June 15, 2016
After her baby was born, a Philadelphia mother could not leave her side without crying. The mom would wake up multiple times during the night to check her breathing. Sometimes while carrying the newborn down the stairs, she feared she would drop her.
Her friends and family told her she was just experiencing a bit of the “baby blues.” But a post-pregnancy survey revealed something deeper: She was suffering from post-partum depression —a condition that can last for several months or longer and affects more than 3 million U.S. women per year.
The mother is not comfortable releasing her name, due to the stigma attached to her disorder, but she is in her mid-twenties and lives in Northeast Philadelphia.
“This was supposed to be a very happy moment in my life, and I felt the opposite. You try to explain it to people, and they don’t get it,” she said. “The expectations of how you’re supposed to feel kind of keeps you quiet.”
After her survey results revealed symptoms of depression, the mother’s OB-GYN referred her to a new, interdisciplinary pilot program based at Drexel University.
The program, called Mother-Baby Connections, is one of only five or so intensive outpatient clinics of its kind in the United States, and the only one in the mid-Atlantic region. Unlike many other postpartum psychiatric clinics, the Drexel program emphasizes the mother’s relationship with her baby and encourages patients to bring their children to therapy.
Based on models common in Canada, Europe, Israel and Australia, Mother-Baby Connections provides an assortment of therapies, including creative arts and dance classes — which the mothers attend as a group twice per week — as well as individual and couples counseling sessions that use evidence-based approaches to treat patients. The intensive program squeezes one-year worth of therapy into eight weeks, allowing women to feel better quicker and to resume therapy at their usual pace after the program ends.
Mother-Baby Connections is also helping to train a new generation of mental health professionals and allowing researchers to gather much-needed data on the understudied topic of postpartum depression. Most of all, it is giving a voice to women who assumed they would have to suffer in silence.
Giving Mothers a Voice
Bobbie Posmontier, PhD, an associate professor in the College of Nursing and Health Professions, is a midwife and advanced practice psychiatric nurse who has delivered over 2,000 babies. She has treated mothers who suffered from mental illness during and after pregnancy.
Many of the women who she worked with could not easily access the type of mental health care that Posmontier believed would be the most beneficial: treatment that focuses on a mother’s needs, while also helping improve relationships with her baby, partner and other family members.
In January, a government-appointed health panel recommended for the first time screening for maternal mental illness. And while the recommendation may encourage physicians to identify mothers affected by depression, Posmontier said handing a patient a referral slip does not often ensure she will get connected with care.
“If you screen for any kind of psychiatric illness, then the question is, where do you send them? There are very few mental health resources, especially for low-income women in Philadelphia,” Posmontier said. “There are community behavioral health centers that provide some treatment, but I believe these mothers really need specialized care.”
Aware of this gap, Posmontier teamed up with Pamela Geller, PhD, an associate professor of psychology in the College of Arts and Sciences and research associate professor in the College of Medicine, whose research focuses on women’s reproductive health and mental illness.
Together, they introduced a pilot program and began recruiting patients from the Women’s Care Center at Drexel Obstetrics and Gynecology.
“We realize that, with many women who have high-risk pregnancies, if we don’t address their mental health issues, their medical conditions are not going to get better,” said Owen Montgomery, MD, chair of the OB-GYN Department in the College of Medicine.
Mother-Baby Connections addresses four important areas — the role transition to becoming a mother, interpersonal communication, social isolation and the mental health symptoms women are experiencing. In addition, the program works on improving the attachment bonds between new mothers and their families, including the baby and partner. Group therapies and counseling sessions give mothers safe outlets to express themselves, while also providing a community of mothers who are sharing the same struggles. Mothers may also receive medication if needed to treat their condition.
Especially for mothers who have experienced Post Traumatic Stress Disorder after a traumatic birth, meeting other women in their same situation can help to validate and normalize their experiences, Posmontier said.
“A lot of times women don’t have a voice in labor. I think the providers want to make the best experience possible, but they don’t really understand what it’s like to go through that — how public and traumatic the experience can be — even if it is a healthy birth,” Posmontier said. “In this program, it’s about telling women, ‘Your experience is really important.’”
Driving Research and Education
In addition to the clinical side of the program, Mother-Baby Connections also has a mission to train new mental health care professionals and gather research data to help better understand postpartum depression.
“We have tools to identify postpartum depression, which should be instituted more regularly, but we do not have enough perinatal mental health care providers in the community to address the need,” said Geller. “Through Mother-Baby Connections, we are developing experiential learning opportunities for Drexel students in this specialized area.”
Several graduate and post-doctoral students are already working in the program, and Drexel faculty members are applying for grants to train more.
According to Geller, many studies have linked postpartum depression to cognitive, behavioral and socio-emotional impairments for the mother and child. However, more research is needed about contributors to postpartum depression, how to identify biological markers of the disorder and how to measure treatment outcomes.
“We can look at behavioral markers like impaired mother-infant interactions and reports of depressive symptoms,” Geller said. “But we don’t yet have an objective, physiological marker to say that a woman has postpartum depression and to measure whether she is getting better.”
Geller and a research team plan to work with Drexel biomedical engineering faculty to potentially come up with that marker, and they also want to evaluate the best treatment options for mothers with postpartum depression.
For current mothers in the program, they are hoping Mother-Baby Connections, and other programs like it, will encourage other mothers who are experiencing perinatal depression to seek help.
“This gives us a chance to work on ourselves, and I’m learning that’s not a selfish thing,” said one of the program’s patients. “We’re doing it for ourselves, but ultimately we’re doing it for the baby, too.”
By Lauren Ingeno, University Communications
This story first appeared in Drexel Now. Creative Arts Therapies are also a part of this interdisciplinary Program.