PROVIDENCE HEALTH
DECEMBER 2020
Perinatal mood and anxiety disorders are mostly invisible, but integrated care helps providers spot and treat this common problem
Throughout this ordeal, Saba remembers that the people who tended to her, from the surgeon to the nurses, were all wonderful. But looking back, what stands out to Saba are the professionals who weren’t at her bedside. There was no social worker, no psychiatrist, no mental health professional of any kind to assess her state after surviving such a trauma. Hospital representatives merely handed Saba some release paperwork, which contained a standard questionnaire about her feelings — a single sheet of paper.
“It asked me to rate on a scale from 1 to 10 a variety of feelings including sadness, fear and anxiety,” says Saba. “Of course, I felt all of those things. I’d nearly died and had just had a baby. I’d been there for five days, and I just wanted to get out of there with my baby.”
Saba’s is an extreme case of something that is all too common. Up to 80 percent of all new birthing parents feel sad, afraid, angry, or nervous in the time before or just after their baby is born. Between 10 and 15 percent of new birthing parents experience the more serious postpartum depression — as do 1 in 10 new partners. Other perinatal mental disorders include
These perinatal mental health issues impact birthing parents of every age, race, and ethnicity. And they often go overlooked or misdiagnosed for a number of reasons.
One problem is the unrealistic expectation placed on a new parent to be automatically delighted with their new baby and filled with an overwhelming sense of love at first sight. Any experience that falls short of those lofty expectations, any negative feeling or uncertainty, is ‘unnatural’ — and therefore, a source of shame for the new parent.
Coreyanne Griffin, counselor and clinical social worker with Providence Health, says the reality can be quite different. “It’s normal to struggle,” she says. “Pregnancy is the most radical thing that a human body can do, and parenting is one of the greatest challenges anyone will face.” With the spotlight invariably on the excitement of a new baby, a new parent’s misery can be overlooked. “That creates more depression and makes it harder to get help.”
There’s also a paradox prevalent in American culture in which new parents are pressured to accept the advice of experts over their own instincts and innate knowledge of their own body and their baby. Simultaneously, new parents are not encouraged to look outside the immediate family for help. The problem is exacerbated by other iniquities, such as poverty, being a racial minority, being transgender or gay, or being a single parent.
“There’s a reason they say ‘It takes a village,’” says Griffin. “In other parts of the world, you don’t have to ask for help; it’s built into the way things are. Here, you have to humble yourself.”
For instance, at every OBGYN or primary care appointment, new parents are routinely asked how they are feeling emotionally and mentally, to screen for perinatal mood and anxiety disorders (PMADs).
“It’s innovative and really effective,” says Griffin, a behavioral specialist at an OBGYN and midwifery office. “Many doctors don’t know what to do. When someone screens positive, all they have to do is call me, and I’ll meet someone right there at their doctor’s appointment and/or they can be scheduled to see me shortly thereafter.”
This initial contact is a gateway to getting birthing parents into further therapy and group sessions without having to face the stigma of asking for help. The integration has also helped doctors and other providers become more comfortable in dealing with behavioral health issues that are outside of their realms of expertise.
“Two years ago, a patient confessing to having suicidal thoughts would leave a provider scrambling because of lack of resources and training,” says Griffin. “Now they’ve become more comfortable talking to the patients and helping them.”
Eventually that comfort level made all the difference for Saba. Following the appointment with her OBGYN, she contacted one of mental health professionals he referred, but it wasn’t a good fit, and Saba terminated the relationship after a couple of months and tried to move on. But then in May 2011, a mere 13 months after her traumatic childbirth, Saba had a miscarriage. The sight of large amounts of her own blood triggered the PTSD. She rededicated herself to finding help and finally engaged a therapist who specialized in postpartum mental health and trauma.
If you or someone you know is in need of assistance with mental health concerns, please visit work2bewell.org/wellnessresources.
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It's normal to struggle. Pregnancy is the most radical thing that a human body can do, and parenting is one of the greatest challenges anyone will face.
UP TO 80% OF ALL NEW BIRTHING PARENTS FEEL SAD, AFRAID, ANGRY, OR NERVOUS IN THE TIME BEFORE OR JUST AFTER THEIR BABY IS BORN
In 2010, Timoria McQueen Saba was in the hospital having just given birth to her first child when she suffered a postpartum hemorrhage. She underwent emergency surgery to stem the massive loss of blood. She almost died.
A few days later, Saba's OBGYN called to ask her how she was doing. She had changed, she told the doctor. She was getting only 45 minutes to an hour of sleep each night, scant even for a new parent. She was also suddenly afraid to leave the house and obsessed with locking her doors, checking and double-checking them over and over. She would bleed in the shower, the sight of dark red triggering tears and sobbing. And she kept replaying the events of what happened in the hospital in her mind. The OBGYN told Saba that this sounded like something other than postpartum depression — it seemed like she was suffering from a form of post-traumatic stress disorder. He urged Saba to come into his office where they could discuss connecting her with a mental health professional.
pregnancy and postpartum anxiety, obsessive compulsive disorder, bipolar mood disorder, and postpartum post-traumatic stress disorder.
In other parts of the world you don't have to ask for help; it's built into the way things are. Here, you have to humble yourself.
Another major complication is the fact that these perinatal mental disorders are not always conspicuous. If the birthing parent is too frightened or unaware to seek out help on their own, they will be reluctant to reveal it. It’s then up to their healthcare professionals to spot signs of trouble during routine appointments. But pediatricians and OBGYNs aren’t mental health professionals. The expertise lies elsewhere.
Providence aims to overcome both obstacles through a behavioral health integration program. They are working to place behavioral health professionals in every clinic, across the healthcare system, in order to have treatment readily accessible to all patients and providers. These are general social workers, clinical social workers, and psychiatrists who are in the office and on a first-name basis with the providers who can offer help when needed.
But it was that seemingly routine call from her OBGYN following birth of her first child that made the difference. The doctor suspected that Saba was not experiencing depression, but rather a form of postpartum PTSD. That insight led Saba to a breakthrough. Today, she is an advocate, writer, and speaker specializing in perinatal mental health.
“When I found help, I finally felt validated,” says Saba. “Now I continue to share my story in a way that will validate what other mothers have gone through.”
For more information and resources visit Postpartum Support International.
Please know there’s always help available whenever you need to talk to someone. Reach out to the Crisis Text Line (Text TALK to 741741) or the National Suicide Prevention Lifeline at 1-800-273-TALK to talk to someone who can help.
If you or someone you know is in need of assistance with mental health concerns, please visit work2bewell.org/wellnessresources. Please know there’s always help available whenever you need to talk to someone. Reach out to the Crisis Text Line (Text TALK to 741741) or the National Suicide Prevention Lifeline at 1-800-273-TALK to talk to someone who can help.
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