As a young woman, Jennifer Ford struggled with anxiety and depression. When she was pregnant, her doctor recommended that she stay on the antidepressant she had taken to manage her symptoms.
Her first pregnancy and childbirth went smoothly, she says, but things were different after she gave birth a second time. "It's when I hit my wall," said Ford.
She remembers feeling overwhelmed by sorrow, just after going home.
"I couldn't tell a full sentence about how I was feeling," said Mind. "What I could do is cry."
She was not able to eat, sleep, do not take care of her newborn.
One evening, she was in her bedroom trying to take the stairs, but she could not sleep – she felt her feelings were overwhelmed. "I wanted to take all my pain and go to bed," she says. She wanted to end her suffering.
But instead, she went into the kitchen where her husband was, and he told him how she felt. "That was when it was like" OK, obviously something must change here. We're going to get help. And we have to get it now. "
Her husband made an appointment with OB-GYN, Dr. Christopher Conlan.
"She came in and I could see her face immediately that she had a very difficult time," recalls Conlan. "She needed help and she didn't know where to go."
Conlan gave Ford a standard depression questionnaire confirming her post-year depression.
But it was about how to deal with her loss. Like most OBs, he was not trained to provide mental health care.
"At that point, the tools I had in my daily practice were used," he says.
The story could be finished there. Around the country, it is estimated that 1 in 7 pregnant women and new mothers receive clinical poverty during pregnancy or a former member. However, their main point of contact in the medical system – their obstetricians – often do not have the skills to address this common problem. As a result, few women receive a diagnosis or treatment. According to one study, less than 20% of women are treated.
Luckily for Ford, Dr. Conlan had other resources to go. Recognizing the importance of the midwife's relationship with patients who are pregnant and with new moms, a statewide program in Massachusetts provides support to obstetricians and gynecologists in screening and dealing with depression among pregnant women and new moms.
“Every time a midwife provider sees a woman, it is an opportunity to detect depression, teach them and really engage them,” says psychiatrist Nancy Byatt at the University of Massachusetts Medical School, who helped to launch the program, called the Massachusetts Child Psychiatry Access Program for Moms, or MCPAP for Moms.
MCPAP runs for Moms training sessions and provides tools for physicians, midwives and nursing practitioners in midwifery practices across the state to help them identify symptoms of depression in pregnant and new moms. It also runs a helpline for practitioners to link with psychiatrists for advice on patients' symptoms and treatment.
So that day when Ford needed help, Conlan called on the helpline and got a link with an on-call psychiatrist. Before Ford left his office that day, he established her help.
In the six years since the program was launched, "we have 74% of the practices (DA) registered in the state, which covers 80% of deliveries," Byatt says.
And the program is now a model for a national plan to address maternal mental health as part of the 21st Century Care Act. Seven states, including Florida, Kansas and Louisiana received funding through the action to develop modeled programs after the head in Massachusetts.
Similar programs are already in place at Washington and Wisconsin states.
Maintenance for doctors
Women like Ford, who have a history of depression during pregnancy or after birth, have a higher risk of depression, known as perinatal depression.
Untreated perinatal depression affects not only maternal health, but also the social and emotional well-being of all her children and families. It can increase the risk of miscarriage and low birth weight. And when a new mom is depressed, she affects her ability to care for her child and her band. This can affect the physical and emotional development of the child and even put them at a higher risk of mental health problems later in life.
And there is a cost without treating perinatal depression, says Dr Tiffany Moore Simas, an associate professor of obstetrics and gynecology at the University of Massachusetts Medical School, and director of participation with MCPAP for Moms.
One study estimated that the state of California cost $ 2.4 billion for all births in 2017 when untreated disorders had gone and pine, where pairs of infants were followed for 5 years.
Despite the health care costs associated with perinatal perinatal depression, a program like MCPAP for Moms is still rare. Ideally, pregnant women and new mothers would find depression a psychiatrist, says Byatt. But there is a shortage of mental health care providers in the country – it is difficult to find a provider and to find a timely appointment and difficult, especially when someone is depressed. The stigma surrounding this depression also prevents women from seeking help.
For all these reasons, Byatt says that medical authorities, including the American College of Obstetrics and Gynecology, recommend that OB-GYNs will screen their patients for depression and help them to receive treatment.
When Byatt started her initial research on perinatal depression, she began chatting with OBs in the state to find out if they were screening women. She learned quickly that most doctors did not feel comfortable screening, although they wanted to help them.
"They said we'd like to address this. We think it's so important. We don't know what to do. We're not trained, we don't have the resources," Byatt recalls.
Dr. David Klein, OB-GYN, in Mass, Mass., That he began screening women and postpartum women for the first time about 12 years ago. "But it was stronger then," says Klein. "I used it when I thought someone had a question (with depression)."
