birth centers as a Nurse Midwife. She previously had her own practice that emulated midwife practices you might find in the United Kingdom. Posmontier gave her charts directly to the patients with which she worked, explaining, “There were no secrets between us.”

The work that Posmontier is doing today to address postpartum depression on a global scale is deeply rooted in her past experiences and relationships with mothers. There is a trust that develops between a woman and the midwife who stays with her through prenatal care, the birth of her child, and postpartum care. Posmontier believes that midwives are ideally positioned to provide Interpersonal Psychotherapy to new mothers because of the trust and comfort level that develops. Research shows that mental health care delivered by trained midwives is as effective as that provided by psychotherapists. 

For Posmontier, home visits are an essential piece of the puzzle in understanding the stressors moms face in their daily lives that may contribute to postpartum depression. “I started seeing women in their natural habitats,” she said. What she saw were strained relationships, sleep deprivation, and environmental factors that sometimes overwhelmed her patients. Because it can take a long time- sometimes a month or more, on average- to be seen as a new patient in our mental health care system, Posmontier did not know where to send patients who needed help with their postpartum depression right away.

She became a Psychiatric Nurse so that she was certified to provide interventions along with the primary care she delivered as a midwife. Some of her patients were teenagers confronting unexpected pregnancies. Others were victims of rape. Many were new mothers who did not know how to communicate their needs with family members. In 2010, Posmontier became a Psychiatric Nurse Practitioner so that she could also prescribe medication, an important milestone in her career that allowed her to meet the needs of her patients across the spectrum.

Interpersonal Psychotherapy (IPT), which is the type of treatment that Posmontier uses in her work with patients combatting postpartum depression, focuses on four main sources of potential stress: role transitions, interpersonal disputes, grief and underdeveloped social skills. Posmontier has trained midwives to deliver the structured IPT in eight sessions, starting with an inventory of relationships and stressors, and ending with a review of the tools developed collaboratively by the midwife and patient. The objective of postpartum IPT is to have the patient functioning well by the end of the eight weeks, as well as for the patient to be able to identify when they need to seek additional treatment to address depression. IPT sessions are scheduled at the busy new moms’ convenience; some midwives have even conducted sessions over the phone in order to meet patients’ needs.

Posmontier’s experience as a midwife, Psychiatric Nurse and Psychiatric Nurse Practitioner brought her to a climactic moment in her career this year. On June 4, she was notified by the Senior Vice Provost for Academic Affairs at Drexel that she has been awarded a prestigious Stein Fellowship for the upcoming academic year. The fellowship will support her work in Israel, where Posmontier will train social workers to administer IPT to postpartum depression patients.

“I was absolutely thrilled on receiving the notice about this award,” Posmontier said. “It will allow me and my team to further my work in addressing the needs of women with postpartum depression in Israel who might not otherwise receive care.” Her Stein Fellowship project was incidentally timed perfectly with a new Israeli healthcare mandate that took effect on January 1. All new mothers in Israel must be screened for postpartum depression. With a social worker in every clinic, these individuals are the best fit in the Israeli health system for taking information from these mandatory screenings and reacting with the appropriate treatment approach, which may now include IPT.

In addition to training between 10-20 social workers to administer IPT, Posmontier will complete a non-randomized trial comparing regular social worker care with that provided by IPT-trained social workers. The Stein Fellowship has afforded Posmontier an opportunity to form relationships with collaborators in Israel. CNHP faculty member Dorit Breiter, who is an Israeli native, will travel to the country with Posmontier as her co-investigator.