Mental Health Support for New Moms | Adrienne Griffen of Maternal Mental Health Leadership Alliance

My personal ultimate goal is that all pregnant and postpartum people are educated about mental health conditions during pregnancy and the first year following are screened for them and have access to resources for recovery. Again, this is the most common complication of pregnancy and childbirth. We cannot ignore it. We have to talk about it, we have to normalize it, and we have to let people know where they can find help.

Welcome to the Mental Health Entrepreneur Podcast. We are here to inspire creative ideas and connections for entrepreneurs and advocates working to address our mental health crisis. As you listen, I hope you will experience new ideas and motivation to innovate in your business, your community, and in your life.

Welcome.

Welcome, everyone, to the Mental Health Entrepreneur Podcast. I'm your host, Rachel Harrison, and with me today is Adrienne Finn. She's the executive director of Maternal Mental Health Leadership alliance, as well as a subject matter expert in maternal mental health. Welcome, Adrienne.

Thank you, Rachel. It's so great to be with you today.

Yeah. So let's dive right into our topic. I feel like it's such an important one. What is happening in the world of maternal mental health?

Oh, well, great question. But let me first start if it's okay with sort of defining maternal mental health so that everybody knows what we're talking about. Right. So I'm guessing most people have heard the term postpartum depression, or ppd. Many people refer to it as ppd, and that is sort of an umbrella term for mental health conditions that impact women and childbearing people during pregnancy and the first year following pregnancy. So we call that the first year postpartum, but it's kind of a limited definition. So postpartum depression means postpartum after the baby's born. And depression, which we all know, you know, it's sadness, listlessness, all of that. But what we know is that many women actually start experiencing depression or anxiety during pregnancy and that there's more conditions than just depression. So anxiety is often present. People say that anxiety and depression are like best friends. They often show up together. We also see things like obsessive compulsive disorder, post traumatic stress disorder, and in rare situations, psychosis. But when we talk about maternal mental health, what we're really talking about is the mental health of pregnant and postpartum people from conception all the way through that first year postpartum. So a two year timeframe. So I just sort of wanted to level set that so that when we talk about this.

Really helpful.

Yeah. So in terms of what's new in the field of maternal mental health and what's going on? I have to tell you, I've been working in this field for 20 years, and never have I seen more people paying attention to this issue, more people writing about it, more people in our government paying attention to it, new interventions being made available. And so it really is sort of an exciting time to be working in this field, and we could talk about any and all of those things.

I'm curious to hear a little bit about your. Why. How did you get connected to this work?

So I got connected to this work because of my personal experience, as do many people who work in the field of mental health in general, or, you know, anybody who's, like, an advocate for a specific topic, most often it's because of their personal experience. And so I had postpartum depression after my son was born. He's now 22. I have three children. He's the middle of the three. The other two pregnancies, and everything were great. What I've learned and what I know contributed to my experience were a couple of things. Number one, I had a very scary emergency C section. We were in the hospital, but had we not been, he probably would have died. And then he was a little bit needier baby than my first. My first was really a very, very easy baby. And my second, my son, was, you know, more of a typical baby. He wanted to be held more, but the kicker is he wouldn't take a bottle. And so I was up every two or three hours for what seemed like eternity, getting up to feed him in the middle of the night. And he was born in December, and so it was dark and it was cold, and I felt like I was the only person awake in the whole world. And I was so lonely, and I just couldn't get it together. And, you know, I knew that something was wrong, but it took me about six months to get the help that I needed, despite having every resource available to me. I have a husband, I speak English. I have insurance. I have the Internet. Right. All of those things. And it really was very challenging to navigate the mental health or behavioral health system, which is a whole parallel system to our. Our medical system. And I knew nothing about mental health. I had never experienced anxiety or depression before. I didn't know the difference between a psychiatrist and a psychologist. I knew nothing. And so I was trying to, like, dig myself up out of this hole that I had fallen into when, you know, people are, like, throwing dirt back on me, like, stay down in that hole. It was really quite challenging. And it was during that dark time that I Decided I needed to do something to help other women so they didn't suffer as I did.

I think that is such important work. And so, yeah, I do want to see, you know, you kind of mentioned this 20 year journey of the field and seeing more awareness now, which is great. Maybe more treatment options. So what are some of those things? What are you seeing people doing differently for either the advocacy or the treatment?

