Maternal Mental Health

Coalition

Meeting #3: Path to Wellness

Local / hospital logo

TREATMENT

PCPs will initiate care if possible

FREE social support

Therapy is accessible / affordable

Medication management

from many providers

EDUCATION / SCREENING

Childbearing women

will receive information

about PMADs

and be screened for them

COMPREHENSIVE MATERNAL MENTAL HEALTH CARE

Goal of The Coalition

Conception to baby’s 1st birthday

Perinatal Mood & Anxiety Disorders

PERINATALConception to baby’s 1st birthday

It’s not just postpartum. It’s not just depression.

Depression

Bipolar Disorder

MOOD

Generalized Anxiety

Panic Attacks

Obsessive-Compulsive Disorder

Post Traumatic Stress Disorder

ANXIETY

4

SELF CARE

TALK THERAPY

MEDICATION

Low Cost, Low Barrier

High Cost, High Barrier

Treatment

SOCIAL SUPPORT

5

Path to Wellness

SELF-CARE

1. Sleep

2. Eat

3. Exercise

4. Time off

Mother the mother

SOCIAL SUPPORT

Validate Normalize Offer Hope

TALK THERAPY

Learn coping skills, manage emotions

MEDICATION

Safe medications during pregnancy and

breastfeeding

SELF-CARE

1. Sleep

2. Eat

3. Exercise

4. Time off

Mother the mother

MEDICATION

Safe medications during pregnancy and

breastfeeding

TALK THERAPY

Learn coping skills, manage emotions

SELF-CARE

1. Sleep

2. Eat

3. Exercise

4. Time off

Mother the mother

MEDICATION

Safe medications during pregnancy and

breastfeeding

SOCIAL SUPPORT

Validate Normalize Offer Hope

TALK THERAPY

Learn coping skills, manage emotions

SELF-CARE

1. Sleep

2. Eat

3. Exercise

4. Time off

Mother the mother

MEDICATION

Safe medications during pregnancy and

breastfeeding

SELF-CARE

1. Sleep

2. Eat

3. Exercise

4. Time off

Mother the mother

MEDICATION

Safe medications during pregnancy and

breastfeeding

TALK THERAPY

Learn coping skills, manage emotions

SELF-CARE

1. Sleep

2. Eat

3. Exercise

4. Time off

Mother the mother

MEDICATION

Safe medications during pregnancy and

breastfeeding

SOCIAL SUPPORT

Validate Normalize Offer Hope

TALK THERAPY

Learn coping skills, manage emotions

SELF-CARE

Sleep

Nutrition

Exercise

Time off

Mother the mother

MEDICATION

Safe during pregnancy and breastfeeding

Always a risk-benefit analysis

Self Care

TIME OFFNo other job is so challenging

24/7

Keeping another person alive

EXERCISELight exercise, Outdoors

Vitamin D + fresh air + change

of scenery + endorphins

SLEEP4-5 hours

uninterrupted

EATEvery time baby eats

High protein

Calories for breastfeeding

Women need

to recover

from the

physical and

emotional

effects of

pregnancy

and childbirth

Mothering the mother

How can we help new moms?▪ Hold the baby so she can shower, take a nap, go for

a walk, get a massage

▪ Take the baby out so she can be alone

▪ Stock a feeding station with water & healthy snacks

▪ Remind her she has been through a lot physically

and emotionally

▪ Help her figure out what she needs

▪ Help her find a doula or babysitter

Self Care

Social Support

EMOTIONAL

Let mom know she is valued

Create warmth, nurturing, caring

Show empathy, concern, acceptance

Provide encouragement

COMPANIONSHIP

Provide a sense of social belonging

You are not alone

INFORMATIONAL

Guidance and suggestions

Information and resources

Speak from experience

TANGIBLE

Preparing meals

Watching children

Tidying the house

Running errands

Doing laundry

The perception and actuality that one is cared for,

has assistance available from other people,

and is part of a supportive social network.