But, he says, it wasn't easy, because he wasn't trained to provide mental health care. If one of his patients examined positive for perinatal depression, "the question was okay, now what do I do?" "He says." It was very difficult to find someone to help me help her. "
Klein would have to make numerous calls to get a psychiatrist who was taking a new patient and to accept his patient's insurance.
"It was a great effort for me to find someone," said Klein. "Fortunately, over the years I found a small network that I could use, but still, it was an attempt to connect with those people and ensure that the patient is being cared for."
When Byatt spoke to OBs during her initial research, they told her that they would be more willing to refined perinatal depression and treatment if they had more training and support.
"We need the life, basically they said," Byatt says.
How it works
Byatt and his colleagues in the University of Massachusetts Medical School aimed to create this line of life. They launched the helpline for doctors, ran training sessions and provided a toolkit to educate and treat physicians and nursing practitioners about perinatal depression.
If the doctor has patients who give a positive view of perinatal depression and are not sure how to treat it, they can call the helpline at 1-855-Mom-MCPAP (1-855-666-6272) from Monday to Friday, 9 am to 5 pm, for telephone consultation with a psychiatrist. The goal is that “one of our psychiatrists will call them back within 30 minutes,” says Byatt. "Basically, we are holding their hands and helping them to work out how to help the patient out."
Where necessary, the psychiatrist carries out a one-to-one consultation with the patient within a week or two. And the program's resource and referral specialist helps the patient to get a longer-term mental health care provider – individual or group therapy sessions – and support groups close to her.
While the helpline has been created primarily for midwifery providers, it is also open to paediatricians, primary care providers and other psychiatrists. "Any provider from the state who attends a pregnant woman and postpartum can call our program," Byatt says.
The program is funded by the Massachusetts Mental Health Department. State law, however, requires insurance companies to pay part of the annual cost of the program, depending on how much of their clients use it, says Dr. John Straus, founding director of the Massachusetts Child Psychiatry Access Program, has produced a blueprint for MCPAP for Moms and is designed to increase access to pediatric healthcare in the state.
Usually they cover about 50% of the annual costs, Byatt adds.
Until recently, the annual budget for MCPAP for Moms was about $ 850,000, says Byatt. In 2018, the program received an additional $ 175,000 to expand services for substance misuse among pregnant and new mothers. The program currently runs for $ 1 million per year, or about $ 1.16 per month for each woman served, gives Byatt a note.
Her helpline has been greatly influenced by the helpline, Klein, the midwife in Mass, Mass. "I will talk to a psychiatrist within two hours. We will talk about the case, make a plan and take care of the patient."
These days, he regularly examines his patients for perinatal depression. " I think it's like any other screening now, ”said Kelin. "I am very comfortable talking to women about their mental health."
This is true of OB practices across the state, says Moore Simas.
"We are finding that OBs are willing to prescribe drugs led by our perinatal psychiatrist, during which time a patient is waiting to see a psychiatrist," she says.
And they are still becoming more comfortable dealing with more complex mental health issues in their patients, byatt adds to it.
"We have some practice (if) if a patient has a bipolar disorder, it is managed, because it is difficult to find a psychiatrist," she says.
And the mindset has risen among the physicians raising awareness in women and breaking down some of the stigma, Klein says.
"Patients don't feel more embarrassed … to talk about it," he says. "They are very comfortable starting medication and they are very comfortable looking at a consultant."
Conlan has also noticed a change in attitudes among its patients.
"Patients now know that this is a very common issue, they are not alone. And that it is best to talk and that we can help," he says. "They do not need to suffer in silence."
"People were on my team"
After her second baby was born, Ford did not even consider the possibility that she could become depressed and needed help, although she had been depressed before and had received treatment.
"It is very difficult to admit that something is not right … when you have a new baby in the house," she says. "It is supposed to be this amazing happy time, and not so it was."
But when she went in to meet her doctor, Dr.. Conlan, and he received a psychiatrist on call, the psychiatrist recommended that Conlan Ford prescribe a different antidepressant and made an appointment to see her in a few weeks.
By the time she left Conlan's office, Ford says she was very happy with all the support. "I really felt that there were people on my team," she says, "I was not alone in my room, feeling like a terrible person and a terrible mom."
MCPAP for Moms also linked it with a social worker, who helped her find a longer-term therapist and a local support group for moms with post-natal depression.
The changes in medication, the visit to the psychiatrist, the mother support group, all helped her to manage her depression and eventually recovered from her. She began to feel better within a few weeks.
“I had the time to blow my hair, simple things,” she recalls. "I was taking the time to brush the floor, or make my makeover or wear something other than pajama pants."
And she was starting to care for her girl and her bonds with her.