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Porter team helps treat mothers with postpartum mood disorders

PORTER HOSPITAL CERTIFIED Nurse-Midwife Emily Zolten, left, and Alison Underwood, licensed social worker, help identify and treat depression and anxiety experienced by expectant and new mothers.

Ninety-five percent of what (new parents) need to hear is that this is hard, that it’s hard for everyone.
— Alison Underwood

MIDDLEBURY — A local study shows that in the weeks just before and just after giving birth, mothers may experience mood disorders such as depression and anxiety related to pregnancy, childbirth and postpartum recovery more often than caregivers had thought.
Along with the substantial life changes that come with having a baby, a person who has given birth experiences dramatic hormonal changes within their body during pregnancy and immediately following childbirth. During that period, which can last as long as a year after birth, young parents are often sleep-deprived from spending long nights up with a newborn.
Additionally, new mothers may not be able to exercise, have as much mobility or be as social as they were before the baby arrived. All these factors can lead to an extended period of what is commonly referred to as “the baby blues,” according to a quality improvement project completed at Porter Women’s Health this spring
Collectively, says Porter Chief Medical Officer and physician Anna Benvenuto, these maternal health disorders cost over $14 billion per year in America.
“Moms are often the stewards of family care, including for their partners. (An untreated perinatal mood disorder) can have multi-generational implications,” Benvenuto told the Addison Independent. Further, “untreated maternal depression in pregnancy leads to higher rates of pre-term birth in infants and can have long-term implications for growth and development of children.”
But for many women, those symptoms go untreated due to a host of factors.
“We know that nationally, these health issues are underreported,” says Emily Zolten, nurse-midwife at Porter Hospital in Middlebury. “Nationally, the data says that they occur in about 7 percent of pregnant and post-partum women. What we found in our study was that the rate was closer to 25 percent.”
Between December 2018 and April 2019, Zolten oversaw a qualitative improvement project (QI), where women were surveyed using the Edinburgh Postpartum Depression Scale at the beginning of their pregnancy, at about 24 weeks, two weeks after giving birth and six weeks after giving birth. Prior to the QI, mothers were formally screened only after birth. Additionally, the entire Women’s Health office in Middlebury participated in regular luncheons to discuss ways to detect perinatal mood disorders in patients and how to direct them to care. All of this was designed using a protocol and toolkit for hospitals developed by the Alliance for Maternal Health.
For the last two years, the hospital has been able to set up those appointments in-house, saving new moms time and energy in getting a referral for a mental healthcare provider elsewhere — something Dr. Benvenuto says is in short supply in Addison County. Further, many women are afraid to seek help for mental health during or after pregnancy because they are afraid it will reflect poorly on them as mothers or result in their children being taken away from them.
Porter Women’s Health has had a Licensed Independent Clinical Social Worker on staff, who provides mental health counseling to clinic patients, typically around women’s health issues, since 2017. Those services are free to patients thanks to funding from the state of Vermont’s Blueprint for Health program.
Alison Underwood fulfills that role and says that there is no reason to suspect that rates of perinatal anxiety and depression are higher in Addison County than elsewhere — it’s just that in Addison County, moms are now being asked and offered what Underwood calls “a menu of potential treatment options.” Further, they are working with healthcare providers that they have already built a relationship with. “We are a small enough office that often times I can come right into an exam room to see someone in a space where they are used to bringing their children and feeling a level of trust with a provider,” she says. “That’s huge.”
Zolten’s research found that, given this new protocol, more than 84.6 percent of patients who reported a perinatal mood disorder during the study period were referred in-house for treatment and accepted it — a figure above their initial goal of 80 percent. Prior to the QI, that figure was closer to 58 percent. “We’ve kept the system we’ve implemented in place and are planning to evaluate our numbers again six months out to see how much progress we’ve made,” Zolten says.
The reason for presenting new mothers in their care with a list of standard treatments that they can choose from is simple: pregnant and breastfeeding patients report to medical staff at Porter that they have strong ethical and other concerns about taking medication and other treatment during or immediately after pregnancy. “Treatment of mental health disorders and use of medication is both safe and effective,” Benvenuto says. “Many medications are safe and effective throughout pregnancy.”
For community members, Underwood suggests taking a proactive approach to helping new moms. “There is so much you gain during that period, but what society doesn’t let new parents talk about is the fact that something is lost: your independence. Ninety-five percent of what people need to hear is that this is hard, that it’s hard for everyone, and that you will get that part of yourself back, and it’s OK to grieve for it,” she says.
Instead of leaving it at saying, “You must be so happy!” to new mothers, Underwood suggests keeping the compliments and adding in phrases like, “How are you holding up?” or making concrete offers to show up and help out with friends and family in small ways.
If a woman is thinking about harming herself or her children, she should seek immediate assistance from her medical provider and/or dial 911. However, for others, services are just a phone call away.
“Asking for help is not going to land you in a place where you could lose your children. And talking through these feelings with another human being may help you find strategies to cope so that you can be a better parent in the end,” Underwood says.
Zolten seconded that: “We need to reframe this as a really common healthcare concern that happens around pregnancy and the postpartum period. I’d like to see us normalize this culturally, bring it out of the shadows, so that people feel they can share their stories, help each other and get care.”

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