Post-Partum Depression: The Broader Picture

An Interview with Nancy Byatt, D.O., M.S., M.B.A., F.A.P.M.
MCPAP for Moms

Care for Your Mind approached Dr. Nancy Byatt, Medical Director at MCPAP for Moms, about the broader issue of maternal mental health. The incident in Sacramento caused us to take another look at the maternal mental health series we ran in February and March of 2016, which Dr. Byatt had helped to orchestrate.

Care for Your Mind: With your support, CFYM published a series of posts about postpartum depression in 2016 (links are below). At that time, you noted: “Because of a severe lack of resources and education, perinatal mental health has become a national public health crisis, and it’s time for reform.” What has changed – for the better or for the worse – with perinatal mental health since then?

Dr. Nancy Byatt: A lot has gotten better since then! We now have recommendations from the U.S. Preventive Service Task Force about screening for depression in adults, including in pregnant and postpartum women [released immediately prior to the 2016 CFYM maternal mental health series] and from the American Medical Association [Resolution 910, “Improving Treatment and Diagnosis of Maternal Depression through Screening and State-Based Care Coordination,” adopted in November 2017].

The American College of Obstetricians and Gynecologists is very committed to addressing the issue of perinatal depression and has convened a Maternal Mental Health Expert Work Group to develop concrete ways to help OB [obstetrics] practices to detect, assess, and treat depression during pregnancy and the postpartum period. The Council on Patient Safety in Women’s Health Care has included maternal mental health in its Maternal Safety Bundle. The goal is to help obstetric practices integrate depression care in obstetric care.

In addition, other states are developing and funding programs like our Massachusetts Child Psychiatry Access Program (MCPAP) for Moms, which help OB providers and psychiatric providers to be comfortable and effective in addressing perinatal depression in their practices. Our team has also developed a new center, Lifeline4Moms, which is focused on helping the health care community optimize maternal mental health. Exciting things are happening in the field!

CFYM: If this nurse practitioner had been in Massachusetts, what might she have done differently?

Dr. Byatt: She could have called MCPAP for Moms, of course. We would have been able to provide education and guidance in how to respond to the patient’s thoughts of harming the baby. We could have provided education on the range of treatment and support options available to women experiencing such thoughts. There are many treatment options ranging from outpatient assessment to hospitalization. Sending a patient to the emergency room setting for a safety evaluation is appropriate when there is concern for imminent risk of harm to mother or baby.

I assume that the nurse practitioner was acting in what she believed was the best interest of the baby and the mother. Managing the health and safety of mothers and babies is a huge responsibility that can be difficult to navigate, especially when the provider does not have the training or skills to assess or respond to such concerns. We [the medical community, policymakers, etc.] need to give providers the tools they need to practice effectively and equip them so they know what to do in such situations.

CFYM: The 21st Century Cures Act included provisions about training providers and medical students about postpartum depression. Do you foresee enough providers being educated about depression and suicide risk that there is no need for MCPAP for Moms?

Dr. Byatt: We began training OB providers before the 21st Century Cures Act and now more than 70% of OB providers in Massachusetts have received training in perinatal mental health. I don’t think these trainings will put us out of business. Every case is different. As providers have become more informed and more comfortable assessing and treating maternal mental health and substance use disorders, they are calling about increasingly complicated cases, such as treatment-resistant depression or bipolar disorder. In our medical system, most depression is treated by primary care providers. MCPAP for Moms’ goal is to have OB practitioners providing mental health care and managing depression cases similarly to PCPs, and to refer complicated cases to psychiatrists.

CFYM: What do you see as the role of pediatricians in maternal mental health?

Dr. Byatt: Women should be screened for depression at least twice during pregnancy so that, hopefully, cases of depression can be identified and treated before birth. Women should also be screened for depression at their postpartum appointment, usually six weeks after birth. But the period for postpartum depression extends 12 months past birth and usually the only medical provider consistently seeing the mother during that time is the baby’s pediatrician. Ideally, women would be screened at the 1-, 2-, 4-, and 6-month visits. Pediatricians regularly inquire about environmental factors that might affect a baby’s health, whether there is smoking in the home, for example. The mother’s mental health is a significant factor that needs to be addressed to optimize the baby’s health, so it makes sense that the mother’s depression screening should be a regular part of the well-child visits. MCPAP for Moms recently developed a toolkit to help pediatricians screen for postpartum depression during well-child visits. Now, we’re not expecting pediatricians to treat the depression. We encourage and expect them to provide education and to make a referral for the woman to get assessed and, if applicable, diagnosed and treated. In Massachusetts, pediatricians can call MCPAP for Moms for help with resources and referrals.

CFYM: Any other thoughts?

Dr. Byatt: There is a great deal happening to address maternal mental health. We need to continue to build capacity and raise practice standards, along with providing systems that support OB providers through education and consultation. I hope that this incident doesn’t discourage women from seeking help for their mental health concerns and also that it doesn’t result in a negative view of OB providers, who are generally acting on what they believe is the best interest of the mother and baby. The obstetric setting is an ideal place to address depression and other mental health concerns. To harness this opportunity and promote maternal and child health, we need to educate and support both patients and providers in navigating concerns related to mental health.

Editor’s Note: MCPAP for Moms is funded by the Massachusetts Department of Mental Health.

Additional Perinatal Mental Health Resources on Care for Your Mind

Personal Stories


Bio

Nancy Byatt, D.O., M.B.A., M.S., F.A.P.M., is a perinatal psychiatrist focused on improving health care systems to promote maternal mental health. She is an Associate Professor at UMass Medical School in the Departments of Psychiatry and Obstetrics and Gynecology.   She is also the Founding and Statewide Medical Director of MCPAP for Moms, a statewide program that addresses perinatal mental health and substance use disorders in Massachusetts by providing mental health consultation and care coordination for medical providers serving pregnant and postpartum women. Her research focuses on developing innovative ways to improve the implementation and adoption of evidence-based depression treatment for pregnant and postpartum women.  She has a Career Development Award that funds her research to help women access and engage in perinatal depression treatment in obstetric settings. She has also received federal funding from the Center for Disease Control to test an intensive, low-cost program that aims to ensure that pregnant and postpartum women with depression receive optimal treatment. Her academic achievements have led to numerous peer-reviewed publications and national awards.

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