Tiny, soft and sweet — when we think of newborns, we envision their cuddly heads, fingers and toes and experience hope as well as potential cuteness overload.
But beyond those peak moments, childbearing is a monumental, life-altering effort for women, and pregnancy, labor, delivery and life circumstances often have serious mental health consequences. Indeed, one in five women will experience a perinatal mood and anxiety disorder or perinatal substance use disorder during pregnancy or the first year postpartum.
Further, the leading causes of pregnancy-related death are suicide, drug overdose and homicide, all of which may be avoidable with suitable interventions and treatments.
Sadly, less than 20% of women facing these problems ever make it to treatment, instead struggling alone. For Constance Guille, M.D., director of the Women’s Reproductive Behavioral Health Division of MUSC Health, this means that there is a wide gap in women’s mental health that needs to be closed, and she and her colleagues are championing practical, effective solutions.
“These conditions often go unrecognized and go without treatment,” Guille said. “But we've been able to leverage really simple technology to improve health care system screening and treatment.”
Using readily available and simple techniques, Guille is leading two major efforts to make sure that pregnant and postpartum women receive the care that they need.
Listening to Women
While she was performing research to determine how best to implement a web-based substance use and mental health treatment program for pregnant and postpartum women, Guille had a surprising revelation.
“Initially our plan was to do some research with women to make sure that they like the content and the flow of the program, and also with providers to get their feedback,” Guille said. “But the upshot from all our qualitative research with women was a shock: ‘this is a program we all need, but none of us are going to use it.’”
Based on that insight, the Listening to Women and Pregnant and Postpartum People (LTWP) program was born – by literally listening to what women had to say.
The LTWP program is a text-based screening program that allows patients to answer questions in private. Questions cover topics including substance use, intimate partner violence, and issues with mood or outlook. Patients are enrolled when they enter the health network, usually through a prenatal visit to a clinic or through the hospital during labor and delivery.
Once a woman completes the initial screen, the data is run through an algorithm and reported to a care coordinator, who can then act appropriately. The coordinator can reach out to the patient and set them up for treatment or determine any other resources they need, and the system then continues in a monitoring role. Women receive the text-based screening questions during each trimester of pregnancy, one month after delivery, and every three months for one year postpartum.
The LTWP program was piloted in late 2019 and early 2020 and currently has over 1,200 women enrolled. And the results so far?
“The results are incredible,” said Guille. “Women are much more likely to get screened with this approach, and they're almost twice as likely to screen positive in comparison to when they get asked these questions in person.”
Listen to Guille discuss postpartum depression and anxiety on MUSC's Innovatively Speaking podcasts.
Moreover, those who screen positive are five times more likely to make it to treatment in comparison to in-person referrals to treatment. And Guille was astounded to see that a lot of the racial disparities that are typically seen around screening and treatment were absent. With the LTWP program, black women and white women are equally as likely to make it to treatment.
To follow up on these promising results, the Patient-Centered Outcomes Research Institute (PCORI) recently granted a $7 million research funding award to the MUSC Health Women’s Reproductive Behavioral Health Division, led by Guille. With this award, Guille and her colleagues will begin a randomized control trial of the LTWP program in 12 clinics to study how best to effectively implement the program on a broad scale.
With the LTWP program, pregnant and postpartum women are screened and monitored regularly for mental health issues, but both patients and providers need on-demand capabilities as well.
To meet this need, Guille and her colleagues in the Women’s Reproductive Behavioral Health Division created another program, which they christened MOMS IMPACTT (IMProving Access to maternal mental health and substance use disorder Care through Telemedicine and Telementoring).
With this two-pronged program, run by Guille, program manager Courtney King, Ph.D., and care coordinator Kerry Blome, providers gain immediate access to psychiatric resources and guidance for treating patients, and patients can reach out directly for help. The program is open to pregnant women and postpartum women for up to 1 year after delivery and to providers giving care to these women.
The program was launched in May 2022 and was modeled after other perinatal psychiatry access programs. But because of the known gaps in maternal health care and mental health care in South Carolina, MOMS IMPACTT adds the patient access component in tandem with the provider component.
The simplicity of the program means that patients simply make a call or fill out a form online to receive help. And this piece has been crucial to the health and well-being of more than 200 women who have reached out so far.
Blome speaks to each patient, performs a brief assessment of their needs, and creates a plan which could include seeing a psychiatrist that day via telemedicine and getting treatment started. She can also guide women to community resources that can help, such as support groups, food pantries or financial assistance.
But even before those steps happen, she sets a tone for trust and hope.
“The women who call are often very distressed by what they're feeling, and they may be coping with guilt and shame because they want to be good moms and think they are alone,” Blome said. “So one of the first things I say is that I’m so glad they called. It sounds so simple, but it has a profound impact.”
She goes on to listen without judgment and lets women know that they’re not alone and that others have lived the same experiences, whether they are dealing with substance abuse, an unsafe home situation or thoughts about self-harm.
And importantly, she not only listens but also assures women that there is help available if they want it and are ready for it.
“But I follow their lead about what kind of help they would like,” said Blome. “And if they’re not ready now, they may be ready later. The door is always open.”
Providers benefit from MOMS IMPACTT as well, with immediate access to mentoring for acute situations with patients as well as training on ways to implement mental health care into everyday practice.
“Most of our clients have been women coming straight to us or being referred by their providers,” said Guille. “But we also receive calls every month from providers who can use us to walk them through next steps for their patients.”
MOMS IMPACTT is funded through the Duke Endowment and the South Carolina Department of Alcohol and Other Drug Abuse Services, but the program has seen engagement with health insurers even at this early stage, which Guille finds promising.
Mentally healthy moms
Guille is encouraged by the early results of both MOMS IMPACTT and the LTWP program. She acknowledges that there is still some stigma around mental health issues, but she says it is a lot less than it used to be.
The timing may be right to help new moms thrive now by tackling their most pressing mental health concerns.
“I'm really excited that we're able to have some tools that are helpful to women,” said Guille. “I think these programs are really successful because people are talking about these issues and normalizing them in a way that allows people to get help.”
If you are a provider or patient interested in learning more about MOMS IMPACTT or the LTWP program, please contact the Women’s Reproductive Behavioral Health Division at 843-792-MOMS (6667).