Having a baby is a huge life alteration - who wouldn't be at least a bit anxious? The vast majority of women experience mood shifts surrounding pregnancy: Around 80 percent experience "baby blues," and in up to 20 percent this develops into something more serious. But most of these women go untreated, and many undiagnosed.
The California Maternal Mental Health Collaborative (which is changing its name to "The 2020 Mom Project" as they expand outside California) is spearheading efforts to get the word out about perinatal mood disorders. Last Friday, they hosted a seminar on emerging considerations in maternal mental health. As a birth doula, I was particularly happy to listen in. The keynote speakers approached the issue from a pointedly broad perspective, considering the social, economic, and cultural factors that influence health problems and care provision. The take-home message was that to address perinatal mood disorders, we need to address the context in which they happen, including protecting tomorrow's moms while they are children today.
Vincent Felitti, MD, professor of medicine at UC San Diego and founder of the California Institutes of Preventive Medicine, has done extensive research on how "adverse childhood experiences" affect health by correlating an "ACE score" of self-reported negative experiences such as abuse, neglect, or household dysfunction with incidence of disease. The top-10 causes of death in the U.S. are strongly correlated with high ACE scores. Moreover, so are their risk factors! Much abuse of alcohol, drugs, and food is a coping mechanism for prior traumas. "What we see as the problem turns out to be somebody's solution to problems we know nothing about," Feletti said. "Depression is considered a disease, but what if it was a normal response to adverse life experiences? ACE score statistics support this."
In a similar vein, Calvin Hobel, MD, an obstetrician-gynecologist at Cedars Sinai Medical Center in Los Angeles, spoke about how maternal stress surrounding pregnancy causes complications and adverse child outcomes, including premature birth. Stress causes uterine irritability, which causes cervical changes that favor pre-term delivery. It signals to the placenta that things aren't going well, and the baby better get out early. Just as soldiers with stressful backgrounds are more at risk for PTSD, moms who've had a rough life are more stress-reactive and less prepared to cope with the demands of motherhood.
According to Neal Halfon, MD, professor of pediatrics, public health, and public policy at UCLA, there is a catastrophic loss of Americans' health potential in the first five years of our lives. Directing our attention to childhood living conditions and stresses is the best way to treat the well-being of our future adults (including moms). Halfon sees modern medicine as having three eras. The first era was about reducing deaths: emergency medicine and public health. Hospitals were built like factories, and insurance was designed for catastrophes. Later, medicine became about prolonging life. Chronic diseases have become the most pressing problems, and new research focuses on screening and long time horizons. Financing has changed to a prepaid corporate model. He claims we now need to transition into "version 3.0" and optimize life. This life course model would treat infants in ways that promote them becoming healthy adults taking protective measures and creating a social scaffolding that helps youth in high-stress environments "withstand earthquakes." The cost curve will be reformed by shifting expenses upstream, before stress has become manifest `in lifestyle and bodily symptoms.
"This is not about individual people" Halfon said, "but about all of us and how we're going to shift the curve."
But what to do in the short term? Marguerite Morgan, PhD, with Early Childhood Services in Grand Rapids, Michigan, discussed how she implemented a successful community maternal-health program. It takes a holistic approach and molds itself to the culture of the African American community it serves. Something as simple as having the maternal mental-health clinic housed with the pediatrician's office has significant effects by enabling women to work around the stigma attached to mental-health issues. The 2020 Moms project proposes simple actions like posting awareness flyers in exam rooms, giving providers resource lists to distribute, encouraging insurance companies to note maternal mental-health specialists in their provider lists, and turning off the lights in postpartum hospital units to keep it quiet so new moms can sleep.
The 2020 Moms project is supported by local alliances across the country, including the nearby Santa Cruz Perinatal Mental Health Coalition. The National Coalition for Maternal Mental Health was formed in 2014 as a result of their efforts, drawing people from the American College of Obstetrics and Gynecology and Postpartum Support International, among others. At Stanford, the Women's Wellness Clinic is an excellent resource. As the clinical section of the Stanford Center for Neuroscience in Women's Health, it has been treating mood disorders in women for over 20 years, specializing in medication and psychotherapy during pregnancy and postpartum.
Previously: "The child is father of the man": Exploring developmental origins of health and disease, Helping moms emerge from the darkness of postpartum depression, A call for depression screening for pregnant women, moms, Depression in pregnancy: To treat or not to treat?
Photo by enviied