So I'll just start with saying, you know, just in the last week there have been two really excellent articles, one in the New York Times, that focused on mother baby units, psychiatric mother baby units, where mom and baby can be inpatient together. Unfortunately, we don't have any of those in the United States.

I was going to say, where is this?

So, right. They're in the uk, in England as well as in France and some other European countries. They have figured out that moms in some cases need to be hospitalized, but they need to be with their baby as well. And so they have these terrific mother baby units. So that was the first article in the New York Times and there was also an article in the New Yorker magazine about Patrick Clancy. This is a tragedy. His wife, Lindsay Clancy, about a year and a half ago was in the depths of postpartum depression and perhaps postpartum psychosis and tragically took the lives of her three young children and then attempted suicide. It's just tragedy. And, you know, a terrible, terrible crime has happened. And yet this was a very well balanced, well researched article. And so I hold these two articles up as, as examples of people getting it right. Right. We've learned so much. When articles were written, you know, when I first came into this work, people would say postpartum depression, but it would always be, it would be these cases, these tragic cases where women were experiencing, in some cases, postpartum psychosis. And so, you know, we're getting the language right. The reporters are, people are understanding more and more about these illnesses. And it's being reflected in, I'll say, pop culture, but I mean, like in news articles and in people talking about it more used to be like this hush hush thing. And like, wait a second, this is the most common complication of pregnancy and childbirth. We need to talk about it, right? And we need to make sure that women and their partners and other childbearing people, families, understand that this can happen to anybody. And it doesn't make you a bad parent, it doesn't make you a bad mom. It means that you need help. I mean, I could go on and on. You know, again, when I started in this. About 20 years ago, I first started volunteering with an organization called Postpartum Support International, and they're the leading organization in the world in both providing support to new parents and families, as well as training providers. And when I started, I was one of their volunteers in Virginia, where I live. And they didn't even have paid staff at that time. So here we are 20 years later, and they have like 60 staff. They have volunteers in every state. They have state chapters. The growth in support organizations, the fact that we have an organization like Maternal Mental Health Leadership alliance, which focuses on advocacy. Right. So we have different people leaning in to take the lead on different aspects of this field. We have a boom of intensive treatment programs, whether it's a partial hospitalization program or intensive outpatient programs, we see them cropping up. We have federal funding for things like a national maternal mental health hotline, and also a program that provides grants to states to create programs to treat moms in their state.

Wow.

This is all, like, within the last 10 to 20 years, which sounds like forever, but really is quite remarkable amount of time for all of these things to have happened.

And so what is your ultimate goal or mission? What. What are you wanting to achieve?

So my personal ultimate goal is that all pregnant and postpartum people are educated about mental health conditions during pregnancy and the first year following are screened for them and have access to resources for recovery. Again, this is the most common complication of pregnancy and childbirth. We cannot ignore it. We have to talk about it. We have to normalize it, and we have to let people know where they can find help.

Yeah. Because the story that you're of, your story is, I've heard so many similar versions of that over the years, working in mental health. And that the piece that sounds very familiar to me is that sense of being alone and not knowing how to get connected and get help. So that's where I think that education is huge.

Absolutely. And, you know, in our country, we have this false divide between physical and mental health. Like, for whatever reason, somebody decided that, like, above the neck, like, that's somebody else's problem. Right, right. Like, you know, you see your primary care provider and more primary care providers are being trained on how to treat, you know, common mental health conditions like anxiety and depression. But like, for example, you know, when I was having children, I have three children, they're two years apart. So I was not seeing my primary care provider, was seeing my obstetrician, but OB was really my de facto primary care provider. And again, back then, 20 years ago, like, they didn't want to talk about this. Like, I remember saying to my ob, you know, this was with my third pregnancy. I said, you know, I had postpartum depression with my, with my second pregnancy, the one right before this, and I'd like to talk about what we can do to help prevent it. And she's like, good luck. Like, you know, she didn't want to touch it. And I was like, wait a second, I'm asking for your help. And yeah, and again, I still hear stories, right, about women who aren't super screen. They experience this. And so we continue to persevere until we're making sure that, you know, this is, it should be universal.

