Mental health after pregnancy: OB-GYN adds social worker for postpartum depression

The baby wouldn't stop crying.

In the first months of her son's life, Michelle Reyes tried everything to soothe her newborn, but he had colic, a common condition among babies that results in long stretches of crying, often in the evening. It exhausted the already tired mom and made Reyes feel guilty.

She and her husband had struggled with fertility for several years before her son was born. This was everything she wanted, but it was not how she expected to feel.

One day, while on the phone, Reyes' mother finally said to her: "It's OK to be sad." 

Three years later, those words now appear on a letter board in Reyes' office at Dedicated to Women OBGYN in Dover, where she was recently hired to be the practice's first social worker.

Despite the prevalence of postpartum depression among new moms in the United States, it's still uncommon for OB-GYN practices to employ in-house mental health professionals, doctors and midwives say. 

The Centers for Disease Control and Prevention estimates that one in nine women experience postpartum depression. 

Dedicated to Women's midwives have noticed that many of the new mothers are struggling with depression and anxiety and often face barriers to get help, said Katie O'Brien, Dedicated to Women's lead midwife. 

That's where Reyes comes in. 

"In my own experience, I realized that at times questions weren’t being asked," Reyes said. "The emotional well being of the patient isn’t the focus, currently."

Dr. Christie Miller, an OB-GYN at the practice, said she has never seen a mental health professional embedded in a practice, but has always wanted one. 

"I would guess that I have a woman in tears in here for a visit with me at least four times a day. And it’s for multiple reasons," she said. "Sometimes women are so busy taking care of other people. And then I ask and it opens up that space."

Miller said doctors are pressured to see as many patients as possible a day. This means physicians don't always have time to go into a patient's mental health, she said. 

Patients also face the barrier of insurance companies not being willing to pay for mental health care, she said. 

The idea for Reyes to work at Dedicated to Women came from a conversation she had with O'Brien when Reyes was a patient. 

Reyes had just given birth to her second child, now 4 months old, when she met O'Brien, who was the midwife scheduled to give Reyes discharge instructions. They began talking about Reyes' work as a social worker and how unfortunate it is that mental health services are separate from OB-GYN services.

A couple of weeks later, Reyes got an email from O'Brien asking if she wanted to start a mental health program at Dedicated to Women. 

The practice has about 200 patients a day in its three locations, and the midwives often interact with expecting moms more than with the physicians, O'Brien said. Many of the patients were confiding to the midwives about their anxiety and depression. 

While midwives will recommend mental health professionals to patients, their training doesn't allow them to do much more than that, O'Brien said. 

"When mental health is not treated, you're not going to have the best health outcomes,'" she said. Historically, Kent County is one of the unhealthiest populations in the state due to its high rates of obesity and lack of access to exercise opportunities and physicians.

As the practice's social worker, Reyes works two days a week. She will drop into patient's appointments, if requested, especially if a woman has recently miscarried or has shown signs of depression or anxiety. Physicians or midwives will also walk patients down the hall to her office.

Reyes plans to screen every new mother for postpartum depression at the practice with a questionnaire.

While doctors typically screen patients before they leave the hospital, the midwives have found that signs might not be evident until a couple weeks later, O'Brien said.

In addition to offering individualized talk therapy, Reyes also plans to start support groups for new moms and for women struggling with fertility. She accepts all major insurers and will be billed separately from the practice. The practice couldn't say what the charge for the service is. 

Reyes said some women often feel isolated when raising their children, unlike generations ago when women had a "village that would help raise your child."

She hopes to create a network for new moms, where they can talk about the aspects of motherhood that aren't "sunshine and rainbows." 

"It's giving women a place to say 'This sucks,' " she said. 

Contact Meredith Newman at (302) 324-2386 or at mnewman@delawareonline.com. Follow her on Twitter at @merenewman.

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