A tragedy & a trial shine a spotlight on new moms’ mental health

The national fixation on the murder trial of Lindsay Clancy may seem like just the latest high-profile court case. 

Sensational media coverage day after day brings dramatic details about the deaths of her children, and her mental health struggles in the months after her pregnancy with the youngest of the victims.

But to Maria Muzik, M.D., M.S., the Clancy trial represents something else: a chance to draw attention to the full range of mental health issues that women can face during pregnancy and the months after giving birth. 

Muzik hates that it often takes such tragedies to bring the spotlight on an issue she and her colleagues have worked on for years. 

Yet she also sees this as a reminder of the responsibility everyone shares, to spread the word about the treatment and support that can help prevent such things from happening, and help so many other mothers who suffer from what can be treatable illnesses. 

Muzik is a Professor in the U-M Medical School’s Departments of Psychiatry and Obstetrics and Gynecology. She and her colleagues run special programs at University of Michigan Health focused on perinatal mental health, which covers pregnancy and the year after delivery. 

Much of their work is through the programs called MC3 for Moms and Zero to Thrive.

Immediate help for pregnancy & postpartum mental health concerns

Muzik underscores the importance of reaching out if you are concerned. Many women and their partners and families suffer in silence, and it is always OK to reach out for help when you are concerned something may be wrong. 

There are two hotlines that Muzik recommends to everyone who is pregnant, postpartum or knows someone who is pregnant or postpartum. These are the ones to call, text or chat 24 hours a day, 365 days a year if you have immediate concerns about yourself or someone else: 

• The National Maternal Health Hotline – call or text 1-833-TLC-MAMA  (6262) or webchat
• The 988 Suicide and Crisis Lifeline – call or text 988, or webchat 

Both are available in Spanish and the 988 Lifeline has services in other languages and for people who are Deaf and hard of hearing. Pregnant and postpartum veterans and active duty service members can press 1 after contacting the 988 Lifeline to contact the Veterans Crisis Line.

For pregnant women and new moms in Michigan having troubling mental health symptoms, the MC3 for Moms team offers free, same-day connection to mental health support online. 

This program, funded by the Michigan Department of Health and Human Services, was piloted in southeast Michigan and is now available statewide.

The licensed Behavioral Health Consultants from MC3 and Michigan Medicine reach out to pregnant women or new mom within 24 hours after they request help, talk with them to understand their needs, and together, create a support plan. 

This could mean navigating available community resources, making referrals to therapy, addressing tangible needs like diapers, food and housing, and if needed, connecting with a psychiatrist in real-time.

U-M Health also has a Perinatal and Reproductive Psychiatry Clinic offering specialized care. MC3 for Moms and the U-M Perinatal Clinic work collaboratively, and complex cases that require more intensive direct psychiatric care can be directed to the U-M Perinatal Clinic. 

In addition to expert state-of-the-art perinatal psychiatry care, the clinic also delivers evidence-based psychotherapy, such as Strong Roots Perinatal Dialectic-Behavioral Therapy (DBT) groups and parent-infant bonding therapy.

No matter where a woman is located, it’s important to connect with online support groups of peers. Muzik recommends Postpartum Support International, or PSI. PSI offers over 50 free of charge peer support groups weekly, built around a wide range of topics from perinatal loss, infertility, trauma, psychosis, depression, anxiety and groups for fathers.  

PSI also offers a national directory of providers who specialize in the mental health of pregnant women and new moms, and a wealth of educational resources. 

Brush up on your knowledge

The Clancy trial shows the extreme end of the spectrum, and Muzik emphasizes that going into pregnancy, delivery and the postpartum period with information about what to look for, and what to do if symptoms arise, is critical. 

This is especially true for anyone who had experiences with mental health symptoms or diagnosis such as depression, bipolar disorder or anxiety disorders before pregnancy, whether they got treatment or not, because the hormonal changes and stress of the perinatal period can raise the risk for developing new, or more intensive, concerns. 

Even a family history of mental health conditions, whether or not you’ve experienced them yourself, can mean your own risk of experiencing perinatal mental health conditions might be higher.

