When Liz Friedman gave birth to her first child seven years ago, she experienced what she calls a "severe post-partum crisis." She felt isolated and alone, a problem exacerbated by her partner's demanding work schedule. She was mourning the loss of an uncle who'd died shortly before her child's birth. She went for days without sleep.
It's hard to describe any person going through such difficulties as lucky. But Friedman was fortunate in one very important way: her healthcare providers were able to identify what she was going through, and refer her to a well-regarded postpartum depression treatment program at Women and Infants Hospital in Providence, where she was living at the time.
A few years later, Friedman moved to the Valley, where she found a much less promising picture for new mothers experiencing emotional difficulties. At the time, she says, there were no postpartum support groups in the three Pioneer Valley counties; indeed, she says, there was none in the region stretching from Worcester westward to Albany, or anywhere in the states of Vermont and Connecticut. That left a significant number of women without ready help; a 2008 CDC report that looked at pregnant women in several states found that between 11 and 20 percent experienced postpartum depression.
Three years ago, Friedman helped start the first postpartum support group in the Valley through MotherWoman, an Amherst-based nonprofit. Today she's coordinator of the organization's Postpartum Support Initiative, which runs several local support groups.
That's great news for new mothers in the Valley—at least, those who find their way to the services. But as Friedman and others engaged in the issue have found, too often women who are struggling with postpartum depression fall through the cracks—because their doctors don't recognize what they're going through, or don't know where to send them for help; because their insurance provider doesn't cover treatment—with potentially devastating consequences for them and their babies.
New state legislation proposed by state Rep. Ellen Story (D-Amherst) would close many of the holes in that still-developing support structure by providing universal screening of new moms for postpartum emotional problems, to be covered by insurance companies.
Story and her staff began working on her bill a couple of years ago, after meeting with MotherWoman members and following the media coverage of some high-profile stories about postpartum depression. (Story points, for instance, to actor Brooke Shields' disclosures about the crisis she underwent after having her first child.)
Story didn't experience depression after the birth of her own two children, who are now adults, she says. But she did have friends who struggled after becoming mothers, from relatively mild cases (what's commonly, and sometimes controversially, called the "baby blues") to instances of severe depression—more specifically, as Story puts it, "major depression with extremely bad timing."
Symptoms of postpartum emotional problems can fall along a fairly broad range of responses. The Mayo Clinic describes three categories: "Baby blues," which last only a few days or weeks, include mood swings, trouble sleeping, anxiety, crying jags. Postpartum depression, which lingers and can prevent the mother from properly caring for her baby, involves typical signs of depression, such as a loss of appetite, profound fatigue, feelings of guilt and inadequacy, as well as thoughts about hurting her baby or herself. Postpartum psychosis—which, according to the Mayo Clinic, is rare and usually occurs within the first weeks after birth—can involve feelings of paranoia and delusions, and actual attempts by the mother to harm herself or her child.
"The timing is so bad, because [new mothers] think they should be feeling euphoric, and they feel tremendously puzzled and worried about why they feel so bad," Story says. "They wanted this baby so much, and now they wish it would go away." Compounding the problem are the challenges faced by new parents: lack of sleep, hormonal shifts, financial pressures if they've taken time off work, a sense of isolation. Meanwhile, once a baby's born, the attention—of friends, partners, healthcare providers—often shifts from the pregnant woman to the new child, which can make it harder for someone to notice when the mother is in crisis.
Story's bill aims to identify women who are having emotional difficulties early on. The legislation calls on the Department of Public Health to train obstetricians, nurse midwives and pediatricians on maternal depression, including screening techniques.
It would also require insurance providers to cover at least seven screenings, starting during pregnancy and continuing into the child's first year. While MassHealth already covers screenings, Story says, there's no guarantee private insurers will. That, she says, leaves some doctors searching for ways to submit requests for coverage under existing billing codes that are legitimate but that are often overlooked for postpartum depression cases.
Universal screening of all new moms means that women won't feel embarrassed or ashamed if their doctor singles them out for the screening, says Friedman, of MotherWoman. It also ensures that women with problems won't slip by unnoticed.
"Women [who are depressed] tend not to give very clear signals," Story says. "They will say they are fine. They bring the baby in for the well-baby check and … the doctor often doesn't take time to say, 'Well, so how are you? Tell me, how are you feeling?'" As a result, women might go weeks or months before their problem is recognized and addressed.
