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The trial of Lindsay Clancy, the Massachusetts mother accused of killing her three children, is laden with painful what-ifs: What if she had more support? What if she had more people to confide in? Could all of this suffering have been avoided?
Those are urgent questions, whatever the outcome of this particular case, because millions of women experience postpartum depression. Severe postpartum psychosis may be extremely rare, but every year at least 1 in 8 women who give birth in the US experience some depression symptoms — and that is likely an undercount.
A jury will ultimately decide whether or not to convict her for her children’s deaths; by Tuesday morning, the jurors were still unable to reach a unanimous verdict but the judge in the case ordered them to keep deliberating. Their verdict will rest in part on whether they believe that Clancy was in her right mind when she killed her children — the defense does not contest the underlying facts — or whether, as her attorneys are contending, she was experiencing severe psychosis that should render her not culpable for her actions.
Clancy’s case has become a national flashpoint for maternal mental health — a gripping courtroom drama that also exposes how new moms’ mental well-being has been neglected by the health system and researchers for years.
It’s easy to feel hopeless in the face of such a tragedy, and much of the coverage has — rightly — focused on the gaps it exposed in the system for women getting the care they need. But even now, there’s good reason to feel optimistic.
Doctors and health workers across the United States are experimenting with strategies that can improve postpartum mental health care. They have found a secret ingredient that can help new mothers when they are struggling: other moms who have been through the same thing before.
“You just had a baby. You’re responsible for a new human life. And it’s really hard to juggle everything in your life,” Dr. Jessica Gaulton, a pediatrician who founded FamilyWell Health, a postpartum mental health support service that incorporates peer coaches into its program, told me. “Oftentimes what women need is just somebody to be there and have their back.”
Postpartum depression is a health system problem, a public health problem — but it’s also a deeply personal one. Helping people make connections that make them not feel so alone is one way we can start to improve the postpartum outlook for American mothers.
And a wave of local programs — and research showing that they really work — is offering some promising new ideas about how to deliver more compassionate and effective care for postpartum depression.
How to help new moms with postpartum depression right now
During the Clancy trial, the Maternal Mental Health Alliance has listed five steps that could be taken to improve postpartum care. One of their top priorities is better care coordination among the different healthcare providers who see a new mom after she’s given birth.
The so-called “collaborative care model” has been building momentum for years now, since it was first introduced for postpartum care for Medicaid patients in Seattle’s King County more than a decade ago. The model has since spread to other places, but the basic tenet is this: It takes a whole team to care for a new mother and watch out for her mental health, and they need a point person to help manage their care.
In Los Angeles, for example, where a group of nonprofits is wrapping up a five-year pilot program based on the collaborative care model, new mothers are assigned to a behavioral-health care manager. The manager performs assessments and brief interventions, works with a psychiatric consultant to continually assess how the patient is doing, and cooperates with the OB/GYN or primary care doctor to manage the patient’s treatment. Rather than waiting for a psychiatrist to have an open appointment when she’s struggling right now, the new mom’s preexisting healthcare providers can step in with support from a mental health professional to manage postpartum depression symptoms.
In evaluations, the model has consistently outperformed other standards of care in reducing symptoms. But while we have started to see collaborative care spread to other parts of the US, its progress has been halting for various logistical and financial reasons. The Maternal Mental Health Alliance is urging health systems and health insurers to invest in more care coordination programs.
And now some providers are building on the collaborative care model with an important new element: peer support. In Washington, the MOMCare program is now experimenting with peer “navigators” to help their patients figure out the appropriate place to get the care they need. In Massachusetts, Gaulton’s FamilyWell Health, which works with OB/GYN practices to provide mental health services, launched a pilot program that added certified behavioral health coaches.
