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We Need Better Mental Health Care for New Moms

Anxiety and depression affect between 10 and 25 percent of women during pregnancy and after childbirth. Throw a global pandemic like COVID into the mix and those numbers have skyrocketed.

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At around six months pregnant with my third son, I started getting anxious.  I laid in bed at night unable to sleep, replaying the same scenario in my head: I was speeding down the highway on the way to the hospital in labor, but I didn’t make it in time and had the baby by the side of the road.  This anxious thought then spiraled into other anxious thoughts, and some could get pretty dark – what if I couldn’t cope with three children?  What if I couldn’t get an epidural in time for the delivery? What if all my children died in infancy?  How was I meant to feed a newborn baby and watch a toddler run around in a building site?  Fun fact: during my pregnancy, while also having a toddler, a child, and a job, my husband and I decided to renovate our home.  

Unlike other sensible people, we stretched our budget as far as it could possibly go, which meant we had to live in our house during the renovation.  Highlights of this living arrangement included having no kitchen, washing up in the bathtub, losing air conditioning in most of the house for the three hottest months of the summer, and all sleeping in one bedroom.  Pregnancy had also never served me well.  I was never one of those glowing women who felt she was living her best life growing a child to bring into the world – I was quite the opposite; pregnancy and I fell out a long time ago.  If you open a medical textbook about  all the complications you can get while pregnant, I probably hit a good 75 percent  of them.  gestational diabetes to migraines, to acid reflux and  sciatica, to early signs of labor, and my favorite – shingles – the list just went on.  It wasn’t a huge surprise then, that given a third pregnancy, complications, a renovation, and a busy family life, I was feeling an elevated level of anxiety.

At a routine appointment, I decided to raise this with my OBGYN.  Being British, my delivery was couched within an apology, “I’m so sorry to bring this up, I know you’re super busy, but I haven’t been sleeping well and I keep getting these thoughts that I get fixated on….”  I really liked my OB.  Medically, she was absolutely awesome.  But her efficient response to this was to promptly say I could either take anti-anxiety medication or try an app like Headspace or Calm to help reduce my stress levels.  She also said we should sort this out pre-baby as anxiety is statistically likely to persist after pregnancy.  I agreed to the anti-anxiety meds prescription.  I picked up the prescription, but then the medicine bottle sat on my nightstand unopened until my next OB appointment.  

Why didn’t I take them?  Honestly, I was petrified.  I didn’t understand the possible side effects, how they actually worked to reduce my anxiety, and what I’d do in the event that  they didn’t work.  Ironically, I was having anxiety about the anxiety medication. It wasn’t surprising that by the next appointment, my anxiety hadn’t  improved.  I waited for the question on how the medication was going.  It never came.  As someone who has worked in healthcare my entire career, I should have felt empowered to advocate for myself.  But I felt shame that I didn’t have my shit together, especially as a woman on her third baby who at this point should be a child-rearing pro.

At 35 weeks, my body decided to go into early labor.  My husband drove us to the hospital and we successfully made it – no child was delivered on the highway that day, or at least not by me.  William was born 13 hours later and as a preemie he was taken to NICU, while I was taken to a room in the maternity wing.  I wanted to nurse him, but as he was in NICU, I had to pump.  Anyone who’s given birth knows how much of an exhausted fog you’re in afterwards, so when the nurse brought me the breast pump and declared something along the lines of “you know how to do this as it’s number 3, I’ll be back soon for the milk,” I felt a strong sense of total bewilderment. How do I  put this  thing together?  How long do I  use it for?  The next morning, I visited Wills at 8 AM to be told that two hours earlier he had stopped breathing, but all was apparently now well.  At 10 AM I’m back in my room on the phone with the building inspector about our repeat footing inspection for the 10-foot hole in my backyard.  I’m then on a Zoom conference call interviewing a potential au pair to join our family. Clearly not the right actions in retrospect.  That morning, a nurse asked me to complete some forms including the Edinburgh Postnatal Depression Scale (EPDS), a standardized measure given to all new mothers at the hospital.  I contemplated lying but decided to push aside my feelings of shame and answer the questions honestly.  The nurse scored the questionnaire and told me I had met the threshold to meet with a social worker.  I agreed to meet with one.  