Story's bill also calls for DPH to establish a task force to strengthen the network of support services and to look into promoting education about postpartum depression in medical schools, among other measures.
Treatment could mean hospitalization, medication, therapy, depending on the individual woman's need. Support groups can be invaluable, too, providing a place where mothers can speak honestly about their struggles, "so they understand that they're not the only one, and also [to alleviate] their worst fears, that they're really, deep down, a terrible person," Story says.
Early detection and intervention is key, she adds. "The benefits of this are obvious. If the mother and child don't bond, there can be lifelong effects on both of them, but especially the child."
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When MotherWoman started its first postpartum support group three years ago, "a movement was really born," says Friedman (who is also coordinator of the Western Mass. Pregnancy and Postpartum Support Coalition).
That first group, in Amherst, would bring women from as far away as Longmeadow, Pittsfield, Brattleboro—some of whom had gone months before finding the support they needed, Friedman says. "They were desperate for any kind of support."
Today MotherWoman offers groups, run by trained facilitators, in Northampton, Holyoke and Springfield, with a new group to start soon in Greenfield, Friedman says. In addition, the Prison Birth Project offers a group for incarcerated mothers at the woman's jail in Chicopee. (For more information on local resources, see sidebar.) MotherWoman also trains health care professionals and others who work with new mothers, like WIC employees, on how to detect signs of postpartum problems and where to refer women in need.
MotherWoman's approach to postpartum issues, in keeping with the organization's larger mission, looks at the social factors that make the post-birth period especially difficult for women in our culture—and for some women more than others. Friedman points out that postpartum depression rates are higher in some populations than others. The 2008 CDC report, for instance, found the problem was more common among teen mothers, those with less than a high school education, Medicaid patients, women who'd been physically abused and women who'd experienced financial stress while pregnant.
"Don't tell me those women are going through more hormonal shifts than the larger population," Friedman says. Rather, she suggests, certain mothers are at particular risk because they are already deeply affected by the lack of public policy—on healthcare, on childcare—that supports families. "The strain of that goes on to the mother," she says.
Story's bill joins other efforts to improve postpartum support, from the Melanie Blocker Stokes Mothers Act, part of the pending federal healthcare overhaul, to the Andrea Yates Bill, which passed in Texas in 2003. In both those cases, Friedman notes, the laws were born of tragedy: Yates is the mother who drowned her five children in 2001, while in the throes of postpartum psychosis; that same year, Blocker Stokes, an Illinois woman, committed suicide while suffering from severe depression after the birth of her daughter.
"In most other states, [these bills were] inspired by tragedy," Friedman said. With Story's legislation, Massachusetts has the opportunity to offer new mothers help before another tragedy occurs.
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The Bill
House Bill 3897: An Act Relative to Post-Partum Depression will have a public hearing before the Joint Committee on Financial Services at the Statehouse's Gardner Auditorium at 10 a.m. on Jan. 27. The committee is chaired by state Sen. Stephen Buoniconti, a Democrat from West Springfield; Sen. Michael Knapik, a Westfield Republican, also sits on the committee.
The bill was introduced by Rep. Ellen Story (D-Amherst) and has 20 co-sponsors, including, from the Valley, Reps. Cheryl Coakley-Rivera (D-Springfield), Peter Kocot (D-Northampton) and John Scibak (D-South Hadley).
MotherWoman, Inc., of Amherst is organizing car pools for bill supporters who would like to attend the hearing, and for those who'd like to participate in a press event about the legislation. For information, call 413-253-8990.
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Where to get help
MotherWoman of Amherst offers several support groups for mothers around the Valley, as well as a resource guide to other services. Call 413-253-8990 or go to www.motherwoman.org.
Cradle, a maternal wellness center at Thornes Marketplace in downtown Northampton, offers a free emotional wellness drop-in program for pregnant women and new mothers every Thursday at 1 p.m. The program, run by Nicole Stevens, a licensed social worker, and cosponsored by MotherWoman, "is designed to assist pregnant and postpartum women to connect with resources to assist them in achieving emotional wellness." No appointment is necessary. For information, call 413-341-5282 or go to www.cradlefamily.com.
