After her oldest son, now 16, was born, Harlem native Winter Parris couldn’t sleep. “I thought obsessively about my son’s health,” she recalls. She imagined harming herself, and felt ashamed for having these thoughts. In addition, “I was not eating, not taking care of myself.” But she told no one, wondering “if I sought help, would my child be taken away from me?”
Parris was suffering from depression, the most common complication of childbirth. Perinatal depression occurs during pregnancy or up to a year after birth (postpartum), and affects at least 10,000 women in New York City annually, according to NYC Health + Hospitals (H+H), the city’s public healthcare system. Perinatal depression is often untreated, and can be devastating for women and their families.
In November 2015, as part of the ThriveNYC mental health initiative she’s championed, First Lady Chirlane McCray and Deputy Mayor for Strategic Policy Initiatives Richard Buery announced a plan to screen and treat all pregnant women and new mothers for depression within two years. This could prevent nearly 3,000 cases annually, H+H says.
The program began in February 2016, the result of a collaboration between H+H, the Greater New York Hospital Association (GNYHA, a trade association of nearly 160 hospitals and health systems), Maimonides Medical Center, and the NYC Department of Health and Mental Hygiene (DOHMH). About 30 area hospitals, which together are responsible for 78 percent of births in the city, are involved. Through the initiative, known as the Maternal Depression Learning Collaborative, participating sites share information and best practices.
The Greater New York Hospital Association is just starting to collect information about the project from all the participating sites, but preliminary data from four H+H sites shows that between April and July 2016, approximately 2,183 of nearly 2,300 patients were screened at four sites during prenatal and postpartum visits; about 98 women, or 4.5 percent, were diagnosed with depression and referred for treatment. (This echoes findings from an analysis of multiple studies, and refers to women identified during a particular time period—over the course of pregnancy and the first postpartum year, one in seven women will suffer from depression.)
Depressed women are referred for treatment, which usually involves therapy, and sometimes medication. There are concerns about treatment: Some health care providers have expressed a need for training, which is not mandated, in order to better meet the needs of this population.
Still, most stakeholders believe the program can make a significant difference to many new moms in New York City.
How it works
Screenings occur at the first prenatal visit and then at eight and 16 weeks postpartum. Patients complete a brief questionnaire during appointments at ob/gyn, pediatric, and faculty clinics, and outpatient settings. Postpartum screenings are covered by Medicaid and private insurers, and prenatal screenings should be covered for most NYC women, DOHMH says.
The inclusion of pediatricians sounds counterintuitive—new mothers are not pediatricians’ usual patient population—but pediatricians see babies (and their moms) frequently in the first months after birth, when symptoms of perinatal depression often appear.
If a patient screens positive, she is evaluated by staff who have experience in behavioral health, who determine if referral to a doctor or other specialist is necessary.
GNYHA, which is collecting and organizing collaborative data, is not compiling information on patients’ race, ethnicity, or socioeconomic status, but studies show that Black and Latina women, who accounted for 50 percent of the live births in New York City in 2014, are less likely than whites to seek, start, or continue treatment for depression. Furthermore, low income women are more likely to suffer from postpartum depression. Approximately 60 percent of babies in New York City are born to Medicaid recipients, but at Health + Hospitals/King’s County, “We have been able to reach women, and they have put their trust in us,” says Wendy Wilcox, MD, chairperson of the department of obstetrics, gynecology, and women’s health there, and a member of the project’s steering committee. “Women are seeking help.”
Like Wilcox, Parris, now a postpartum doula, thinks the diverse group of new moms she works with are willing to address perinatal depression. However, “There needs to be more awareness,” she says. In her own case, “It was only in hindsight I realized I had postpartum depression.”
Worries about complications
“As much as we applaud the universal screening, we’re concerned about how and where the moms who screen positive will be treated,” says Ann Smith, NP, CNM, president of Postpartum Support International (PSI, a non-profit organization that educates the public and health care professionals about perinatal mood and anxiety disorders.) Smith is on the project’s steering committee.
She points out that many patients will likely be seen by providers who aren’t necessarily trained to treat this population. (It’s not clear how many providers are screening or treating patients, though 70 people attended the first monthly Maternal Depression Learning Collaborative meeting, in February 2016.) Training is offered by PSI and other organizations, but is not mandated.
“Postpartum depression is complex, and although it can often be handled by a primary care practitioner or a nurse practitioner, they need to have specialty training to handle it well,” Smith says. For instance, an untrained provider might not be aware of symptoms of other mental health issues, and “If you give someone with undiagnosed bipolar disorder an SSRI [a commonly prescribed class of antidepressants] you can cause mania.” Smith raises an important point: According to one study, a whopping 22.6 percent of screen-positive women have bipolar disorder.
