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For 1 in 7 pregnant women and new moms, things can feel off. They can have trouble sleeping or feeling connected to their baby, feel weepy, have low energy. They could be clinically depressed, and depression during or after pregnancy is very treatable if it's diagnosed. But only a small percentage of those women get the treatment that they need. Massachusetts is trying to change that. NPR's Rhitu Chatterjee has this story about how the state is tackling depression in pregnant women and new moms.
RHITU CHATTERJEE, BYLINE: Jennifer Ford lives with her husband and two daughters in Oakham, Mass. As a young woman, she struggled with anxiety and depression and was on antidepressants through both her pregnancies. While her first pregnancy and childbirth went smoothly, things were different after the birth of her youngest.
JENNIFER FORD: That first week home - and almost immediately after I got home, all I could do was cry. I couldn't even communicate a full sentence about how I was feeling; all I could do was cry.
CHATTERJEE: Ford couldn't eat, sleep or take care of her newborn, and yet she couldn't accept that something was wrong - that she wasn't her usual self.
FORD: It's very hard to admit that something's not right, I mean, especially when you have a new baby in the house. And it's supposed to be this wonderful happy time, and that's not how it was.
CHATTERJEE: One afternoon, she was in her bedroom trying to take a nap but couldn't fall asleep. She felt overwhelmed by her emotions.
FORD: I wanted to take all of my pain meds and go to bed.
CHATTERJEE: Go to bed and not wake up. Ford told her husband how she felt.
FORD: That was when he was like, OK, obviously, something needs to change here. You're not going to do that. We're going to get help, and we're going to get it now.
CHATTERJEE: So they went to see her OB-GYN, Dr. Chris Conlan.
CHRISTOPHER CONLAN: She came in, and I could immediately see just in her face that she was having a very difficult time, and she needed help and didn't really know where to turn.
CHATTERJEE: Conlan gave Ford a questionnaire that confirmed that she was depressed, but he wasn't sure how to help her. Like most OBs, he wasn't trained to provide mental health care. He knew just enough to have prescribed her an antidepressant during her pregnancy because of her history with depression, but that medication wasn't helping her anymore.
CONLAN: The tools that I have in my everyday practice were kind of used up.
CHATTERJEE: So he turned to a new statewide program created specifically to help OB-GYNs provide mental health care to pregnant women and new moms. He called the program's helpline and was connected to an on-call psychiatrist.
CONLAN: I was able to talk to the psychiatrist. They were able to give me some initial thoughts, and we decided that they should do an in-person consultation.
CHATTERJEE: The psychiatrist suggested some changes to Ford's medication and made an appointment to see her in person.
FORD: Within a couple of weeks, I noticed a difference. I was taking the time to blow-dry my hair - simple things. I was taking the time to sweep the floor or to put my makeup on or to wear something other than pajama pants.
CHATTERJEE: The program also connected Ford with a social worker, who in turn helped her find a longer-term therapist and a local support group for moms with postpartum depression. Psychiatrist Nancy Byatt at the University of Massachusetts Medical School helped launch this program about five years ago. It's called the Massachusetts Child Psychiatry Access Program for Moms, or MCPAP for Moms.
NANCY BYATT: The mission of our program is to build the capacity of frontline providers to address depression.
CHATTERJEE: Ideally, she says, women and new mothers with depression would have access to a psychiatrist. But there's a dire shortage of mental health care providers, and the stigma around this kind of depression prevents women from admitting that they're depressed during pregnancy or after childbirth. For all these reasons, Byatt says, medical authorities recommend that OB-GYNs screen their patients for depression and help them get treatment.
BYATT: Every time that a woman is seen by an obstetric provider is an opportunity to, you know, detect depression, to educate them about it and to really engage them in treatment.
CHATTERJEE: But, as Byatt learned through her initial research, doctors in Massachusetts did not feel comfortable tackling the problem, even though they wanted to help.
BYATT: They said, we want to address this. We think it's so important. We don't know what to do. We haven't been trained. We don't have the resources. We need a lifeline, is essentially what they said.
CHATTERJEE: So Byatt and her colleagues created the help line for doctors. They held training sessions and provided a toolkit to educate OBs and nurse practitioners about perinatal depression.
BYATT: We've enrolled 74% of the practices in the state, and that covers 80% percent of deliveries.
CHATTERJEE: She says, over the years, OB-GYNs have become more comfortable treating mental illness.
BYATT: And now they're managing sometimes very complex illness. We have several practices that are - if a patient has bipolar disorder, they're managing them because it's hard to find a psychiatrist.
CHATTERJEE: In fact, the program has now become a model for other states to tackle depression during pregnancy and postpartum. And its success has in turn helped to raise awareness among patients in Massachusetts, says Dr. Chris Conlan.
CONLAN: Patients are now realizing that this is a very common issue and that they're not alone and that it's better to speak up because we can help. They don't need to suffer in silence.
FORD: I really felt like there were people on my team.
CHATTERJEE: Jennifer Ford.
FORD: That I wasn't just alone in my room, feeling like I was a horrible person and a horrible mom.
CHATTERJEE: She says the changes in medication, the visit with the psychiatrist, the support group of mothers - all of it helped her manage her depression and, eventually, recover from it.
UNIDENTIFIED CHILD: He eats the rest of...
CHATTERJEE: Today, her youngest daughter, McKinley, is a healthy, happy 4-year-old. Addison, her oldest, is 7. Ford no longer struggles with depression. She's an active, engaged mother, and it's easy to see the bond between her and her daughters as she gets them ready for bed with their nightly ritual.
JENNIFER FORD, ADDISON FORD AND MCKINLEY FORD: (Singing) You are my sunshine, my only sunshine. You make me happy...
CHATTERJEE: Rhitu Chatterjee, NPR News.
(SOUNDBITE OF MUSIC)
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