Postpartum Depression Rx Links Mother's Day and Children's Mental Health Month

On Sunday we celebrate mothers- bringing breakfast in bed, going out to dinner, buying flowers. In my personal experience, one of the greatest pleasures of Mother's Day, in addition to having the "day off," is to take joy in my beautiful children as they grow and develop and make their way out into the world.

D. W. Winnicott, pediatrician turned psychoanalyst, famously said, "There is no such thing as a baby." What he meant  is that one cannot fully understand a baby without considering the relationship with the mother. Equally true is that without a child, there is no such thing as a mother. In order to understand a mother's experience, it important to consider the child and what he or she brings to the relationship.

I have been thinking about this a lot as I participate in the important work of Representative Ellen Story's Postpartum Depression(PPD) commission. Rep. Story originally filed a bill that mandated universal PPD screening in multiple settings (OB and pediatric), but it was amended to a law that calls on the Department of Public Health to issue regulations on best practices for PPD screening. The law also created the Commission, whose  job is to help DPH in its work to come up with a proposal for what the state should do on PPD. 

I think this was a good plan. Universal screening is important. Liz Friedman, program director at MotherWoman, an Amherst based non-profit that was instrumental in he bill's passage, addresses the issue in a recent article.

Friedman continues to believe in the crucial importance of screening all new mothers, rather than screening only those whom doctors suspect might be struggling—a practice that runs the risk of "profiling" women who might seem distressed while overlooking others who are suffering but don't show it as obviously. 

However, without a carefully thought through way to provide treatment for women with PPD, universal screening is meaningless. One excellent model of care, the Community-based Perinatal Support Model, developed by MotherWoman, has been implemented in Franklin county with great success, is currently being implemented in Berkshire and Hampshire counties. It will likely be the basis of the recommendations to the DPH. 

The Community-based Perinatal Support Model (CPSM) has been developed to address the gap between screening and services for mothers. CPSM aims to prevent, identify and facilitate treatment of PMD (perinatal mood disorders) by creating a comprehensive, community-based, multi-disciplinary safety net for women.

Winnicott again is helpful in understanding why such a model would be effective. He coined the phrase 'the holding environment" to describe the way in which a mother, by being present both physically and emotionally with her baby, helps him to manage and contain intense feelings.  Quoting Winnicott: 

It will be observed that though at first we were talking about very simple things, we were also talking about matters that have vital importance, matters that concern the laying down of the foundations for mental health

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The phrase "holding environment" has been used to describe other caregiving relationships, such as a therapist-patient relationship. In the CPS model, a network of people, including nurses, primary care clinicians, mental health professionals, and other parents in the group setting, provides a "holding environment" for mothers who are struggling emotionally in these early months with their baby. 

What makes postpartum depression different from other forms of depression is that it occurs in the setting of responsibility for a new life-with a person who is completely dependent, and brings his or her unique qualities to the relationship.  To fully hold the mother's experience, it is important to recognize the baby's contribution. For example, when a baby is born with difficulties settling to sleep, or  is not naturally cuddly, it will have significant impact on the mother's emotional experience. Sleep deprivation and feelings of inadequacy may compound an existing depression. In turn, the mother's state of mind, particularly if she is preoccupied with her own distress, may impair her ability to help the baby to contain and manage his experience. A recent study showing that mother's struggling with anxiety and depression often wake their babies at night offers an example of how a mother's emotional state may affect her child's development. 

How fitting that Mother's Day occurs in the middle of Children's Mental Health Awareness Month. The work of Representative Story and the PPD commission is a tribute to both.  When we as a society attend to the emotional needs of new mothers, we help them to emerge from pain and suffering to take joy in their children.  This not only promotes their children's healthy development, but it makes for a really great Mother's Day!!