There’s also the risk of undertreatment. Smith has seen patients who’ve been prescribed a too-low dose of an antidepressant because “the doctor was skittish because he or she didn’t know too much about treatment, and didn’t want to give too much.” Moreover, “Not everyone responds to the first medication.”
Alison Burke, Vice President, Regulatory and Professional Affairs at GNYHA, agrees that educating providers is important: “Participants have communicated a real need for it, in particular in settings that do not traditionally address mental health issues (e.g., ob/gyn and pediatrics).” For mild to moderate cases, with training, these participants “should be able to treat a rather common issue associated with pregnancy,” she says. In July, GNYHA hosted a one-day training for providers, conducted by PSI.
And while participating sites have identified behavioral health resources within each system, some behavioral health professionals (many of whom don’t often treat women with perinatal mood and anxiety disorders) should also find training useful: “They need to feel comfortable with this patient population,” Burke confirms; more trainings are planned for early 2017.
One other possible stumbling block? Money. “This initiative does not have any money attached to it,” says Brooklyn-based Paige Bellenbaum, LMSW, a member of the steering committee. “In a perfect world, hospitals would be able to finance one or more licensed clinicians who have experience with this population to treat moms on site.”
The former Democratic District Leader for the 52nd Assembly District and a mother of two, Bellenbaum suffered from a debilitating postpartum depression after her son, now 10, was born. She was anxious and miserable, but like Parris, “I didn’t tell anybody. I was a trained social worker, and I didn’t recognize what was going on. I hated my son, and I hated myself for hating him.”
Bellenbaum eventually sought treatment, and when she recovered, she wanted to make sure other new moms knew about the issue. She approached State Sen. Liz Krueger, and in 2014, S. 7234B/A. 9610B, which requires hospitals to inform maternity patients about perinatal mood and anxiety disorders prior to discharge, and encourages doctors to screen for these issues, became law.
More screening data won’t be available for a few months, but it’s clear that women who’ve been affected by perinatal depression are often moved to help others: Both Bellenbaum (with Catherine Birndorf, MD) and Parris are opening centers to assist new moms with the challenges they face. And while awareness may not yet be widespread, New York City has many resources for struggling new moms.
Select Resources for Women and Families Dealing With Perinatal Depression
Some programs listed below are free; many offer reduced or sliding scale fees.
The Postpartum Resource Center of New York
A statewide clearinghouse for perinatal mood and anxiety disorders support and education, has an extensive list of local resources.
Toll free: (855) 631-0001
Circulo de Apoyo (Mother’s Group)
NYC Health + Hospitals/Woodhull, 335 Central Ave (a Linden)
Para informacion llamar a: (718) 963-8009
Healthy Start Brooklyn
Education and support for pregnant women and new moms.
The Motherhood Center
Opening February 2017
205 Lexington Avenue, 10th Floor, New York, NY 10016
Newborn Home Visiting Program
Available to new moms
North and Central Brooklyn: (718) 637-5230
South Bronx: (718) 579-2878
East and Central Harlem (646) 672-2894
Talk, text, or message a counselor about your concerns.
NYU Langone Medical Center/NYU Psychiatry Associates
Perinatal Mood and Anxiety Group Therapy
Contact (646) 754-4750 or email
Northwell Health Perinatal Program/Zucker Hillside Hospital
75-59 263 Street, Glen Oaks, NY 11004
Postpartum Doula: Parris hosts a free anonymous conference call for moms. It’s held the second Monday of the month at 9 PM EST.
Call (712) 770-8071, code is 815918.
The Payne Whitney Women’s Program
Consultation and treatment for perinatal women.
525 East 68th Street, New York, NY 10065
Postpartum Depression Support Group
Richmond University Medical Center
1st Floor – Maternity Unit, 355 Bard Avenue, Staten Island, NY 10310
To register, call Catherine Mooney, RN, MSN: (718) 818-4298
(718) 818-2032 (Warmline)
Postpartum Support International
A toll-free Help Line (English and Spanish) refers callers to appropriate local resources.
The Seleni Institute
Services, including support groups, for new moms.
207 E 94th St, New York, NY 10128, (212) 939-7200
Uptown Village Cooperative
Coming soon: A resource center for new moms.
Woodhull Mother’s Group
NYC Health + Hospitals/Woodhull
760 Broadway, Brooklyn, NY 11206
Contact Gianna Lafronza MS, LCAT, R-DMT: (718) 963-8371