The public controversy over Georgia’s dismal maternal mortality statistics continues to spur action among the state’s elected officials, and this past week state legislators heard from medical professionals on the problem and what could be working in some areas, especially as it comes to women’s mental health.
“One of the most striking things that was ever said to me was, in downtown Macon, we were administering the Barkin Index to low-income … postpartum women, and one of the women, after she filled out the Barkin Index she looked at me and said, ‘Thank you for this. No one has ever asked about me before,’” said Dr. Jennifer Barkin, an associate professor of community medicine and obstetrics and gynecology at Mercer University, at the hearing of the state House Study Committee on Maternal Mortality.
She developed the Barkin Index of Maternal Functioning, which “is a 20-item self-report measure that was designed to assess overall functioning in the context of new motherhood.”
Barkin continued, “I feel like that really encapsulates the problem. In general, nationally, we focus on the clinical outcomes of the pregnancy — the baby’s weight, premature or not, your C-section scar, is it healing? That’s all super, super, super important, but the mom’s mental health, which is really related to physical health and family health, is also incredibly important.”
She said the incidence of postpartum depression is around one in seven women, with perinatal anxiety around the same number. Perinatal mood and anxiety disorders affect physical health health care practice and utilization, quality of life, relationships, sexual functioning and risky behaviors — these conditions can also affect partners and children in serious ways.
Barkin noted that PMADs during the pregnancy can show clear influence on child development, that the intrauterine environment impacts the developing fetus.
“The research is at the point we can say there’s a clear influence in maternal mental health and the development of the fetus,” Barkin said.
The American College of Obstetricians and Gynecologists suggests a full assessment of mood and emotional wellbeing during the postpartum visit, and the American Academy of Pediatricians suggests screening at the 1-, 2-, 4- and 6-month visits.
Barkin said the tools already exist to address the issue, through passionate providers, validated screening tools and postpartum support international’s state chapter, which facilitates PMAD training and provides resources.
Joining legislators for the hearing was Dr. Chad Ray, an associate professor of obstetrics and gynecology at Augusta University.
“I guess the challenge here is that, one, I agree with the idea of universal screening, but it is — I don’t think I would ask a psychiatrist to deliver a baby,” Ray said. “That may sound crazy, but my point would be … it is a specialty, and I think it does become challenging and something that you don’t do routinely day in and day out. While it’s common, the problem may fall in that across a specialty — even a primary care specialty, if you will — the comfort with this is going to be problematic no matter how it’s rolled out, when you have a positive screen, what to do next, because that’s just the nature of medicine.”
Dr. Toby Goldsmith, director of the Emory Women’s Mental Health Program, gave a rundown on the partnership there between Emory, the state Department of Public Health and the Healthy Mothers, Healthy Babies Coalition.
She said the goals are to screen all pregnant and postpartum women for psychiatric issues, treat the vulnerable, educate the med community and others to recognize signs and symptoms of psychiatric illness among women; also decrease stigma, provide resources to clinicians and moms, provide statewide consistency and encourage more psychiatrists to specialize in women’s health.
“There are more and more psychiatrists being trained — and I believe that more individuals are choosing to specialize in perinatal mental health, because as more of us speak up and let it be known, and hospitals support the education of such programs, there are more of us — but there’s never enough,” Goldsmith said.
Mary Catherine Moffett of the Nurse-Family Partnership described the work that program is doing with a little more than 100 families in Houston County.
She said those who didn’t receive home visits were three times more likely to die from all causes and eight times more likely to die from external causes like unintentional injuries, suicide, drug overdose and homicide; meanwhile, those visited exhibited 35 percent fewer cases of pregnancy-induced hypertension, 18 percent fewer preterm births, 79 percent reduction in preterm delivery among women who smoke and 31 percent reduction in closely spaced subsequent pregnancies.
One of the mothers assisted by the program, Ashunti Duncan of Centerville, discussed how the nursing care she received in at-home visits made a major difference.
“She helped with sleeping techniques, she helped with breastfeeding, how to wash hair — as a first-time mom, you think, ‘I know how to do all this stuff, I babysit all the time.’ No, no you don’t,” Duncan said. “And you quickly learn from the lessons, but also through the journey. I think the most important thing Takira has taught me is probably just to be ready and stay ready, from the preterm labor to having a little boy who was underweight. And he grew so fast.”
She said she learned things from her nurse that she wouldn’t have known otherwise, that she was someone on whom to rely.
“It’s a bond that you really can’t get anywhere else,” Duncan said. “She’s family now.”