The next morning was the day I was being discharged and I decided it was time for a good shower.  New moms, you will know and empathize that your  first shower experience resembles a graphic scene from a horror movie.  While in the shower there is a knock at my hospital room door – it’s the social worker.  Only I’m in the shower, post-childbirth which isn’t the time to shout out “wait a minute,” jump out of the shower, grab a towel, and answer the door.  Needless to say, I didn’t make it to the door, and I didn’t ever hear from the social worker again.  That afternoon I was discharged, without a baby – the worst feeling ever.  My husband drove us home to our building site of a house and our other two kids, and I was totally and utterly overwhelmed, exhausted and full of guilt.  Three hours later, I drove back to the hospital on my own to be with Wills in NICU.  Why am I driving 16 miles alone so soon after giving birth? Because obviously I’m completely fine.  I arrived at NICU just at the time of a shift change so I waited, starving (the cafeteria happened to have just closed), alone in the waiting room for an hour before I was allowed in.

Anxiety and depression affects between 10 and 25 percent of women during pregnancy and after childbirth.  Putting that into real numbers mean that approximately 380,000 to 950,000 women a year experience anxiety and/or depression during the time they have a newborn.  Throw a global pandemic like COVID into the mix and recent studies show that number has skyrocketed to 57 – 72 percent for anxiety, and 37 – 40 percent for depression. Wills stayed in NICU for six nights before we got to take him home.  I wasn’t due to see my OB for a month (yes non-baby friends, no one is going to routinely check on you for one month), so the first clinician I saw was the breast-feeding specialist I opted in to see at the hospital three days later.  We sat in the appointment and the first thing she asked me was, “how are you?”  That phrase led me to breakdown into a silent slow but bizarrely contained sob of tears.  

Upon her, my husband and I agreeing I probably wasn’t ok at this point  – she gave me a nine-page long list of therapists whom I could contact.  Please do honestly tell me, what part of a newborn has the time and mental bandwidth to: a) determine which kind of therapy option is right for them, b) call each therapist on the list to determine if they are still practicing, have an appointment availability, take the right insurance and are easy to get to, c) are actually a good quality provider?  Needless to say, that list sat on top of my dresser until I threw it in the trash months later.  My first pediatrician appointment for Wills was the following day.  When the pediatrician asked me how I was doing; I used my favorite word again, “fine”, while fighting back the tears from behind my eyes.

As one point of international comparison here, I had my first son in the UK.  For all the inadequacies of the National Health Service (sorry – no routine epidurals or private rooms there!), after discharge from hospital, you get a series of appointments with a health visitor – a part-nurse, part-social worker who is responsible for checking on and discussing your mental wellbeing as much as your baby. The National Childbirth Trust (NCT) also exists in the UK; a charitable organization which runs labor and birth classes, but is really there for the support group of new moms you take the classes with – there is an implicit assumption of taking NCT classes that you will all regularly meet up, and there is nothing like having the support of other new moms at exactly the same stage as you when you’re caring for a real human being for the first time, and much of the time (or at least in my case) with zero percent experience.

Over the coming weeks, I mobilized in the ways I knew how. I spoke with friends to talk through my feelings and  walked around my neighborhood pretty much every day. I cried a lot, but had caring friends who bought food every evening for me and my family, and leaned on my husband for a huge amount of emotional support. I went about my daily activities, my mom came to stay to help, and I had a completely chance encounter with a trainee therapist who made it so easy for me to meet her so we could talk.  I was very fortunate to have the time, resources, support network, and economic means to use in my situation.  I came out the other side intact.  But what if I hadn’t?  What if this story had ended another way and my anxiety worsened which had serious consequences for my long-term mental health and the wellbeing of my newborn baby? 

As a healthcare system, we should be making it really easy and simple for expectant and new moms to access and receive high-quality care in a method that’s right for them.  In the story above, I listed five missed touchpoints where healthcare professionals could have offered me better access to mental health care, but in reality, I must have had over 30 touch points overall.  Stories shared by other moms and the statistics tell me I am far from alone in my experience.  It greatly worries me what this says about the prioritization of mental health needs during this vulnerable time for expectant moms.

I’m very proud to work for Quartet – a truly mission-driven organization that is focused on making it easy for people to access high-quality behavioral health outpatient care.  When I went through my interview process at Quartet I thought a lot about the story I have outlined above – as I learned more about what Quartet does I felt more pulled to the mission as I had experienced firsthand the challenges of accessing care.  If Quartet had been involved in my story, at that first OBGYN appointment when I said I was anxious, my OB could have referred me to behavioral health care with about three clicks on her computer.  Then I would have been matched to the most appropriate high-quality care option for me (based on my preferences for care, and my OB’s clinical recommendation) and supported through that process to get the care I needed.  That sounds like a simple process to the member, because it is – the member pathway is designed to be as easy as possible while Quartet’s technology does all the hard work on the backend.  Then once I had accessed care, Quartet’s technology would have allowed my OB to be part of my collaborative care team, see updates on my care/treatment, and share information as needed.  I don’t want our healthcare system to fail any more new moms.  The time is now to do better.

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