New Mother-Baby Intensive Outpatient Program Supports Mental Health in Pregnancy and Beyond.

MedStar Health Research Institute’s work with the D.C. Safe Babies Safe Moms Program informs the new Mother-Baby Intensive Outpatient Program, which provides wraparound, holistic, intensive mental health services to help birthing people thrive.

Pregnancy and the year after childbirth can be a time of overflowing joy, but for some, it is a period of stress, loneliness, and even despair. Pregnancy and the postpartum period can be a perfect storm of challenges related to experiencing changes in identity, biology, relationships, sleep, and hormones all while caring for a new baby. Together, these experiences increase the risk of developing a perinatal mood or anxiety disorder (PMAD), such as:

• Anxiety
• Depression
• Obsessive-compulsive disorder
• Post-traumatic stress disorder
• Postpartum psychosis

In fact, perinatal mental health conditions are the most common complication of pregnancy, with 1 in 5 women experiencing symptoms in the year after giving birth. Studies have shown Black mothers have a higher risk of perinatal depression and more severe PMADs compared to white mothers, while Hispanic mothers have a greater risk of postpartum depression. Tragically, maternal suicide and overdose are the leading cause of death for women in the year after pregnancy

These deaths are preventable, and while most patients are screened for mental health conditions after childbirth, about 75% of women who experience perinatal mental health disorders do not get the help they need.  

The MedStar Health Mother-Baby Intensive Outpatient Program (IOP) is taking action to help more mothers live long, healthy lives with their children. It starts by embracing an innovative model of care that places mothers and their babies at the center of everything we do.

Screening is essential, but it’s just the start.

In the last decade, obstetric care has embraced screening initiatives as essential to helping pregnant and postpartum individuals stay healthy. We now know that a mother’s mental health is just as crucial to the safe delivery of her baby as her blood pressure. 

Important guidance from the American College of Obstetricians and Gynecologists (ACOG) in recent years underlines the importance of screening, education, referral, and treatment. It is recommended that women be screened at multiple points during their pregnancy to learn if they have symptoms of a perinatal mental health condition. Education, referral resources, and follow-up must accompany screening.

Perinatal mental health conditions are treatable. An individualized combination of self-care, peer support, psychotherapy, and, in some cases, medication can help mothers recover and their families thrive.  

Yet, there are too few specialists in perinatal mental health and even fewer who participate with Medicaid and commercial insurance, and intensive treatment options are limited. Inpatient psychiatric treatment and traditional day hospital care require the birthing patient to be separated from their baby, meaning some patients can’t or won’t choose these treatments.

High-quality treatment requires clinicians experienced in perinatal mental health and reproductive psychiatry to help patients recover during this critical life transition. 

A new model of perinatal mental health care.

The Mother-Baby IOP is designed to provide a higher level of care to mothers and pregnant people in crisis. Our team of experts provides treatment and guidance as new mothers build the coping skills they need to feel better and to develop competence, confidence, and independence as caregivers. 

The Mother-Baby IOP multidisciplinary team includes experts who specialize in helping birthing people, including:

• Perinatal Mental Health Clinicians (psychologists, clinical social workers, and therapists)
• Reproductive Psychiatrists 
• Infant Mental Health Clinicians
• Care Coordinators
• Postpartum Doulas
• Physical Therapists
• Arts & Expressive Therapists
• Mothers Helpers Volunteers

We encourage new mothers to bring their babies to treatment for three and a half hours per day, three days a week. Supportive, holistic care includes:

• A diagnostic psychiatric assessment
• Treatment with individual and group therapies, psychiatry, and perinatal health and wellness services to help build coping skills, regulate emotions, bond with the baby, and practice self-care
• Mother-baby relationship support and parenting skills to promote healthy attachment and child development
• Perinatal and infant health and wellness classes on topics like breastfeeding, nutrition, sleep, preparation and recovery from childbirth, and more.
• Care coordination to access health care and community resources

This super-sized support is available to adults who are pregnant or within one year after giving birth who are having new or worsened mental health symptoms. With a commitment and focus on increasing access to care, MedStar Health has ensured that D.C. Medicaid and many private insurance plans are accepted.

For too many women in our communities, socioeconomic challenges present barriers to getting the care they need. The Mother-Baby IOP addresses equity issues by building on the vital work of MedStar Health’s D.C. Safe Babies Safe Moms Program (SBSM).

Related reading: Chatbot Connects New Moms with Timely Infant and Maternal Care.

Addressing equity with care coordination and more.

MedStar Health’s SBSM collaborates with the hospital system and community organizations like Community of Hope and Mamatoto Village to address disparities in maternal and infant care. 

Research shows that social determinants of health, such as access to healthcare, education, healthy food, transportation, and a clean environment, can impact 80% of health outcomes. Yet, they occur outside the hospital and beyond patients’ control. So, the best way to screen for mental health conditions and provide treatment is by integrating these into settings where people are already getting care. 

A critical part of our work to integrate mental health in more pediatric and obstetric settings is to combat stigma by normalizing these important conversations. Sometimes, asking for help can be seen as a sign of weakness, especially in communities with generational mistrust of the healthcare system. Patients can also minimize or dismiss mental health symptoms that should be treated.

The Mother Baby IOP prioritizes conversations about mental health early during pregnancy. I often remind patients that how they’re feeling and coping are just as important as their blood pressure and the baby’s growth. That’s why we ask about patients’ psychological, social, and physical health during the same prenatal visit.

For four years, SBSM has been screening low-income mothers of color before, during, and after childbirth and throughout their child’s first three years of life. We’ve incorporated many lessons learned into the Mother-Baby IOP; making expanding mental health treatment options, supporting community resources, and coordinating care cornerstones of the program. 

Care coordination offers scaffolded support to help patients follow through with recommended treatment services. When a pregnant or postpartum patient needs mental health care, the coordinator will schedule an appointment with the Mother-Baby IOP. Before that appointment, the coordinator will reach out to ask important support-focused questions such as:

• Do you need childcare or transportation?
• Do you need a virtual (telehealth) visit instead?
• Is your housing situation secure?
• Do you need a connection to an assistance program like WIC?

In this way, care coordination helps new mothers address their safety and security needs so they can get the mental health care they need. If our program is unsuitable for them, our care coordinators will help patients connect with a better-fit program. 

Next steps: Measuring impact and making changes.

This is an exciting time to work in the perinatal mental health field. There are many challenges, but incredible momentum exists, locally and nationally, toward making impactful changes for mothers and families in need. 

When the Mother-Baby IOP opened in April, our team was ready to begin evaluating the feasibility, acceptability, and impact of each program’s elements. With collaboration from patients and providers, we’ll continue revising and expanding our offerings to suit their needs. We hope to be able to offer a virtual version of this IOP program, a track for Spanish speakers, and additional support for co-existing perinatal substance use disorders in the future. 

The Mother-Baby IOP is the first-ever intensive psychiatric treatment program for birthing people and their babies in the DC Metro region. This program is poised to make an impact, thanks to support from MedStar Health leadership, clinical leaders in Psychiatry and Obstetrics at MGUH, and the tireless support, advocacy, and donations from mothers and families in our community determined to prioritize the health and wellbeing of mothers so they, in turn, can build loving, stable, and healthy families in our community.  

What affects mothers in our communities affects us all. Healthy mothers play a central role in the health and social wellbeing of the next generation. MedStar Health’s Mother-Baby IOP will be a critical resource to help birthing people access treatment and support when they and their families need it most, strengthening our community in ways that will benefit everyone.