Empowering the Powerful: Supporting New Moms

November 01, 2022
Baby Emily

I became a grandfather for the first time this past summer. And clearly, I’m biased, but here’s a photo of the most beautiful and brilliant baby in the world: our Emily.

In watching our son and daughter-in-law adapt to becoming a family of three, I’ve been reintroduced to the highs and lows of welcoming a new baby into the family (it’s amazing how you forget all the sleepless nights, perpetual diapers and challenge of trying to interpret why the little one is crying). I’ve also taken notice of how much pressure is on women to be “perfect” and “ideal mothers” (the definition of which changes, depending on who you talk to) during pregnancy, childbirth and once the baby has arrived. This is one of the aspects of life for which you wish you had been given the rulebook ahead of time. There’s also that natural tendency when a baby is born to refocus all of the attention there, when every mom still needs lots of support and compassion. Our family and the new parents are blessed with a lot of helping hands, love, being immersed in the health care field – and yes, grandmothers. But even in the best of situations, a new infant is a beloved adjustment.

Every new mother, no matter who she may be, needs some form of support and help with a new baby. This could range from breastfeeding instruction to dealing with feelings of isolation. I know that many women face struggles when they bring life into the world, from the inescapable reality of normal hormonal, emotional and physical changes during her child’s first year of life to dire circumstances involving food and shelter insecurity, depression and substance abuse. And sadly, these struggles became even more real to me recently when Kathy and I learned that someone in our extended community of friends had lost their daughter, a first-time mom, to postpartum depression and suicide. I’m sure that this has been a devastating time for that family, and as you can imagine, the ripple effects of the loss of this mother will be felt for years to come, especially by her child. So rather than pretend that every new mother is somehow perfect, it is probably more helpful to look past the facade and ask, “What do you need?”

Now, when I transition from grandfather to health care provider, I’m interested in what we can do as health care providers to identify and prevent issues and support all mothers better, especially those women who are experiencing or showing signs of postpartum depression and suicidality. I’m also passionate about making sure that this kind of high-quality care is available to ALL women who decide to give birth: That includes those who pursue adoption but don’t raise the child, those who’ve been through reproductive trauma of some kind, those with substance abuse problems, those doing it all alone, those giving birth in the midst of intimate partner violence environments and those who live in underrepresented and rural communities. As I said, ALL moms have needs, and they can vary greatly.

On this topic, as we can all imagine, it’s hard for mothers to be vulnerable in this way – to look for or ask for help, even when it’s being offered (see above comment about unrealistic, societal expectations of perfection, add in embarrassment, shame or insecurity.) Ironically, there is often a significant tapestry of services and support available within the greater community but having an awareness, access and ability to use any or all of these resources is a continual challenge.

But there’s hope. Over a decade ago, our colleagues at The Duke Endowment supported a pilot program that was designed to address these pervasive issues. The initial success of this program has evolved into the Family Connects program. The Family Connects model is an evidence-based model designed to support optimal maternal-child health and advance equitable outcomes while promoting better aligned community care systems. Part of the challenge with implementing this program more easily, and in our local community, has been the cost-intensive aspect of nursing and care providers required to operate it and make an impact.

As part of the work of the MUSC Center for Telehealth (one of only two national centers of excellence), Katie King, M.D., MUSC Health chief medical information officer, has worked to elevate the basic Duke Endowment model by leveraging the expertise and connectivity of telehealth. She is working with colleagues in pediatrics, women’s health and other areas to connect more new mothers across the state to convenient, low-cost telehealth and home visiting support through their mobile devices. I am hopeful that the combination of a proven model with the innovative expertise present at the MUSC Telehealth Center will be able to provide a program that will be high impact, cost effective, reproducible and ultimately become the standard of care in this critical space.

Additionally, the MUSC Women’s Reproductive Behavioral Health Division, led by Constance Guille, M.D., is taking a multidisciplinary and modern-technology approach to this multifaceted and complex issue, too. Guille explained in a recent press release that suicide and drug overdose are leading causes of pregnancy-associated deaths during the year after having a baby. These deaths are due to a lack of identification and treatment of perinatal mood and anxiety disorders (PMADs), perinatal substance use disorders (PSUDs) and intimate partner violence (IPV) as well as poor patient-to-provider / provider-to-provider communication and care coordination throughout pregnancy and the postpartum year.

Guille and her team developed a program called Listening to Women and Pregnant and Postpartum People (LTWP) with the goal of reducing maternal deaths associated with undetected and untreated PMADs, PSUDs and IPV so as to improve women’s health and well-being during pregnancy and the postpartum year and to save the lives of mothers and babies.

Since Guille and her clinical and research colleagues began piloting this program several years ago, and given the success they’d seen to date with patients, it was approved for a $7 million research funding award by the Patient-Centered Outcomes Research Institute (PCORI) to study this new text-and-phone-based screening and referral program further. According to the PCORI executive director, Nakela L. Cook, M.D., “This project was selected for PCORI funding not only for its scientific merit and commitment to engaging patients and other healthcare stakeholders in a study conducted in real-world settings, but also for its potential to answer an important question about how improved screening, technology and communication impacts the critical care women need at this precarious time in their lives.”

And, with two new grants from The Duke Endowment, Guille and King are combining forces to scale up access to the Maternal Newborn Home Visitation Program even further at MUSC, LTWP and Mom’s IMPACTT, a statewide perinatal psychiatry access program. Further impact is coming with a recent donation of $2 million to expand this programming in one of the most underserved counties in our state, and additional philanthropists are considering a $20 million opportunity to continue to scale up around the state.

Reaching out and connecting more women to home visitation and text- and phone-based interventions are brilliant ways to maneuver past some tough barriers to getting this necessary support and care, such as geography, socioeconomic status and feelings of embarrassment or shame in making the first step to ask for help. And as a scientist myself, I recognize the great value in being able to test the effectiveness of the program in the field with a wide range of participants representing numerous communities and cultures so that the findings apply to more people.

I encourage you to read the full press release or listen to a podcast related to this work here and perhaps consider checking in on those friends and family members with new babies, even if all seems to be well. There are always opportunities to offer some understanding, compassion and, if needed, connectivity to resources for those who want to seek help. It never hurts to ask the simple question, “How can I help you?” You might be surprised by the answer.