Beyond Birth: Navigating Perinatal Depression With Endeavor Health

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Tom Haederle
For many new moms, all of the congratulations and best wishes from family and friends would seem to promise a bright future. But for some, the reality of the transition to parenthood can trigger depression and anxiety.

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Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. For any number of reasons, bringing a new life into the world can lead to a period of depression and anxiety for new parents. This is more than the traditional baby blues. And by identifying and treating it, new moms can rediscover the joy of parenthood

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Tom Haederle
as we hear in this moving podcast.

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Anna Ma
So my pregnancy was pretty stressful. The week I found out I was pregnant, my mom was also diagnosed with stage four cancer and was told that her treatment options were really limited. And being the daughter of a first generation low income family, I felt a lot of pressure on my pregnancy to juggle my mom's health as well as taking care of my own health and my unborn child's health at the time.

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Anna Ma
I think initially there's a lot of talk about the birthing process and there's a lot of support around that. But I felt like there was very little talk about some of the potential mental health struggles that a mom can go through, a first time mom. A lot of times you're told, motherhood is amazing.

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Anna Ma
All these expectations of what motherhood will look like. I was pretty much floored by how much I would struggle mentally.

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Julia Resnick
That was Anna Ma. She's a first time mom of a one year old boy. You'll be hearing more about her journey through perinatal depression and what support enabled her to get through it. Perinatal depression, including mood and anxiety disorders, are one of the most common complications of pregnancy, affecting one in seven women during pregnancy or in the first year after giving birth.

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Julia Resnick
Postpartum depression is more than the baby blues. It can cause intense sadness and anxiety. And in severe cases, moms may think about actually harming themselves or their babies. Many of the signs of postpartum depression and anxiety, like lack of sleep and hormone swings are present in all new parents. And as a result, providers and patients may not recognize that the symptoms are more severe than the run of the mill baby blues.

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Julia Resnick
Welcome to Beyond Birth, a podcast series on how health care organizations can support the social and emotional needs of pregnant people and new parents. I'm Julia Resnick, director of strategic initiatives at the American Hospital Association. In today's episode, we'll explore perinatal depression and where new parents can go for resources and support. You'll hear from Laura La Porte, Clinical Research manager with the Perinatal Depression Program at Endeavor Health, formerly North Shore University Health System in Evanston, Illinois.

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Julia Resnick
Endeavor is a suburban Chicago-based integrated health care system with seven hospitals. Endeavor Health is also the principal teaching affiliate for University of Chicago's Pritzker School of Medicine. You'll hear again from Anna Ma, a high school guidance counselor and new mom used Endeavor Health's moms line to help her through her postpartum depression.

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Julia Resnick
We'll start with Laura. She's an expert in perinatal depression. In our conversation, she shared her insights into how perinatal depression can present new parents.

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Laura La Porte, LCSW
In a nutshell, she's not herself and she has a sense that something is wrong. She might conflate the way she's feeling with what motherhood is supposed to be. So that can start to send off a little bit of feelings of hopelessness. So you might see guilt or shame, loss of interest or pleasure in things you used to enjoy; crying, sadness.

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Laura La Porte, LCSW
But with perinatal depression or anxiety, there's some unique features. We see much more agitation, so a lot more automatic, like shaking, trembling, overwhelmed. There's a ruminative quality to the experience for moms. So the key things that a perinatal therapist would look for are women who say, I just don't feel like myself and I'm not sleeping at night when I get a chance to sleep.

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Laura La Porte, LCSW
They're irritable, irritable, irritable. And then they try to keep it together. They're snapping at family. Then they feel guilty and ashamed and like a bad mom. And the cycle repeats itself. A lot of the work that we do are breaking down the myth of motherhood.

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Julia Resnick
For Anna, these myths informed her expectations of motherhood, but that vision was not her reality. Anna experienced these issues acutely after the birth of her son. She shared how she came to realize that she was experiencing postpartum depression and anxiety.

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Anna Ma
I started seeing a lot of the warning signs of postpartum depression anxiety. So, for example, I was having crying spells. I started developing insomnia. I would be anxious even when nothing was wrong with my son and just checking the baby monitor like, constantly. And that's when I realized, okay, this level of anxiety and depression isn't normal. And to be honest, being someone with a mental health professional background, I didn't see it right away.

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Anna Ma
It took a bit for me to say, Hey, something's not going on here and my function's being impacted.

