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By JULIE MINDA

Lourdes Nilon and her husband had spent years trying to have a baby. She'd suffered multiple miscarriages. She'd sweated out several threats to her pregnancy 16 years ago before delivering her son Ethan six weeks before his due date.

Postpartum depression survivor Lourdes Nilon is the face of a Dignity Health campaign to address maternal mood disorders.

Given her deep longing for this baby, she was shocked by her feelings of fear and sadness after his discharge from the hospital. "I brought him home, laid him in the middle of my bed and started to cry. I called my mom and dad, and said, 'You have to come.'"

Nilon spent the first months of her son's life in complete fear of being alone with him. She was afraid she'd accidentally harm him. She felt overwhelmed by the responsibility of caring for this tiny baby. While her parents, husband and other loved ones were on hand to help, no one seemed to intuitively understand her struggles, and she felt embarrassed to tell anyone about her feelings.

"I would shut myself in the shower or closet and cry," she recalled. It took about a year for her to recognize she had postpartum depression.

A decade and a half later, Nilon is a happy, healthy mom of teenaged Ethan and a case study for postpartum depression and other maternal mood disorders in a campaign San Francisco-based Dignity Health is launching to reduce the impact of the condition. Nilon managed Children's Miracle Network activity for Dignity Health's hospitals in the Bakersfield, Calif., area until recently. She now works for a different employer.

High-potential impact
About one in seven women experience postpartum depression, but only about one in 20 sufferers gets professional help for the condition, according to information from experts at Dignity Health.

Wiesner

"When untreated, postpartum depression can have long-term consequences for families," said Suzanne Wiesner, director of maternal child health services for Dignity Health. She said research has shown that when the condition goes unaddressed, one consequence is that mothers can have trouble bonding with their babies. According to information from the National Institute of Mental Health, babies whose mothers have untreated postpartum depression may later develop problems with sleeping, eating and behavior.

To reduce the incidence and impact of maternal mood disorders in communities served by Dignity Health, the system's foundation is funding a pilot program to standardize how Dignity Health providers screen for and treat maternal mood disorders, to educate and communicate with community members about the condition, and to monitor the results of the pilot and tweak efforts as needed before rolling it out systemwide. Nilon discusses her experiences in a video associated with the initiative.

Bussani

"With more than 60,000 births a year at Dignity hospitals, we can have a big impact," said Nancy Bussani, vice president of philanthropy at Dignity Health's foundation. Dignity operates 39 hospitals and a network of other facilities in 21 states; most of its facilities are on the West Coast. Dignity Health raised about $350,000 for the maternal mood disorders initiative during a May fundraising gala, and plans to secure grants and additional donations.

Beyond baby blues
According to information from the National Institute of Mental Health, perinatal depression is much more intense than the baby blues. "Women with perinatal depression experience full-blown major depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany perinatal depression may make it difficult for these new mothers to complete daily care activities for themselves and/or for their babies."

Yin

Dr. Elaine Yin is chair of the perinatal department at Dignity Health Marian Regional Medical Center in Santa Maria, Calif., and the medical advisor for a Dignity Health postpartum depression task force that is providing its expertise to the foundation. She explained that postpartum depression can manifest itself in a mother any time within the first year after she gives birth.

Yin said many women experience sadness and depression and feeling overwhelmed as significant hormonal shifts take place in their body and as they adjust to caring for a newborn that has virtually constant needs. "Mothers may be asking themselves, 'What did I get myself into?'" said Yin.

Screening can reveal if new mothers are suffering a mild case of baby blues as their hormones rebalance and they adjust to parenthood, if they are experiencing the more debilitating and lasting symptoms of postpartum depression — or, in rare cases, if they have acute postpartum psychosis. In an ideal world, all new mothers would be screened postdelivery and at regular but decreasing intervals within the first year of their babies' birth, said Yin.

Countering reticence, stigma
But, that rarely happens, said Wiesner. She said one reason so many women with maternal mood disorder go untreated is because of inconsistent or inadequate screening protocols at hospitals, and outpatient sites including obstetrician offices and pediatrician offices. Pediatricians generally see babies several times in the first six months of life and have the opportunity to ask screening questions to identify maternal mood disorders. While highly reliable screening tools exist, not all facilities or providers have formal guidelines on when to screen patients, who to screen and what to do when patients have the condition or are determined to be at risk.