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And again, just to say, like, what else has changed? Like, last year, the American College of Obstetricians and Gynecologists acog, which is the professional membership society for obs in our country, came out with new guidance that they had worked on for about three years. So two pieces of guidance for their members, one about screening for and diagnosing maternal mental conditions, and then a separate one on how to treat them. And it's really exciting to see that we have some new medications, some new interventions that have come to market within the last five years or so that are specifically focused on treating postpartum depression in particular.

Amazing. Can you say what some of those are?

Sure. So there's two medications. The first one is called Zulresso and the second one is called Zerzuve and they are both found by the same company. I don't know who comes up with these names for these medications.

Yeah, yeah. Those I couldn't repeat off.

I know, I know, I know. So the first one is Lilreso is actually an infusion. This was the first drug that ever came to market to treat postpartum depression specifically. And it's a 60 hour infusion. So it requires that a mom actually be, you know, overnight in the hospital to get this. And so five years later, the same company came out with this oral version of the same drug called Zerzubay. And so this is revolutionary. It's a 14 day course of an oral tablet and after that it's like your brain is kind of resetting. And so it's remarkable, especially when you compare it to typical selective serotonin reuptake inhibitors, typical antidepressants, which can take anywhere to four to six weeks to have a therapeutic effect.

Exactly. Yeah.

These medications are fast acting and they seem to be long acting as well. So that once people have symptom remission, that it continues even after they stop taking the medication.

Wow.

Yeah. And actually I was just talking to another company that is testing a psychedelic a version of psilocybin. Right. They're in clinical trials right now and that would actually be like a one in what they call one and done. You take this one time course, it's like a three hour infusion and that's it, then you're set. So it's really exciting to see drug companies focusing on creating new novel therapeutics.

Right, that is great. All right, and how about like treatment options if people don't want to go the medication route?

Yeah. So we know that there are certain things that can help anybody recover from a mental health condition, but I'll really focus on new moms in particular. So the very first thing is improved self care. I mean, just the fundamentals. Making sure that you get enough sleep, making sure that you're eating adequately, that you're drinking, that you are getting a little bit of exercise, like things that we all do in the normal course of our day. But when you have a newborn, they become very, very difficult to get. And so how do you do that? Can you split the night shift with your partner? Can you have somebody come in and stay with the baby, whether it's a family member or a night nurse or whatever. So anyway, so there's that whole improved self care aspect. The second piece is social support. We know that anybody experiencing a mental health condition does a lot better if they have a peer, a peer supporter who can say, hey, I've been there too. Here's what worked for me. Let me help you. But we really need this for new moms who are isolated and alone at home. Like I said, up in the middle of the night feeding a baby, really feeling like I am the only person in the world who feels this badly. I used to run support groups and talk to moms all the time. And I'll tell you, every mom who experiences a maternal mental health condition feels like they are the only one, they are the worst mother in the world. And so to have somebody else say, hey, I went through this too, I got through it, you can get through it too. The third piece is therapy or counseling or coaching. Right. Talking with somebody who is an objective third party person who can help you sort through some of these things. And in the case of counseling, like provide real interventions, whether it's a cognitive behavioral therapy, whether it's mindfulness, and so giving moms some coping skills and techniques to deal with this incredible change that they're going through. And then there's the medication piece. And so there's some combination of those four things. Self care, social support, therapy, and medication that will help all people recover from a maternal mental health condition.

I love that. I learned in looking at some of your trainings that are offered online that you also encompass the focus on the mother's partner.

Right.

And can you talk a little bit about that piece? I think that there's maybe less light on that piece right now.

Yep. So great question. So I think I said earlier that one in five women or childbearing people will experience anxiety or depression either during pregnancy or postpartum. We also know that dads are at risk. And I'll start with dads and then expand more to partners. But we know in, you know, a traditional married family or mother father partnership, that if the mom is experiencing anxiety or depression, but there's increased likelihood that the dad or her partner will as well. In fact, 1 in 10 dads will experience postpartum depression. You know, they think about all the changes that they go through as well. They don't actually have to birth the baby, but they go through the stress of having a baby in the household, which can be very challenging. Right. Especially if your baby is crying and not sleeping, the lack of sleep, you know, the additional stress of perhaps having. Worrying about financial situations. And dads experience shifts in their home runs too, the changes in testosterone in their body. So we know that, that dads can experience postpartum depression. We actually have written a fact sheet and we host a webinar every June around Father's Day to talk about this. And we also know that other partners, same sex partners, other adults in the household can experience these same challenges. Adoptive parents can experience this. Again, all of those changes. The stress of having a new baby. How do you keep somebody alive 24 7. Having a new baby can be joyful, but can also be very, very challenging.