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Julia Resnick
And that's something is precisely what Endeavor Health's perinatal depression program addresses. Back in my conversation with Laura, she talked about the origins of Endeavor Health's long term commitment to supporting new moms mental health.

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Laura La Porte, LCSW
So I like to say that we are the silver lining of a tragedy. So a local family lost their daughter to postpartum suicide, and they approached our department chairman, Dr. Richard Silver. They want us to do to create something where women could be helped. And that was the birth of screening, universal depression and anxiety screening, and our program

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Laura La Porte, LCSW
so way of identifying patients. And then we also established the country's first 24/7 free confidential for perinatal anxiety disorders hotline. Answered live by licensed mental health Professional. So we had a way of reaching out to and through screening, and they could reach in through the hotline.

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Julia Resnick
Out of that tragedy grew Endeavor Health's perinatal depression program, one of the first of its kind in the U.S. Laura, who has been part of the program for 18 years, shared how the program engages with pregnant and postpartum people.

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Laura La Porte, LCSW
One of the things that Northshore did that was really pioneering is we were one of the first people to actually screen in pregnancy as well as the postpartum. And so we know that we were asking a lot of our medical staff, our busy nurses and physicians, nurse midwives and their medical staff. So what we decided to do was time the screening with glucose tolerance testing that happens around 24 to 28 weeks in pregnancy.

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Laura La Porte, LCSW
And their patients are our captive audience because they're waiting for their results. And we also and that's consistent with onset in pregnancy and mood disorders. And then in the postpartum, women are screened again at their postpartum visits and their opportunity when they can see their obstetric provider again is that we screen them.

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Julia Resnick
So what happens if they screen positive?

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Laura La Porte, LCSW
Those screens are entered into an electronic medical record. The social work staff of the program get alerted immediately and most women are phoned the same day by a social worker who's very skilled in making unsolicited phone calls to patients and getting building rapport and educating them and really being a broker of treatment.

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Julia Resnick
And then there's also the other direction where women can call the hotline, yes?

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Laura La Porte, LCSW
Yes, absolutely. So our hotline is given out literally by all of our physicians. Physicians actually feel really comfortable calling themselves if they have a reticent woman in their office who she's too afraid to contact or they're worried they're not going answer the phone if the social worker calls. So they can call jointly. We have a wonderful staff of licensed master's level and Ph.D. level therapists who are skilled in the perinatal time. Our local hotline gets calls from

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Laura La Porte, LCSW
we've got calls at our local hotline from 47 different states, seven different countries. So we will serve you no matter, you know, and it's incredible.

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Julia Resnick
What is the number for that hotline?

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Laura La Porte, LCSW
Wonderful question. 866-364-6667 (moms).

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Julia Resnick
That is pretty easy to remember.

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Laura La Porte, LCSW
Yeah, we try.

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Julia Resnick
Though Anna didn't receive her pregnancy care through Endeavor, the moms line was there for her when she needed support beyond what her family and friends could offer.

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Anna Ma
So my sister, thank God, reached out to me. Was like, can I see a difference in you? I would call her frequently because we're very close and she had a really good friend that used a support group in Illinois called Beyond the Baby Blues. Amazing program, it connected me to other moms. And the founder of that organization told me about the mom's line.

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Anna Ma
So I jotted down that number and I put it on my bulletin board. And I remember having some really, really bad episodes of anxiety and depression in the middle of the night. So I would call that number. And the mom's line, the staff on there are so wonderful. I love that it was free and that it was readily available as a 24/7 hotline in Illinois.

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Anna Ma
A lot of times I would just call that line and talk to some of the moms. I believe most of the volunteers on that hotline are moms and they have extensive training. And so I would just I would give those moms a call at 2:00 in the morning, sometimes 5:00 or 6:00 in the morning. And they would help me just ground myself and talk about resources.

00;10;27;18 - 00;10;55;15
Anna Ma
And some of them even shared their own experiences, which I really, really appreciated. Because when you're going through postpartum depression anxiety, you feel so much guilt, so much shame. And it's really easy to isolate yourself. But having a network and just the support readily available is really, really important for moms, especially first time mom. I could see the warning signs in me, and so I was like, I need to get support.

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Anna Ma
I need to get better. My son was a huge motivator for me, just saying that I need to get better. I want to connect with him. What I'm feeling right now doesn't feel normal, and I need to get that support.