OPTIONS

In-Person

Online

Postpartum Progress

Postpartum Support

International

9

Social Support

BENEFITS

Validate

Normalize

Offer hope

Make connections

FREE!

The Gold Standard

Timing 2x/month for 1.5 hours

Location Hospital: safe, accessible, plenty of parking

well-lit, well-known, consistent

Facilitators 1 primary leader with 1 or more assistants

1 with “lived” experience

1 with mental health or medical experience

Why Consistency, ease

Partnership

Hospital gains ownership

Social Support Groups

11

Talk Therapy

APPROACHES

➢Cognitive Behavioral

Therapy

➢ Interpersonal Therapy

➢Mindfulness and mind-

body techniques

➢Other approaches

GOALS

Learn coping skills

Regulate emotions

Address underlying issues

BENEFITS

Problem-based

Time-limited

Pragmatic

Why should I see

a therapist?

▪ Objective third party

▪ Problem-solve

▪ Short-term solutions

Talk Therapy

What can a

therapist do?

▪ Create a safe space

▪ Meet moms where they are

▪ Model self-care

▪ Focus on symptom relief

This is the first time many women

experience a mental health issue

Cognitive Behavioral Therapy

▪ Largest evidence base for

depression

▪ 8-12 sessions

▪ Treatment is organized

around cognitive restructuring

▪ Notice relationship among

thoughts, feelings, behavior

▪ Develop constructive ways of

thinking to help produce

healthier behaviors & beliefs

Therapeutic Techniques

Interpersonal Therapy

▪ Only model with good

evidence in pregnancy and

postpartum

▪ 12-16 sessions

▪ Focus on relationships and

relationship problems

▪ 4 problem areas:

– Grief and loss

– Interpersonal distress

– Role transitions

– Role Disputes

Mindfulness

▪ Developing an awareness,

being present in your body

▪ Noticing / labeling thoughts,

feelings, sensations without

judging

▪ Suffering comes from

response: resisting,

struggling against, judging,

fearing rejecting

▪ Goal: change how one

relates to thoughts, feelings,

sensations

Therapeutic Techniques

Other Approaches

▪ Attachment theory

▪ Mothering the mother

▪ Trauma-based therapy

▪ Couples counseling

▪ Internal Family Systems

Medication

GOALSLimit risk of maternal illness

Minimize risk of relapse

Minimize fetal exposure

RISK-BENEFIT

ANALYSIS

RISKSRisks of MEDICATING

Risks of NOT MEDICATING

The answer is different for each woman

Medication

Which

Medication? Do not experiment

Stay on medication if it works

Use medication that has

worked in the past

Use as few meds as possible

TAKE-HOME MESSAGESThere are safe & effective medications

that women can take during pregnancy

and while breastfeeding

Treat to remission

DO NOT abruptly cease medications

Women do not have to “suck it up”

Medication Resources

Research

NIMH - EstrogenSkin patch of estradiol

SAGE-547Metabolite of progesterone

60-hour infusion

Symptom relief in 12-24 hours

Fast-tracking through FDA

www.thehummingbirdstudy.com

www.SageRX.com

PPD ACT AppQuestionnaire

Saliva sample -- DNA

EXAMPLES /

CASE STUDIES

SITUATION

No history of anxiety / depression

Very traumatic birth

Breastfeeding issues

SYMPTOMS

Sense of failure

Physical symptoms

Nightmares, flashbacks

TREATMENT

Support group

Lots of therapy

Medication

Example 1: Alice

SITUATION

Twins

History of fertility treatments

Family history of depression

Recent cross-country move

Lack of social support

Recent parental illness

SYMPTOMS

“I used to be able to do anything”

Overwhelmed / anxious

Focus on baby’s eczema

Example 2: Becky

TREATMENT

Self-care -- sleep

Help at home – nanny

Medication

SITUATION

From El Salvador

Children at home

History of sexual assault

No insurance

SYMPTOMS

Shutting down

Extreme guilt

Ignoring pregnancy

Example 3: Carla

TREATMENT

Intervention at clinic

Tex4Baby

Healthy Families

Home-based CBT