In Georgia, mental health conditions are the second-leading cause of pregnancy-related death. But mental health is often overlooked during and after pregnancy.
Now, the Northside Hospital system is trying a new approach, offering a program of parent-infant psychotherapy to care for women’s mental health, in hopes of also promoting their infants’ development. Northside has a massive footprint in Georgia, with five acute-care hospitals and nearly 300 outpatient facilities spread across 25 counties and serving over 5 million patients annually.
For first-time Atlanta mom Chandra, therapy has been a lifeline. Her daughter is a couple of years old now, but especially in the beginning, Chandra said she experienced anxiety. Sessions with a therapist helped her navigate difficult family dynamics.
“The biggest thing that I have learned and that I have been able to take away and benefit from is being able to establish timelines and boundaries,” said Chandra, “and giving myself grace — being OK to say, just because I was raised a certain way does not need to be the experience that I create for my child.”
‘There’s no such thing as perfection in parenting’
Chandra, 36, who didn’t give her last name to protect her daughter’s privacy, said therapy also helped her tune out unsolicited advice.
“The stigma for Black women especially is that you have to be a strong person, you’re to raise your kids, and all of these generational ideologies, if you will, that are passed down, that you have to rear your children in a certain way,” she said. “There’s no such thing as perfection in parenting. The needs of my child and making sure that I’m able to be my best self for her is what’s important.”
Chandra is participating in the recently-launched program at Northside. The perinatal mental health program offers one-on-one psychotherapy for pregnant patients identified as potentially high-risk for depression and anxiety. And after the babies are born, parent and child attend therapy sessions together.
“With both infant and mother present, we can observe how that infant is connecting with the parent, whether that mother, that parent is aligned with understanding that baby’s cues,” said Dr. Avivah McPherson, who started the program. “If they’re not, we offer developmental guidance and offer interventions to help support the mother with understanding how that baby is communicating.”
Promoting the connection between mom and baby
Early intervention is critical when a parent is experiencing a mental health condition, said McPherson, a Northside psychologist specializing in pediatric primary care and infant and early childhood mental health.
“The perinatal period is one of the most risky times for infant development,” McPherson said. “When a mother experiences psychiatric illness, it risks the establishment between the relationship with mother and child.”
It can interfere with breastfeeding and how postpartum moms relate to their babies, and affect a child’s development over time. And when women with a history of trauma have kids, she said, their babies can be at higher risk for problems, too.
“What we begin to see with infants who are experiencing trauma in their environment, we may see delays in things like their speech, language acquisition, motor and physical functioning, emotion regulation, cognitive processing,” McPherson said.
The program’s goal is to promote the connection between a mom and her baby, and to improve the baby’s chances for a healthy early development stage free of adverse childhood experiences, which are associated with poor health outcomes.
New program starts small with several dozen patients
Northside’s perinatal mental health program is the first of its kind in Georgia. It’s currently treating about 40 patients. The number is a drop in the bucket.
Georgia’s maternal health crisis is among the worst in the country, particularly for Black Georgians, who die during and after pregnancy at much higher rates than other women in the state.
So, to reach other pregnant patients, Northside Hospital also offers a class called Mommy Bootcamp.
That’s what led a half-dozen pregnant women to a nondescript clinic conference room in Alpharetta on a recent Saturday morning. The class is designed to help prepare pregnant women for the challenges of parenting and to share the science behind maternal mental health changes.
Neonatal intensive care unit Registered Nurse Andrea Furman stood at a whiteboard, pointing to a diagram of the postpartum brain.
“You’re going to experience mood swings, anxiety, irritability, a little bit of insomnia, which seems weird, like I should be exhausted,” Furman told the group. “Usually I hear it described as, I’m crying and I just don’t know why. And I’m like, it’s hormones.”
These symptoms are often called the baby blues, and they are temporary, Furman said.
It’s critical, she said, to watch for other, more lasting symptoms that could signal something much more dangerous for women and their infants — perinatal and postpartum depression and anxiety.
The symptoms could include feelings of hopelessness, thoughts of suicide or harming the baby.
“The baby blues will go away on its own,” Furman said. “The postpartum mood disorders — they have to be addressed in some way or another, that’s not something that goes away on its own,” Furman said.
Northside RN advises making an emergency plan before delivery
Extreme symptoms can appear anytime in the year after childbirth, according to the American College of Obstetricians and Gynecologists, or ACOG. And data from the National Institutes of Health show roughly 1 in 7 women develop postpartum depression.
To prevent it, experts recommend screening OB-GYN patients for mental health conditions, and treatments include therapy and antidepressant medications. Yet, pregnancy-related mood disorders too often go undiagnosed and untreated, according to ACOG.
“The biggest way that it can affect them is just the bonding,” Furman said. “And if moms are having this high stress, high anxiety or depression, then they’re probably not caring for themselves or for the baby.”
A partner could be first to notice signs of trouble, she said. And, as the class wound down, she urged the women to make an emergency plan before labor and delivery for what to do if they develop symptoms.
Rebecca Bridges, 30, said she and her husband have discussed it as they await their first child.
“One of my biggest concerns is actually postpartum depression. As a first-time mom, there are a lot of big concerns, but I think that one stands out the most,” she said.
Bridges is in her third trimester of pregnancy and is due in November. She said she hopes to create a peaceful environment for her baby.
“To have her come home to sort of a calm and stress-free environment. Change can be a very stressful thing on anyone, and so trying not to put that stress upon this new little baby who has just entered the world,” Bridges said. “I think calming is really the word that came to my mind first because I think they might thrive a little bit more in a calming environment. I want to try my best to create that for her.”