00;11;11;06 - 00;11;33;13
Julia Resnick
As a society, we need to change the conversation around the challenges of being a new parent. It isn't all beautifully curated Instagram photos and cute stories. No matter how much you love your baby, it can still be hard. And it is okay to admit that you're struggling with the job of being a parent. We need to eliminate the stigma around therapy and medication for perinatal depression.

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Julia Resnick
We need to normalize discussions around mental health and screen new parents for depression. Laura spoke to the changes in the culture she's seen around maternal mental health recently.

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Laura La Porte, LCSW
You know, I've been doing this work for almost 20 years and there seems to be - I think COVID was actually helpful in this way and that we've really seen how important mental health is on an individual level just by screening and having a medical residence, for example, being trained in this. Talking with our patients about it legitimizes it in an outpatient office.

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Laura La Porte, LCSW
I think the other thing is we are very skilled as social workers and therapists in our program to approach patients with destigmatizing language. Very educational, very, you know, not not so are you having these terrible thoughts and feelings and this happens to many women. Is this happening to you? So there's a way that we approach them that's very delicate.

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Laura La Porte, LCSW
I always tell moms there is a difference between the baby and the job of parenting, right? So women feel like they are unable to speak negatively about the experience of motherhood because that means somehow they're bad mom or they don't love their baby. It's not true, right? You are able to reconcile positive and negative feelings in the perinatal time by recognizing this is my baby

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Laura La Porte, LCSW
but the job is what I'm struggling with. And you're allowed to have feelings of: this is really hard. I don't like being woken up. I'm scared all the time. Yeah, it's a tough job.

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Julia Resnick
It's so important to be able to name that, that you can love your baby to the end of the world and also just be struggling.

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Laura La Porte, LCSW
You can complain about the job if you want. I'll listen. Yes.

00;13;17;28 - 00;13;36;26
Julia Resnick
If it isn't obvious, the joys of being a parent come with their own set of challenges. After nearly 20 years of Endeavor's perinatal depression program, it has had incredible reach impacting patients and new parents from across the country. I asked Laura about the impact of the program and how they know they're making a difference.

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Laura La Porte, LCSW
One of the things that we had the foresight to do was to find some funding to do a program evaluation. We were pretty pioneering when we started screening. We wanted to see what it would impact we were having. Overwhelmingly, patients really appreciated screening and 87% of them said, I'm actually more pleased with my obstetrician and nurse midwife because they're doing this for me.

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Laura La Porte, LCSW
And we were really surprised to learn things like two thirds of them said, just by looking at this ten question questionnaire, the number on postnatal depression scale. Now I know what to look for. So just giving a questionnaire was educational for patients. We were also surprised that some of them like I think like 75% of them said we didn't even I didn't even know really how I was doing until I took a look at this.

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Laura La Porte, LCSW
We listened to our patients and we adjusted accordingly.

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Julia Resnick
That's wonderful. And as that broker, do you know how many patients you've connected with mental health resources?

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Laura La Porte, LCSW
This is a statistic I absolutely love quoting, and it keeps rising. So our hotline just celebrated 20 years. We have served over 14,000 callers and again from all over the world, from seven different countries, 47 different states. And so there's clearly a need for this type of work. Our team has personally contacted through screening program 10,000 mothers and most of the women we work with in either case, always get what we like to say as a little care package.

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Laura La Porte, LCSW, 
So these are again, trying to be that broker of treatment, trying to make sure that there are no gaps in linking someone to treatment. We will at least give them robust resources. Where do you live? What are your barriers? How do we bypass them for you? So we do that for our callers as well as patients.

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Julia Resnick
That is incredible. So you've been at this for 18 years and I assume you've learned some lessons that you know now that you wish you knew when you got started. Are there any of those that you can share with us?

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Laura La Porte, LCSW
One thing that I would have loved is to be better at capturing accurate race, ethnicity and language data, for example. And those are initiatives we're really trying to address now, more DEI more explicitly. I think that historically we didn't want to ask some of those questions. We thought, well, it doesn't really matter. Does it really matter when I'm working clinically with somebody?

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Laura La Porte, LCSW
How would that be perceived? But now we're realizing that it is an important thing. We do need to know that. We are seeing some of those barriers to care. We conducted in interviews and we realized that patients are falling through the cracks if they get a referral that doesn't work. If you get a referral, that person doesn't get back, or there's an insurance or provider mismatch, it's just not working for them.