These people were recruited because they had their own life experience of giving birth and having postpartum depression symptoms; the coaches were frequently doulas, nurses, and midwives. Patients would talk once or twice a week with their coach to set goals and receive positive feedback, while the coaches had a protocol to follow if it seemed their patient required more serious support. A study published in April found that this new coach-driven approach was successfully reducing depression and anxiety symptoms. Patients experience remission of their depression symptoms within an average of nine days with a peer coach, versus eight days with a licensed therapist. In other words, the mothers assigned to a peer got better almost as quickly as those who saw a professional.
Gaulton said she introduced the peer-coach concept to FamilyWell Health because of her own experiences as a new mom. She struggled to recognize her own depression symptoms. When she did, she leaned on a friend and fellow neonatologist at the hospital where she worked for help. Then during Covid, she saw moms with otherwise healthy babies struggling during that world-altering public health emergency.
“What I realized was that we were underutilizing coaches,” Gaulton said. “For decades, we’ve been using peer groups, peer coaching in this field to support, but it has never been formalized. There was no formal training.”
So she decided to found a new company dedicated to supporting new mothers’ mental health — and she brought those lessons with her.
This idea — training experienced moms to help new moms — has been gaining traction across the country. In Colorado, researchers from the University of Colorado launched a program called Alma, which connects new moms with another woman who has been through the same experiences and received specialized training to provide emotional support. The program’s mentors receive 80 hours of training and then meet up to 10 times with a new mother, either in person or virtually, to talk about what makes them feel good and how to incorporate it into their day, following long-held protocols for depression treatment called “behavior activation.”
“There is a special kind of trust that can develop when someone feels that the person sitting across from them understands something about their life and their community — someone who has walked the same path,” Sona Dimidjian, a University of Colorado clinical psychologist who helped found the program, said in an email. “A peer can often say, in effect, ‘I have been there too, and I know how hard it can be.’ That shared experience can also help reduce the stigma and shame that many women feel about depression during pregnancy or the postpartum period.”
The concept was based on research from India that found “lay counselors” were effective at reducing mental health symptoms. With the US in a permanent mental health provider shortage, being able to tap into the general population to support new moms was an appealing idea. And evaluations of the program found that it significantly reduced symptoms of depression, anxiety and stress among the Spanish-speaking Latina women who were its initial focus.
The biggest endorsement of a peer-support approach like Alma or the peer coaches in FamilyWell Health’s coordinated care program is its target audience. A nationwide survey of new and expecting Latina mothers in the US found that the vast majority thought talking to a peer would make them feel less isolated and more understood compared to a mental health professional. And providers and policymakers around the United States have started taking notice: English and Spanish-language versions of the Alma program are now being implemented in California and New Jersey.
There is no panacea for postpartum depression. As Amritha Bhat, who has worked on the MOMCare program at the University of Washington, explained it to me: “Having a multipronged approach is a good way to ensure that treatment reaches those most in need.”
There are big-picture institutional-level changes that need to be made. The Diagnostic and Statistical Manual of Mental Disorders, or DSM, the bible of American psychiatry, currently does not categorize postpartum depression as its own distinct diagnosis. As NPR reported, primary care doctors and pediatricians often do not receive sufficient training to help them recognize the signs of postpartum depression and provide patients with the support they need. There is never enough funding for research or for programs for maternal mental health: The Maternal Mental Health Alliance has been pushing Congress to add millions of dollars in funding for the federal programs that focus on new moms. Peer coaching has not traditionally been covered by health insurance; figuring out how to pay for programs like this is another system-level challenge.
But connecting moms to other moms can help the people who need support right now. Sometimes that can happen through organized programs like Alma or FamilyWell; the experts working on those initiatives want to make them an integrated part of post-delivery medical care. But that support might also be found informally in a new parent’s everyday life. There are a lot of social media and in-person groups for new moms to get together, sometimes at a local library or other community organization. Gaulton leaned on a friend when she was struggling after her own pregnancy.
As Gaulton emphasized to me, most cases of postpartum depression never escalate into a tragedy. This is a scary condition — but it’s treatable.
“I just want laypeople to know that the typical case is someone like me who had some symptoms of depression, anxiety,” she said. “I found help. I got better.”
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