“But for some people, pregnancy or postpartum is the first time these issues present themselves, so really everyone should be aware of the symptoms, and know what to do,” said Muzik. 

Zero To Thrive offers a free Perinatal Mental Health Toolkit. It explains the difference between: 

• The “baby blues”, which are short-lived mood changes that happen to most women in the first days after giving birth, and are related to the large changes in hormones that occur after delivery.
• Postpartum depression, which starts a few weeks after giving birth and happens to 10%-15% of new moms. It can include sadness or frequent crying, intense anxiety, obsessions and ruminations, sleep disturbance, reduced concentration and appetite changes, suicidal thoughts, intense worry about baby’s health, loss of interest in an enjoyable activity, irritability, and reduced self-worth or confidence.
• Postpartum anxiety, which can include panic attacks, compulsions, uncontrollable severe worry sometimes accompanied by headache or stomachache, intrusive thoughts or impulsive thoughts including ones about harming the baby, and hypervigilance.
• Postpartum psychosis, which occurs in 1 to 2 out of every 1,000 women who have given birth in recent weeks or months, and can include severe intrusive thoughts, hallucinations, delusions, severe sleep disturbances, thoughts of harming oneself or the baby, and grandiose or self-important thoughts. 

The Clancy trial has drawn special attention to postpartum psychosis, although it’s not clear as of now what diagnosis the mother might have been given, said Muzik. “Most admissions for postpartum psychosis are in the first four to six weeks after delivery, but we have had some further out. While most mothers who suffer postpartum mental illness do not have postpartum psychosis, it is a real psychiatric emergency when it occurs and needs high-intensity medical treatment.”

Additionally, the Zero to Thrive website has a wide array of educational resources that can help pregnant women, couples, new families, and those who are supporting them understand important topics, practice key skills and more. 

For instance, one video on self-care during pregnancy focuses on key tactics that can help prevent mental health issues from worsening. 

Another helps give anyone the basics of using cognitive behavioral therapy, which is one of the most proven tools for depression care. 

Yet another resource showcases ideas on how to practice mindfulness, manage stress, regulate emotions and so much more – the Parent Toolkit. This toolkit helps build skills and find support when facing mental health challenges during the perinatal period.

Support for doctors, nurses, psychologists, social workers, and more

Muzik and her colleagues work to support clinicians of all kinds across Michigan and beyond who take care of pregnant and postpartum patients with mental health needs.

They offer free consultations with prescribing clinicians, a perinatal provider toolkit, educational resources and guides to the dosing and safety of specific medications in pregnancy and postpartum.

The important thing for anyone treating a pregnant woman or postpartum mother with mental health symptoms or a diagnosis is to ensure they have wraparound care and a support network checking in on them often, Muzik said. 

“Every day, there should be at least one touch point with the prescribing clinician, a therapist, a peer support group, a friend or a relative who is really checking in, or others,” said Muzik. That’s in addition to the spouse or partner watching for red flags and knowing how to reach out to the clinician to report what they’re seeing. 

After a hospitalization

She notes that patients hospitalized for any mental health reason in the postpartum period should not just be sent home to occasional outpatient care. 

Ideally, if available, they should be transitioned to a stepped-down program such as a partial hospitalization program that includes weeks of daytime treatment and nights spent at home, or at least an intensive outpatient program that offers several hours of intensive daily therapy for several weekdays during the first few weeks following inpatient care. 

In Michigan, there are specialized programs for mothers and babies for full-week and partial-week care. 

Home help through home visiting programs or doulas to take care of newborns and support with postpartum adjustment can be critical during any intensive treatment. 

The bottom line

“It’s so important to be aware of perinatal mental health issues, and to acknowledge and talk about them as a family openly,” Muzik said. “Awareness and acceptance of perinatal mental health requires a non-shaming, non-stigmatizing language among providers, patients and families alike, and taking a kind, loving approach to care. 

“That, plus real-time access to evidence-based care by trained professionals is what we have learned it takes to get through these situations, and to have the best outcomes for mothers and babies,” she continued.

“Mothers who are suffering postpartum illness are not alone, and there is help. Together as a community we can take responsibility to help prevent such tragedies, as well as to alleviate the distress that is so common in the perinatal period.”