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Laura La Porte, LCSW
So we had to come up with ways of addressing that. And now we're looking at what the future holds. We're looking at novel ways of using technology to bypass some of those barriers, like worked on a National Institute of Mental Health grant to develop an app for women that they can use in lieu of psychotherapy. For those who can't access it, it's really good success.

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Laura La Porte, LCSW
And I'm also working on a multicenter trial where we're looking at the differences between Zoom-based psychotherapy and in-person psychotherapy. So we're always trying ways and I think the main thing that our future will hold is how do we bypass barriers to treatment? How do we continue to be the best progressive treatment we can be?

00;17;10;23 - 00;17;22;14
Julia Resnick
Getting the right support and treatment has been crucial for Anna's journey through perinatal depression. Anna shared how she's doing now and her advice for health care organizations and providers working with new moms.

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Anna Ma
I'm doing a lot, lot better. It's crazy when I compare where I was a year ago and where I am now. I am doing 100 times better. It took a lot of hard work. Lots of hard work. This past year has been easily the hardest year of my life. Like a lot of places that jumped in and helped me because, you know, a lot of times they say it takes a village to raise a child.

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Anna Ma
It also takes a village to get a mom out of severe postpartum anxiety and depression. And you need multiple supports in place. I had a lot of support from friends and family members, but they weren't moms themselves. And so having a network of people that understand what you're going through or who have been there is crucial to getting better.

00;18;18;25 - 00;19;02;02
Anna Ma
I really want to encourage age health care providers and organizations to really educate staff on postpartum anxiety and depression. So I just feel like if there can be more support for or at least a network like and I don't expect doctors to treat me in that manner, but if they can have a network of mental health providers with a perinatal focus, maybe a network of things like the moms line that you can call when you are having exciting or depressive symptoms, having that information readily available to moms when they leave the hospital or when they come in for their checkup is huge.

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Anna Ma
The other thing that I want to stress is making sure that providers are using the perinatal depression screener. That was really helpful in helping me identify like where I was at in my health and what I needed to get help, support. It's such a huge life change. And I know, like my husband and I talked about this, we've been parents or we've been together for a really long time, years and years, but we've been only parents together for a short time.

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Anna Ma
So like just the change in the dynamics then in your relationships and how that can impact mental health for both mom and dad.

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Julia Resnick
We'll close this episode with some thoughts from Anna. Given her journey, I wanted to hear her insights for new moms and parents.

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Anna Ma
I want to tell new moms to have patience and love and grace for themselves. To be a good mom, you need to take care of yourself. And I had a really hard time with that. I, in the beginning felt so much guilt and shame for leaving my son to go get treatment and just feeling like such a failure.

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Anna Ma
And I realize that it's not my fault, I didn't ask for postpartum depression or anxiety to happen, that I wanted to be a good mom and that that's what I needed to do. And so what I want to tell moms who are experiencing any symptoms of PPD or PPA is to have patience and hope. Our society, I feel, says, you know, enjoy these years, you know, the best years of motherhood and all these things.

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Anna Ma
If it's not, that's okay too. It doesn't make you a bad mom for feeling that way. And there's no rulebook on how to be a good mom. I just want to tell those moms to hang on and I want to stress the importance of seeking help. That's how I got better was having the courage to join support groups,
00;21;01;17 - 00;21;14;10
Anna Ma
find a therapist. If you don't find someone that you like initially, keep trying. Just really making sure that you have a village not only for your child, but for yourself, so that you can get better and be there for your kid.

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Julia Resnick
Health care organizations and providers are a key piece of that village that new parents so badly need. Being there to support their patients, detect when something is amiss and connect them with resources. And they need to continue to normalize conversations around perinatal depression and anxiety. A big thank you to Laura La Porte for her expertise and Anna Ma for sharing her story with us.

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Julia Resnick
Anna, because of your openness and vulnerability, you will help other new parents feel less alone. You can reach Endeavor Health's mom's line at 1866-364-MOMS, that is 1866-364-6667. You can also visit AHA’s Growing Library of Resources on improving maternal health at www.aha.org/betterhealthformothersandbabies. Thank you for tuning into the Beyond Birth Podcast series.

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Julia Resnick
If you missed either of the first two episodes, you can find them at aha.org or wherever you get your podcasts. We hope you find these stories useful and help you provide better care for the moms and parents in your community. Stay tuned for future podcasts from Advancing Health on Maternal Health and Child Health in the months to come.