Pelletreau

Barbara Pelletreau, Dignity Health senior vice president of patient safety, said there's a particular challenge when it comes to screening for postpartum depression and other maternal health concerns because these issues bridge the inpatient and outpatient communities of providers, "and it's a challenge to build that bridge" and unite those providers.

Another barrier, said Yin, is the social stigma that persists around mental illnesses, including postpartum depression. "In some cultures, we don't want to acknowledge mental illness." This is true in many Asian and Hispanic cultures, Yin said, noting that Marian Regional's service area includes a large community of migrant farmworkers, most of them Hispanic.

Bussani said like many mental health concerns, maternal mood disorder "is a very complex issue, and there is no single solution." Normally an individualized combination of medication and other therapies will help postpartum patients with the condition. As part of the pilot, Bussani said, Dignity Health hospitals will map out resources both at the hospitals and in their communities, identifying social service providers, counselors, therapists and support groups. That way, once sufferers are diagnosed through screening, providers will have somewhere to send them to get help.

Best practices
Bussani said as part of the initiative, Dignity Health will conduct pilot programs at three of its facilities to study which approaches to maternal mood disorder are most effective, so that those approaches eventually can be standardized across the health system. Marian has been identified as a pilot location. The other two sites will be identified in the next several months. The pilots will be conducted over several years.

The experts who spoke to Catholic Health World said the initiative likely will include the development of maternal mood disorder protocols and a treatment "tool kit" for use in Dignity Health hospitals and by obstetricians and pediatricians affiliated with the system; use of peer educators to teach women to recognize maternal mood disorder and the importance of treatment; and the application of technology, potentially to screen people or to create an online community where new moms can go for support.

Nilon said even after 16 years, it's been cathartic for her to share her experience with postpartum depression to advance Dignity's initiative. "It's healing for me to share my story because, by sharing my story, I can help other people," she said.

SSM facility offers peer support line for new moms with mood disorders Kim Martino-Sexton Expectant and new moms can access free assistance for perinatal mood disorders through a new peer support line from SSM Health St. Mary's Hospital in suburban St. Louis. Any mother in metropolitan St. Louis concerned about her feelings of sadness, irritability, anxiety or depression can call the MOMS Line. St. Mary's Kim Martino-Sexton directs the MOMS Line. She interviews callers to learn what their needs are, the emotions they are experiencing and the source of their concerns as well as to gather demographic information. Martino-Sexton then matches each caller with a volunteer who will establish a connection with the woman and provide her with support and advice on coping with physical and mental challenges. St. Mary's launched the peer support service on Mother's Day. So far, nearly a dozen women have called. Volunteers are St. Louis-area women who have experienced and recovered from postpartum depression and other perinatal mood disorders. Prior to being matched with callers, the volunteers complete 16 hours of training in a workshop taught by Martino-Sexton. The volunteers get an overview of postpartum depression and learn techniques for coping with it, how to practice and model self-care, how to set boundaries and how to provide support by phone, in person or by text. Volunteers assist no more than two new moms at a time. Martino-Sexton said she uses a weighted matching process to connect callers and volunteers whose circumstances are closest to one another. She aims to match the new moms with volunteers who have had a perinatal mood disorder similar to theirs, who are available at similar times and who have the same number of children. Most of the women maintain their relationship by phone — that's what's most convenient for busy moms, and the phone provides a level of anonymity that some callers appreciate, Martino-Sexton said. The women talk about once a week. Martino-Sexton expects the relationships will last about six months to a year. The help line is modeled after "Mother to Mother," a peer phone support network operated by another St. Louis nonprofit from 1995 to 2013. While it was a much-used service, Martino-Sexton said, it lacked the funding necessary to continue. Martino-Sexton had volunteered with that peer counseling service. When that service closed, St. Mary's leadership committed to offer the service, using St. Mary's foundation funding. Martino-Sexton said she suffered from postpartum depression after her first child was born in 1995. She spoke to her obstetrician, but felt her concerns were dismissed. It wasn't until she connected with others who had experienced postpartum depression that she began to address her issues and heal. When she suffered postpartum anxiety with her second child in 2000, she again relied on peers for support. If a caller describes symptoms of severe anxiety or depression, Martino-Sexton offers to connect the woman to case management services, or mental health services such as a professional counselor or support group. Martino-Sexton said women can experience a wide variety of mood disturbances when pregnant or postpartum. "No one understands like another mom who's been through the same thing. These moms need all the help they can get. It is great for them just to be able to talk to someone."