Right. I really like that all encompassing view because I think I sometimes hear just in mainstream media that it's all about the hormone changes for the mom. Right. That can cause these symptoms, which I know can be a piece of it. Absolutely. But I love broadening that definition, that this is actually affecting the entire family union.

Absolutely. And you know, back to these new medications. There has long thought that there has been some women who are susceptible to these incredible hormonal changes that happen during pregnancy and in that immediate postpartum period. We know that estrogen and progesterone do ramp way up during pregnancy and then come crashing back down within 24 to 48 hours after the baby is born. And for some women, they're very susceptible to that change. And these two drugs that I talk about, Zilreso and Zerzuve, they actually are targeting that change in hormones in a woman's brain. So there are some women, yes, it is hormones, but it's also a lot of other things. And so we really do try to paint that picture more broadly that there's lots of things that could contribute to an experience of maternal mental health conditions.

Yeah. So I'm curious, what, if anything, is something that you would like people to take away or even be involved with advocating for wherever they are?

Absolutely. So a couple of different things. I think everybody can be an advocate for their own mental health. And so if you are pregnant or a new parent, you know, ask your doctor, hey, I'm not doing well, or I'm feeling this. What do you think? Who should I talk to? Right. So advocate for your own mental health and advocate for your partners or for other, you know, women who are pregnant or new parents. I often will say to new moms, hey, I just want you to know, anxiety and depression are very, very common. I went through this. It's nothing to be afraid of. I'm not trying to scare you, but if you got any questions, you know, let me know. I recently, there's a young family in our neighborhood, both parents are pediatricians and they recently had their first baby. And you know, I said to them, hey, before the baby's born, I said, the most important thing that you can do is make sure that within the first couple of weeks it's chaos. But then really focus on making sure each of you gets four to five hours of uninterrupted sleep. It said, it's not romantic, but you're in this for the long haul. You've got to like, take care of yourself so you can take care of each other and the baby. And I saw them recently, like that was the best advice anybody gave us. And we both are like, I'm going to be such a better doctor now. So I also just want to take the opportunity. You talked about some new medications, but I want to talk about online digital platforms and apps that are available for new parents. There are several who are, that are really focusing on maternal mental health. Different apps can do things like offer screening so you can see, you know, how you're doing, doing. But also things like some of the things I talked about, the self care and the social support and that therapy and coaching, a lot of these things are now available through our phones or through our computers. And just that technology is also enabling people to get more care.

Very true. Especially if you're tired and you're sleep deprived and you don't even know if you can get a shower and get out of the house.

Right, exactly. If you can talk to your therapist over the phone or be part of a virtual support group. Yeah, absolutely. You know, we can use our phones and our computers to connect people with the care that they need.

Right. I would love to ask you some about this advocacy journey. If you had advice to give to someone who's wanting to advocate, maybe in any field, you've done a lot of this work. You've been a part of, I'm sure a lot of fundraising and all the things to get there. Do you have any advice for people thinking about doing that?

Yeah, that's really a great, great question. And I think if you think about advocacy as education, I think that makes things a lot easier. And so, you know, people think advocacy, oh, you have to be going to Capitol Hill and the lobbing people and, you know, paying people and all that. No, no, no. If advocacy equals education. So just by talking about these issues, doing simple things like posting to Social media. Hey, I've experienced postpartum depression. Anybody needs help, I'm here for you. Writing an op ed to your local newspaper around Mother's Day to say, hey, ask a new mom how they're doing. This was how I first did. This was like, I don't know, maybe 15 years ago. I'm like, I'm going to try this. We had this little local newspaper. I'm going to write a letter to the editor and the next thing you know, I got the newspaper there it was in it. So, you know, anybody can be an advocate just by sharing your story. So just think of advocacy as education.

I love that. I love it. Well, Adrian, thanks so much for being here. For all of you listening or watching, we will have Adrian's links in the biolog. You can find out more about what she's doing and the projects and get involved if you so choose. So thanks for being here.

Thank you, Rachel. It's a real delight to be with everybody today.